Cristiano Jr.’s death: What lessons has Indian football learnt in 20 years since the mishap?

December 5, 2004 is among the darkest days in Indian football. What was supposed to be a celebratory evening for Dempo SC, turned into a state of mourning.

Cristiano Sebastião de Lima Júnior, who scored the brace in the Federation Cup final 2-0 win against Mohun Bagan, succumbed to his death after he clashed with goalkeeper Subrata Pal. In the 78th minute of the game at the Sree Kanteerava Stadium, Cristiano Jr. ran onto a pass and chipped an onrushing Pal to score his second goal. But Pal failed to halt his momentum with his arm clattering into the Brazilian forward’s chest and flattening him.

Cristiano Jr. remained motionless on the pitch and was reportedly allowed assistance from outside only seven minutes after he went down. He was then put on a stretcher and taken to the nearby Hosmat Hospital, where he was pronounced dead upon arrival by the doctors.

Several fingers were pointed in different directions – the All India Football Federation, the tournament organisers, the referee and Pal – to ascertain who was responsible for the tragedy but the fact of the matter was no doctor was present at the venue when Cristiano Jr. collapsed. In fact, no team had a single doctor for the duration of the Federation Cup. Archive footage of the incident shows Cristiano Jr.’s teammates removing their jerseys and desperately fan the fallen footballer in a bid to revive him.

The final post-mortem report concluded that Cristiano Jr. died of cardiac arrest due to over-exertion and excitement.

“It was a shock… I still cannot believe that it happened,“ recollects Ishfaq Ahmed, who had joined Dempo in 2003, but missed the Federation Cup final due to injury. “I was watching the game on TV. I thought he had just fainted and it was nothing more. But when I saw my captain (Stanley Colaco), he was in tears, and then I realised something bad had happened.”

Despite the incident, it has taken several years for the sport in the country to adopt professional standards in ensuring the safety of the players but it is getting there across the pyramid.

The top division in the country, the Indian Super League, has a thorough medical guideline in place. The ISL home clubs are responsible for all medical arrangements throughout the season. The clubs are supposed to submit their medical plans, which will look after the welfare of the players, team officials, spectators and staff, to the league’s medical officer 30 days before the start of the season.

The home teams are supposed to identify a hospital, which fits the league-specific requirements for emergencies and must fit the proximity criteria of being fifteen minutes away from the stadium or training facility.

Matchday venues must have a doctor who coordinates with various medical staff throughout the day. Venues must have a minimum of two fully-equipped ambulances – Advanced Life Saving (ALS) and Basic Life Saving (BLS) – with a medical intensivist, a nurse and a stretcher bearer, and a first aid kiosk before a ball can be kicked. There also needs to be Rapid Response Teams with a medical intensivist and four stretchers for each dugout. The home club must also appoint a medical intensivist and a nurse to tend to the spectators if required.

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The ISL medical guidelines state that any player who collapses on the field must be regarded as potentially suffering from a sudden cardiac arrest (SCA) and will require immediate tending from the team doctors or rapid response team.

In recent years, another incident which caused a scare on the pitch was when Mumbai City FC’s Amey Ranawade lost consciousness after a knock in the 2021 ISL final in Fatorda. Mumbai City’s medical team, led by Dr. Sandeep Kurale, and the Quick Response Team stationed at the venue appointed by the ISL and FC Goa Operations departments were quick to tend to the player. The first act was to cut open Ranawade’s shirt and check the player for SCA diagnosis, which was ruled out.

“Amey had an episode of concussion after he got an elbow over his head. Sometimes the reaction from a concussion incident is immediate or sometimes it is a little delayed. So in his case, it was delayed which meant he started feeling the effects a minute or so after he got the knock. But when we reached the field, we need to identify if it is a cardiac-based incident or a concussion-based incident. As it was stabilised with me and our physician, we realised it was a concussion.

“And whenever you get a concussion, firstly it is about ruling out if it’s only a concussion or a spinal injury. There is a possibility of a spinal injury. Then of course, you also have to check if other parameters pertaining to cardiac were also in control,” said Kurale, who has been working with Mumbai City since 2014.

Once Ranawade was stabilised by the onfield doctors, he transferred to a nearby hospital in Goa, where the ISL final was held inside a bio-bubble due to the coronavirus pandemic, for a full assessment by.

Kurale, who has also worked in the I-League with Mahindra United and Air India FC, stated that the on-field medical assistance has improved over the years.

“The medical arrangements in place means there is no further delay and the particular casualty reaches the hospital and it’s been treated at the first care itself. But that only happens when the player is stabilised on the pitch. The pitch side medical care is now better compared to what it was 10 years before when I was working in the I-League. It’s big transformation from I-League to ISL. For example, in I-League, there used to be only one ambulance but now there are four ambulances (two cardiac and two normal). Ten years ago, I used to be the only medical staff running the show, but now there are six people (four medicos and two masseuses) in my team, who all graduated with Sports Emergency Certification (certified by the University of Edinburgh),” said Kurale.

The protocol for the referee in such situations is to call for medical help if a player goes down injured. “If a player goes down for injury, the referee needs to ask if he needs medical treatment. Then the team doctor enters only to assess and treat the injury. It’s 25 seconds for a normal injury. If there is a serious injury, cut or fracture, you can give treatment in the field of play,” said a top AIFF referee’s official.

The official highlighted the concussion protocol as a positive step in player safety but highlighted a grey area in the rulebook. “Each team gets five substitutions in three intervals during a 90-minute game. When there is a case of concussion, the medical team has three minutes to assess the player and determine if they can continue. If they need to be replaced, then the concussion substitute is activated which is another colour card compared to normal substitutions (yellow colour). The opposition team also thereby gets a concussion substitute. But the law is silent on what happens if there is a second concussion during a game for the same team,” said the official.

Safety arrangements in I-League

The I-League, which was India’s premier division until 2022 and is currently the second division, has also tried to keep pace with the latest safety arrangements. 

“For I-League, there are two ALS ambulances for each match and for I-League, if the spectators are above 10,000, there is one BLS ambulance for the spectators,” Jonathan De Sousa, the vice president of Goa Football Association, told  Sportstar.

“Each home club who are organising the matches has to have a tie-up with the hospital which is no longer than 20 minutes by car. So, compared to those (times), it’s considerably higher facilities now.”

Moreover, according to the latest I-League regulations, each stadium should have two to four stretcher-bearers during a game. They should be at least 18 years old and ‘in good physical condition and trained in carrying and transferring’ of injured players.

“Conditions have gotten much better,” said Dipendu Biswas, the former technical director and current team manager of Mohammedan Sporting, which played in the I-League until last season.

Dipendu himself was involved in a medical episode shortly after Cristiano Jr’s death.

“Mahindra United did ECG and complete medical for all its players, something that was not very stringent then. And every time, they found my ECG to be abnormal and they refused to allow me to play for them. They paid my dues but I was not allowed to play,” he said.

Dipendu eventually got a clearance and went on to sign for Mohun Bagan in June 2005. “But now things are improving every day, the medical room, the ambulances and everything are present on matchdays and even during practice,” he added.

The I-League, in accordance with AFC regulations, has mandated the clubs to keep an AED (Automated External Defibrillator) during training and matchdays, placed “next to the fourth Official’s seat or at the medical bench.”

Ranjit Bajaj, who owns I-League side Delhi FC and was formerly the owner of another side, RoundGlass Punjab, however, feels drastic changes in health and safety arrived quite late.

“For years after the unfortunate incident, the medical check-up form (PCM 3) remained a two to three-page document with basic details of blood group and blood pressure. Fortunately, now they have a 17-page PCMA form which is very thorough,” he told  Sportstar.

Bajaj was involved in an episode involving India centre-back Anwar Ali, a case that took three years to end.

Anwar, who graduated from Bajaj’s Minerva Academy, was diagnosed with a congenital heart defect, hypertrophic obstructive cardiomyopathy, diagnosed only after he signed for ISL’s Mumbai City FC.

FILE PHOTO: Anwar Ali of FC Goa during match 107 of the HERO INDIAN SUPER LEAGUE 2022 played between Bengaluru FC and FC Goa at the Sree Kanteerava Stadium, Bengaluru in India on 23rd February 2023.
| Photo Credit:
FSDL/ ISL Media

It kept Anwar out of professional football for nearly three years after which he burst into the Indian football scene with FC Goa, following a clearance to play despite the condition.

“I fought that battle (for him) and went to court, questioning the (earlier) procedure. Moreover, now, they made comprehensive insurance mandatory for the players,” Bajaj added, whose team won the I-League in 2018.

“Earlier, it was normal for players to get dubious insurance for around 300 rupees. Now, it costs at least 10,000 rupees. Yeah, the costs have gone on but yes the safety has improved. But it has come very late, only in the last few years.”.

Infrastructure further down the pyramid

Indian football looks to have come a long way in the last 10 years, with Subrata Dutta, the then-senior vice president of AIFF saying that only a couple of clubs in the top division have sports science facilities.

In most state division matches across the country, a first Aid Kit and an AED are compulsory but an ambulance is still recommended.

“For the Goa professional league, each team compulsorily has to have a registered physio. Otherwise, the team is not allowed to play in the tournament. Plus for every match, we have a paramedic, an ALS ambulance and an AED,” De Sousa said.

Delhi Football chief Anuj Gupta offered a similar point of view.

“In all our league matches, we try to have an ambulance with all the equipment inside and we always have a physiotherapist on the ground along with an ambulance. This is something we take very seriously,” he said.

“Regarding other protocols, we always advise the clubs to have medical insurance for the players they are registering in the CRS so that if there are any injuries or anything, at least they are insured.”

“We also tell the clubs to have physios as registered staff members in the dugout, but it depends on the club’s budget. In the Delhi Premier League, all the clubs have a physiotherapist, which is also the case at the tier-one youth level,” Anuj, who is also the founder of former I-League side Sudeva Delhi, added.

The mandate is similar in the Santosh Trophy (U-23 National Men’s Championships) and AIFF-accredited academies.

“The host Member Association will provide an Automated External Defibrillator (AED) for all Matches. This is mandatory at all Matches and must be placed next to the 4th Official’s seat or at the medical bench,” reads the Santosh Trophy rulebook which Sportstar has a copy of.

In the Calcutta Football League (CFL), most matches have ambulances provided by the Indian Football Association (IFA). The apex body has three ambulances, one of which is an ALS and keeps six AEDs on standby for emergencies.

“There are ambulances and at least an AED during every CFL match,” said Anirban Dutta, the chief of George Telegraph Group, which owns a CFL club by the same name.

“There are two major challenges in football here – most players come from middle-class and lower-middle-class families. So now, they have an insurance and live cover of two lakh rupees, which was increased from a mere INR 35000 in 2022,” he added.

He also said that officials from all the clubs are trained to give Cardiopulmonary resuscitation (CPR) in case of emergencies while the West Bengal government assists in tie-ups with hospitals.

For matches happening around Maidan, the players are rushed to the Seth Sukhlal Karnani Memorial Hospital (SSKM) while the closest hospitals (from the match venue) in Kalyani and Barachpore are consulted when matches happen there.

“The IFA also has its own medical team of around seven people, of whom at least three are doctors. So, if a player needs a medical beyond his own team, he can go there,” Anirban, who is now the IFA secretary, said.

“Accidents can always happen but we try and take sufficient precautionary measures so that we can avoid such a fate (like Cristiano Jr.),” he added.

In the recently launched state franchise tournament, Super League Kerala, the organisers Scoreline Pvt. Ltd. and the medical partner Lakeshore confirmed that medical equipment, doctors, nurses and three ambulances (2 ICU and 1 basic) were provided for every game, according to the AIFF medical mandate.

While the system is well in place, prevention would always be better than cure, feels De Sousa.

“I feel the medical assessment of players needs to be better. For example, Junior had a medical condition. So, maybe, the medical diagnosis of it could have been better. One doctor said he should not be allowed to play, another said he should be allowed,” he said.

Cristiano Jr.’s sudden demise remains a haunting reminder of the consequences of shoddy infrastructure in sports. After 20 years, Indian football will hope to have learnt its lessons well so that the 90-minute affair continues to be a beautiful game.