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PFA: Current concussion rules are putting players at serious risk

Beth Mead, Arsenal
  • Players union makes fresh calls for IFAB to make temporary concussion substitutions available
  • Calls on UEFA to add existing permanent concussion substitution rules to European competition
  • PFA seeking to establish a protocol to review head injury assessments with leagues and clubs

The PFA have made renewed calls for the introduction of temporary concussion substitutions to protect players and help medical staff.

The players’ union believe that the current rules, which only allow for permanent concussion substitutions, are not providing adequate protection for players, with several recent examples of incidents where the rules have fallen short of their objective and put players at risk.

As of December 2020, under the global rules of football set by the International Football Association Board (IFAB), competition organisers were given the option to participate in a trial of permanent concussion substitutions. 

In English football, the PFA welcomed the decision by the Premier League, The Football Association (The FA) and English Football League (EFL) to introduce permanent concussion substitutions across all professional competitions as a positive step forward in the protection of player welfare.

However, the players' union has consistently remained in favour of temporary concussion substitutions, which would allow for medical staff to conduct more detailed and lengthy checks of the potentially injured player away from the field of play, before assessing whether they were fit to return to the field. 

Head of the PFA's dedicated Brain Health department, Dr Adam White stated: "Put simply, the current laws of the game are jeopardising player health and safety. 

"Permanent substitutions do not allow medical teams to assess a player with a potentially serious brain injury in an appropriate environment. The rules as they are create an extremely challenging situation and offer no support to medical personnel."

Alarmingly, UEFA has not integrated the existing permanent concussion substitution rule into major European competitions such as the Champions League, Europa League and Nations League. 

Dr White said: “This situation needs to be addressed urgently. As a bare minimum UEFA, as one of football’s major bodies, must lead by example and introduce the available permanent concussion substitution rule. This an issue the PFA will be raising with UEFA directly.”

Since the IFAB trial has been running in England, there have been multiple incidents where that the PFA believe a temporary substitution option would have better-protected players. There have been several cases where a player appeared to suffer a head injury but stayed on the field following an initial assessment, only to be removed shortly afterwards once it became clear their injury was significant enough for them to need to be withdrawn.

Dr White will now be looking to initiate a protocol with the leagues, allowing the players’ union to access information regarding specific head injuries and work directly with clubs on decision-making and on-field assessments.

Dr White stated: “The reality of an in-game situation, an assessment of a potentially complex brain injury, is that it’s set against a backdrop of intense pressure. 

“Often players will want to continue playing but, with the adrenaline pumping, they may be unaware of the extent of their injury. Possibly there is a delay in the onset of symptoms. 

“The medical teams, managers, and players are put in a position where have to make potentially game-altering and career-altering decisions within a completely inadequate timeframe. This could all occur while a globally broadcast match in front of a full stadium is put on hold.

“The risk of a player continuing when suffering a brain injury and the consequences of a second hit are severe. Players must be aware of the short-term and long-term implications of continuing to play in that state. No match, cup competition or league campaign is worth jeopardising your long-term health and future quality of life.” 

The PFA is again calling on IFAB to extend the existing trial to include temporary concussion substitutions. This change of protocol 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, managers and medical staff to make quick decisions.

The PFA are clear that, in such situations, player safety and welfare are paramount and should be the only priority.

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