Concussion dangers still not fully accepted

By Paul Gardner

If ever proof were needed that the English style of refereeing is a bad model for American referees, it was provided in abundance this past weekend. Of course, I am of the opinion that no such added proof was needed anyway, so skewed is the English view of officiating.

But we got, in just one game -- Arsenal-Chelsea, possibly one of the most important of the year -- all we needed from referee Michael Oliver.

The hopeless inadequacy of two first-half calls should really mean a lengthy period of retraining for Oliver. Fat chance -- far more likely is that he will be given the FA Cup final.

The game was just 15 minutes old when we got a thunderous example of the sort of goalkeeper thuggery that I have been condemning for some time now. Arsenal’s keeper, David Ospina raced out of his goal to punch the ball away. He mistimed his intervention badly. Chelsea’s Oscar beat him to the ball and lobbed it over his head. Ospina’s impetus carried him into a crunching collision with Oscar -- part of which involved Ospina’s head smashing into Oscar’s face.

Incredibly, referee Oliver found nothing wrong with any of that. No foul. Therefore, no red card to Ospina (definitely should have been, for endangering the safety of an opponent), and no penalty kick to Chelsea, which there also should have been.

The refusal to call a foul for a highly dangerous challenge was simply outrageous. And there’s more to say, shortly, about what happened to the obviously battered Oscar.

Just seven minutes later, Oliver made another disgraceful call when he booked Chelsea’s Cesc Fabregas for diving, thereby neatly depriving Chelsea, for the second time, of a penalty kick. The call was atrocious. Fabregas was clearly tripped by Santi Cazorla. Fabregas did not embellish his fall. So the rule book definition of simulation -- attempting “to deceive the referee by feigning injury or pretending to have been fouled” could not possibly apply. Because Fabregas obviously was fouled.

So, 22 minutes into the game and Chelsea had been done out of two penalty kicks by fatuous decisions from Oliver. But it is impossible to escape the thought that these incidents (one call, one no-call) were anything but fatuous. That they were made quite deliberately by Oliver with the direct intention of avoiding the obligation to call a penalty kick.

Whatever, they were both woeful calls, calls that one has a right to expect would not be made by a top level referee.

To return to Oscar. He received treatment on the field for some 2 minutes, was helped off, then quickly returned. That should never have been allowed. Not with the information we now possess about the danger of playing on after a concussion injury. Exactly why it is proving so difficult to get soccer people -- players, coaches, referees -- to face up to the very real and very serious dangers of head injuries is a mystery to me.

At halftime -- in other words, over half an hour after Ospina mugged him -- Oscar was sent to the hospital for observation. A 30-minute delay when dealing with head injuries is not advisable, to put it mildly. One thing was clear -- Oscar was not examined by a doctor until halftime.

That is something that should be of interest to MLS referees. MLS has its own Concussion Protocol. That protocol was called into action early this season when NYCFC goalkeeper Josh Saunders whacked his head with a sickening thud against a goalpost. This looked bad. There was blood. Referee Alan Kelly stopped the game, and on came two NYCFC trainers. Neither was a doctor. After a lengthy delay, the game continued -- with Saunders still on the field. That did not seem like a good idea. Anyway, what did the protocol have to say about it? It’s a wordy document, but one of the things it says very clearly is this:

“The Team Physician has the ultimate and absolute authority to decide when a player should be removed for evaluation and whether that player is fit to return to play.”

But the team physician was not involved. I later asked Saunders who had made the decision that he could stay in the game, and he replied, somewhat boastfully, “I did.” Great. A vital decision made by the one guy who, all expert opinion agrees, is the very guy who should not make the decision, the concussion suspect.

Saunders was not looked at by the NYCFC doctor until halftime. Which is a clear contravention of the protocol. Referee Kelly, to strictly apply the protocol, should have insisted on the doctor being on the field. But there is obviously some potentially dangerous confusion here over the definition of medical assistance.

According to FIFA guidelines, the referee, after questioning an injured player “may authorize one, or at most two medical personnel, to enter the field of play” to assess the injury and arrange the player’s safe and swift removal from the field of play.

To achieve removal from the field, “the stretcher-bearers should enter the field of play with a stretcher at the same time as the doctors ...”

The clear implication of that second quote is that the “medical personnel” mentioned in the first quote are doctors. That certainly seems logical -- after all, when a doctor is present, and when he is the one who has “the ultimate and absolute authority to decide when a player should be removed for evaluation,” why would that evaluation be carried out by another, less qualified, member of the “medical staff” -- presumably someone who is later defined as an “athletic trainer.”

The MLS protocol, evidently, does not make the point forcefully enough: A player with suspected concussion must be evaluated by the team doctor, not the athletic trainer, and it is the referee’s responsibility to ensure that is what happens. Yes, the protocol does say “Players who are suspected of having sustained a concussion shall be removed from play immediately and evaluated by team medical staff,” but that was not the way it worked in the Saunders incident in Orlando. There, the athletic trainer evidently made the decision, based on input from Saunders, that no concussion had occurred. That should not be allowed to happen again.

In fact, it is vital that the initial judgment be made by the team doctor. The likely serious consequences should a second head injury be suffered soon after the first one are now established.

Extreme caution, not mindless machismo, must be the controlling attitude. The need for caution is something that the MLS protocol does spell out: “Of significance is our current understanding from the research literature that the signs and symptoms of concussion are dynamic and evolve over time. Consequently, symptoms may not be present until hours or days following the initial blow(s).”

As the Saunders incident in MLS, and the Oscar incident in the EPL, revealed, this is an ominous warning that has still not gotten through to everyone who should be concerned.

7 comments about "Concussion dangers still not fully accepted".
  1. John Heath, April 28, 2015 at 8:54 p.m.

    As John Moss has already been allocated the FA Cup final, I doubt it will be moved to Oliver, despite the cynical suggestion.

  2. Vicki Zacharewicz, April 28, 2015 at 9:04 p.m.

    A doctor's assessment on field is the right way to go. The injured person should not be asked whether or not they want to return to play - their reasoning is the function that is damaged if they are concussed!

  3. uffe gustafsson, April 28, 2015 at 9:53 p.m.

    I'm shocked that Oscar was allowed to play on.
    On the replay you could see him almost unconciuss. Really poor decition on both the ref and Chelsea staff. And sure enough he had to go to hospital. They are not following their own rules.
    This goes for youth players as well they get concussions and not treating it properly and next thing they get one to many and can't play sport anymore. We need to take overly protections for our youth. Not to take lightly anymore.

  4. R2 Dad, April 29, 2015 at 1:42 p.m.

    You've got it right again, PG. The LOTG do not stipulate separate rules/laws for the keeper wrt contact. It's only bad habit that allows this to continue. re concussion, the English FA should have come down hard on responsible parties for allowing Oscar to continue. Leading a very bad example for youth players and coaches.

  5. Scott Johnson, April 29, 2015 at 4:43 p.m.

    One problem with this that is unique to (professional/international) soccer, is limited substitutions. If Saunders comes out, then NYCFC either has to play a man down, or they have to burn a substitution. The difficulty here is magnified when its a goalkeeper--which do you think many managers would rather do: keep the woozy keeper in the game, if he can at all stand and play, or instruct a field player to change shirts and put on gloves? Perhaps a good rule change would be this: a) referees may order players off the field for medical reasons, if the player is deemed unfit by a doctor, and b) when this occurs, it does not count as a substitution. Or else, teams may be given a limited supply of medical substutitions to use in a season/tournament, at the referee's discretion, above their usual allotment. Obviously, one concern is players faking injuries to be subbed out. (At youth levels, with unlimited subbing, this does not apply, obviously).

  6. Kenneth Barr, April 29, 2015 at 5:39 p.m.

    Assuming that "medical personnel" means doctors and not a combination of doctors and the club's trainers is a dangerous assumption to make. Any time FIFA uses ambiguous language means get the truck ready. The situation with Oscar last Sunday gives us reason to doubt that match officials really understand the concussion protocol and need immediate instruction. Oscar should have been replaced at that point in the match, not allowed to play until half time. Kyle Martino's commentary on NBC, where he made it clear that it takes at least 7 minutes for concussion symptoms to begin to fully set in, needs to be taken seriously. After all, his career was shortened due to head injuries.

  7. ROBERT BOND, April 30, 2015 at 2:29 p.m.

    at least Chelsea have progressive medic......Ospina was straight on, no contact with the ball, shows you can get a foul right that the ref actually did miss, 1-2 min of replay review while players are assessed done by a replay ref certainly seems in order, how did Lewendoski ever get cleared to play past his injury?

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