Lukas Brud, Secretary
International Football Association Board (IFAB)
For the Attention of the Board of Directors
Patrick Nelson & Ian Maxwell.
And: Members of IFAB Football Advisory Panel & Technical Advisory Panel
Temporary Concussion Substitutes
14 April 2021
Dear IFAB Board of Directors,
Since the beginning of IFAB’s permanent concussion substitute trial, we have seen several incidents where the new laws of the game have fallen short of their objective and jeopardised player health and safety. We write to ask for the existing trial to be extended in order to test in parallel temporary concussion substitutions as soon as possible.
In December 2020, player unions FIFPRO and PFA welcomed the decision by IFAB to invite competitions to trial permanent concussion substitutions. At the same time, we have remained in favour of testing temporary concussion substitutions. This has been our position for many years.
The PFA is pleased that both the Football Association and the Premier League are integrating the new laws of the game into their competitions in English football. The Premier League introduced permanent concussion substitutions on 6th February, and three days later, Issa Diop became the first player in English football to be replaced with a concussion substitution.
In England, since the trial began, we are aware of two incidents where a temporary substitution option would have better protected players. In each case, the players suffered from a head injury but, following an initial on-field assessment, continued to play. They were subsequently removed when it emerged their head injury was worse than first thought.
Both of these incidents were in the Premier League, where the trial is taking place, and concerned West Ham United’s Issa Diop and Sheffield United’s George Baldock.
These cases underline our concern that permanent substitutions do not give medical teams the appropriate environment to assess a player with a potentially serious head injury.
The reality of the in-game situation is loaded with pressure. Medical teams can be presented with a situation where a globally broadcast match is on hold, awaiting their assessment. They have to make a potentially game-altering decision in a multi-billion-pound industry.
We have no doubt medical teams act in the sole interests of the players. However, the rules do not do enough to support medical personnel. Pressure on them will be amplified with the return of crowds. It is also important to note that players often try to continue playing while unaware of further potential risk to their health, and the possibility of a delay in the onset of symptoms.
Temporary concussion substitutions have been used successfully in other sports. Furthermore, a new FIFPRO poll of 96 professional football club doctors from the first-tier Belgium, English and French leagues, show that 83% believe that the use of temporary concussion substitutions would form an effective part of future protocol. (The poll is part of a research paper recently submitted to BMJ Open Sport & Exercise Medicine).
The inclusion of temporary concussion substitutions will:
- Provide medical teams with additional assessment time.
- Allow for the assessment to take place in an appropriate environment.
- Permit a match to restart with neither side numerically disadvantaged.
- Reduce pressure on players and medical staff to make quick decisions.
Player safety and welfare is paramount, and should be the only priority. Therefore, we are writing to ask that IFAB’s Board of Directors extend the scope of the 18-month trial to include parallel trials for temporary concussion substitutions starting no later than the 1st June 2021.