By Peter Staunton
The FA announced new rules on Tuesday concerning the treatment of concussion in football and now leads the way in how head injuries should be treated around the world.
Any player in England who falls unconscious, or even appears to, will no longer be permitted to continue in a match. Any player suffering a head injury will undergo an assessment on the pitch and those who suffer two such head blows will be sent for psychometric testing.
The decision of whether or not a player returns to action, crucially, will belong to club medics and not members of the coaching team nor the player himself.
Dr Ian Beasley, chair of the FA’s medical committee, said in a statement. "Managers, players and clubs need to understand the risks associated with head injuries. The advice of medical professionals is key in this area, and whilst we have developed processes to deal with many types of injury, this is an area that has perhaps needed some more scrutiny.
"We have worked closely with the stakeholders to develop these new guidelines and the message is clear for players; listen to medical advice and take no chances - stop playing and take your time to recover."
While the FA is to be commended for its new legislation, there is significant ground to be made in the treatment of head injuries in the game as a whole with no centralised directives from Fifa yet in place. That has led to inconsistent and sometimes negligent treatments of potentially concussive blows.
Alvaro Pereira suffered one such clash at the World Cup in Uruguay's first-round match against England. In a challenge with Raheem Sterling, the Sao Paulo midfielder was struck hard in the head and was knocked unconscious. Once roused and brought to the sideline for assessment, Pereira took the decision to return to the field, clearly overruling his medic and insisting he play on.
The incident, as well as the one involving Christoph Kramer during the World Cup final itself, brought the issue of concussion in football to light. Pereira, Javier Mascherano and Kramer were knocked out during the tournament yet returned to the field of play by medics in charge of their well-being. Coming in such a high-profile tournament, the paucity of football's concussion procedures were laid bare.
"The World Cup was shockingly bad," Andrew Orsatti, the Communications Director for the footballers' union FIFPro told Goal. "We do not see Fifa making necessary steps to ensure the players are protected at all times. It was reflection of football's inability to come to terms with realities of modern day medicine and ensuring that the players' health comes first, which clearly it does not."
Lasting damage? | Kramer said he could not remember going back on to the pitch
Now that the Fifa circus has packed up and left Brazil, it is no less apparent that the manner of treating concussion in football remains careless. Last weekend in front of around 46,000 people at Sao Paolo's Morumbi stadium the issue was back to the forefront. It was Pereira again.
Playing for the hosts against Criciuma in a 1-1 draw, Pereira galloped through the midfield before tripping up and hitting the grass face first. At first he was prone as opponents and team-mates alike called for assistance. He was placed on the cart and moved to the sidelines. And just like at the World Cup, he was returned to the field shortly after. "I was a little dizzy but I came back to help the team. That's the way I play," Pereira told the press after the match.
This deeply entrenched attitude among players and coaches needs to be avoided. Given that some of the symptoms of post-concussion syndrome are impaired cognition, attention and memory, the decision should be taken away from the player.
"There is clearly a lack of education," Orsatti said. "The first port of call in addressing this issue is the players - making them understand why in certain situations they are not in the best position to make a decision about their health."
The FA's new legislation hands power to team doctors, but even this is shaky ground: "What is going to have to happen is more of a compromise which ensures that team physicians are not pressured by their managers to return players too quickly to the field of play," said Orsatti. "We need to remove these potential vested interests and have independent doctors."
FIFPro is now leading the calls for an independent sideline concussion policy to deal more effectively and impartially with the issue of head injuries. "It needs to be monitored independently side by side with team physicians because players have to have another level of protection," Orsatti adds. "FIFPro brought up some solutions to deal with this including the laws of the game and temporary substitutes."
There is no current legislation in the Fifa Laws of the Game on how concussion should be treated, only guidelines, which leaves the welfare of the player in the hands of his coaches and medics. Fifa operates with a Pocket Concussion Recognition Tool (below) which offers recommendations of what should be done in the event of a potential brain injury.
Guidelines | Fifa has no concussion legislation - only a Pocket Concussion Recognition Tool
"It's not a matter of trying to wake the player and ask them a few questions to see if they're fit to continue, said Orsatti. "That's not how it's done in this day and age."
FIFPro is engaged in discussions with Fifa over the issue but admits it could be a long process before legislation covering the entire football world is introduced. There has been encouragement given from the FA's announcement but in the meantime, the players' union is worried that it could take one devastating blow to speed things up.
"It certainly does frighten me the prospect that something serious could happen on the field of play," Orsatti continues. "Whilst players may not have lost their lives on the field during the World Cup, we don't know what the long-term effects may be. Over time, we will understand more about what the potential long-term effects could be.
"Players were not dropping dead on the field at the World Cup based on concussion but they have been mishandled, mistreated and put in harm's way.
"We certainly would never want such a thing to occur but I think you could also argue that certain crimes have already been committed against the players."