FIFA hosted the “Fourth International Consensus Conference on Concussions in Sport” in November 2012. The conference highlighted previous FIFA efforts to reduce the number of concussions – red cards by rule for deliberate blows to the head (unless performed by goalkeepers) – and set forth the following guidelines for when an athlete displays concussion symptoms.
When a player shows ANY features of a concussion:
The player should be evaluated by a physician or other licensed healthcare provider onsite using standard emergency management principles and particular attention should be given to excluding a cervical spine injury.
The appropriate disposition of the player must be determined by the treating healthcare provider in a timely manner. If no healthcare provider is available, the player should be safely removed from practice or play and urgent referral to a physician arranged.
Once the first aid issues are addressed, an assessment of the concussive injury should be made using the SCAT3 or other sideline assessment tools.
The player should not be left alone following the injury and serial monitoring for deterioration is essential over the initial few hours following injury.
A player with diagnosed concussion should not be allowed to RTP on the day of injury.
Those guidelines sound sensible and responsible. So do the ones on FIFA’s website. But, at the 2014 World Cup, they were not followed. It is not due to ignorance.
Uruguay’s Alvaro Pereira appeared to be knocked out, following a knee to the side of the head against England. Argentina’s Javier Mascherano stumbled to the ground, after a head to head knock versus the Netherlands. Germany’s Christoph Kramer took a nasty shoulder to the head against Argentina in the World Cup Final. All three were back on the pitch faster than it would take to do a proper concussion evaluation. Kramer was subbed off in the 31st minute, looking clearly disoriented. He has no recollection of the first half.
The conference spells out an “80-90 percent” recovery period of 7-10 days. Yet, Pereira played against Italy four days later. Mascherano started the World Cup Final, four days after the Netherlands match. One concussion, properly managed, should have little lasting impact. Playing in the minutes, days and even weeks after a concussion can leave one vulnerable to exacerbated further damage. FIFA and team officials are not ignorant of this. What this appears to be, at the very least, is competition trumping caution.
The solution is simple: get players off the pitch, properly evaluate them for a concussion before clearing them. But, as with FIFA corruption reform, enforcing it in practice is far trickier.
On field decisions are not easy. On TV, we view multiple, slow-motion angles of the collision and subsequent reaction. Medical personnel see it once, in real time from 40 yards away, maybe. The difference between a player who says he’s fine and wants to get back on the field and a concussed player who says he’s fine and wants to get back on the field may be indistinguishable. Erring on the side of caution is easier said than done in soccer. The costs of a decision are far greater. It’s one thing to sub a player out for a couple minutes and a commercial break in football and basketball. It’s another to leave a team down to 10 men for a significant portion of a World Cup Final. The context should not factor in, but it will.
Any change must shift the decision-making onus from the player or other partisan parties. It also must alleviate the competitive disadvantage. FIFA should take a hard look at Rugby Union’s concussion procedure implemented in 2012. Under their guidelines, a player can be pulled off the field for five minutes at the direction of the official, the team doctor or an independent monitoring physician. Both team and neutral doctors administer a standard concussion test. Teams are permitted a temporary substitution during this period. If the player is not cleared, it becomes a permanent one. It’s a wonky change, for a sport that has only had permanent substitutions. It’s also a simple, modest one that could be implemented immediately and have a major impact.
[Photo via Getty]