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Football needs a robust procedure to prevent risks of brain injury

By 26th March 2019 No Comments

In the News

David Ospina is a footnote for most Arsenal fans. Short of stature and short on authority, he was one of the many post-Seaman/Lehmann goalkeepers under Arsène Wenger who simply failed to step up to the mark for a team that was supposedly aiming to be title challengers. But last week, he entered the news for reasons other than his middling ability.

Ospina, currently on loan at Napoli, sustained a head injury in a clash with Udinese’s Ignacio Pussetto during the first half of their game last Sunday.  After minimal checks, he stayed on the pitch, only to collapse shortly before half time. Mercifully, Ospina underwent scans which have shown no damage. We feel the incident demonstrates the inadequacy of football’s current rules on head injuries and concussion. By allowing Ospina to stay on the pitch, perhaps even risking a further blow to the head, could have been extremely dangerous and with a very different outcome.

Ospina prone on the ground after his injury

Health Impact Assessment in Rugby

Rugby Union has a mandatory health impact assessment (HIA) for all players who sustain blows to the head. The process is:

  • When there is a suspected incident of head impact by a player or players, this should be identified by match officials on the field, team doctors or independent match-day doctors who have access to video replays. If the independent match-day doctor decides an incident may have occurred, the player(s) involved must be removed, either permanently or for further assessment.

  • Players displaying obvious on-pitch signs of concussion must be immediately and permanently removed from play, without further assessment.

  • When not showing clear on-pitch symptoms or signs, players must undergo an off-field assessment consisting of a clinical evaluation by an attending doctor (the team doctor does this or they can delegate to the match-day doctor) who is aided by screening tools and video reviews. Players cannot return before ten minutes for assessment has elapsed. Players taken off for HIA can be replaced, and any replacement can take a kick.

  • After the match every player entered into the HIA protocol must undergo another evaluation within three hours. This is done using a check of symptoms, memory assessment and balance evaluation – compared with previous player baselines.

  • At around 36-48 hours after the head impact, the player(s) will be assessed again, going through a symptom check-list, studying the player’s balance and using a cognitive assessment tool like CogSport or Impact.

  • Each union and/or competition must appoint trained HIA review processor(s) to look over the process used in every head injury event.

  • There will be a post-game video review process. Depending on the findings, the reviewer may recommend further education and training for the club or team medical personnel or recommend that the process moves to HIA review.

  • The HIA review group will formally investigate the incident and make recommendations for: further education and training for the club or team medics; a request to World Rugby’s HIA working group to consider a change to the process, education and/or training; or a referral to the appropriate disciplinary group to consider disciplinary action in line with competition rules.

    Nigel Owens sends Jamie Cudmore for a HIA

The mandatory element of this process is key – witness Christoph Kramer in the 2014 World Cup final. Despite being evidently concussed, he had no wish to leave the field voluntarily (understandable, in some senses). HIA takes the decision out of the hands of players and management by having a clear and robust process. The health of the player is paramount as opposed to any tactical considerations. The Ospina incident shows football’s current legislation as woefully inadequate.  By leaving potentially concussed players on the field, not adhering to proper medical procedures is a real and current danger.

A Solution for FIFA?

Whilst a player is being assessed for their head injury, a potential solution for FIFA could be to have a short-term injury replacement.  We know this already happens in rugby and so it would make sense to apply this to football too. In Napoli’s case last week, they would have been able to send on their substitute goalkeeper for 10 minutes whilst Ospina was being assessed.  If he would have been cleared to play (although evidently he was in no condition to carry on, and proper medical intervention would have determined this) he could have returned to the field. Player safety has to be the number one concern at all levels and should come above the outcome of any game.

No restrictions for football

Glenn Murray was allowed to play only a week after suffering a head injury.  Which goes against all contemporary medical advice and guidelines.  Football does not currently enforce a mandatory restriction period for a player sustaining a concussion injury.

Another example of being allowed to continue playing after being knocked out was Switzerland’s, Fabian Schär. I feel that, football should be taking the lead on these matters rather than being reticent to changing procedure.

Are you worried about the failure to treat players correctly resulting in various levels of injury? We are too! We want governing bodies to create a robust procedure.