Premier League referee Howard Webb has warned players that simulating injury could endanger the lives of their fellow professionals.
Webb, 40, was in charge when Bolton's Fabrice Muamba collapsed after suffering a cardiac arrest on the White Hart Lane pitch in March.
The Yorkshireman spoke for the first time about the match at a FIFA medical conference in Budapest and cautioned that referees could ignore a similar situation in the future if players continue to feign injury.
"If players and if people cry wolf too many times, then there is a possibility that maybe we will not react in the way we need to," said Webb. "If we come under criticism for stopping the games too many times for doctors or physiotherapists to enter the field of play, then referees might be inclined not to stop the game."
And England's top official said Muamba's collapse had had a lasting impact on him and described the player's recovery after his heart stopped beating on its own for 78 minutes as "an unbelievable miracle."
"I turned and saw Fabrice Muamba lying face down on the floor with no-one else nearby - this was clearly a major concern and clearly something more than a normal injury," said Webb.
"The fact that he wasn't rolling around screaming in agony, the way he went down with no contact, meant immediately it was serious. And it was not only me - the players recognised it. You see William Gallas' reaction - an opposing player - immediately waving to the bench to come on.
"If the game had not been stopped within 20 or 30 seconds that might have made a difference to his chances of recovery. One of our obligations as a referee is to try and observe fair play and keep the game flowing when we can. But, if players cry wolf too many times, then there is a possibility that maybe we will not react in the way we need to do based on what we saw there.
"If we come under criticism for stopping the games too many times for doctors or physios to enter the field of play then referees might be inclined not to stop the game.
"I'm not saying it's a particularly big problem but I have seen games stopped where players weren't as seriously injured as they would have you believe and that is an issue when you are dealing with something as serious as this."
Webb said like many who were at White Hart Lane, the incident has had a profound impact on him.
"The sensation I got was that the crowd was pushing with [Bolton doctor] Jonathan Tobin and his colleagues to get Fabrice Muamba's heart going," he said.
"It was amazing, absolutely astonishing. It was just the most unbelievable crowd reaction I have ever experienced in football and thinking about it now makes me feel emotional.
"It just puts things into perspective. The game is important, the result is important and it does affect people's livelihoods, we are reminded of that on a regular basis - but without life there is no football at all."
A survey undertaken by FIFA showed 84 players have suffered cardiac arrests on the pitch in the last five years, with only 23 survivors.