New medical study shows FIFA protocol is being ignored

By Paul Gardner

To laugh ... or to cry? There is no middle course here, no way of dodging the utter failure of soccer’s response to the concussion crisis. No way to ignore the inadequacy of the protocol, no way to pretend you haven’t noticed the pathetic hesitancy of referees when confronted with head injuries.

To laugh at the lengthy learnedness of the protocol and the timid dithering of the referees? Or to cry in despair at a sport so smitten with its own image that it can’t even realize that it has a serious, potentially tragic, human problem to deal with.

FIFA and the IFAB are the problem here. Caught up in the inertia and the ineptitude of those two supposedly ruling bodies are the referees, involved where it matters -- at the human level -- and called upon to give public respectability to shoddy cynicism.

As the referees have no strong representative body, they are never heard from. They are content to go meekly to the slaughter. They deserve some sympathy -- but not too much. Going meekly becomes, far too often, going enthusiastically. 

That is what we are seeing with concussions. We saw it on Saturday during the MLS game between San Jose and Los Angeles. In the 62nd minute San Jose forward Cordell Cato positioned himself to get under a high ball in the LA penalty area. Clement Diop, the LA goalkeeper raced out of his goal and, arms flailing, jumped into Cato from behind, flattening him and not getting within a mile of the ball. Cato stayed down, holding his head.

At this point, the referee -- who was well positioned to see everything -- had two reasons for halting play: one, Diop’s challenge was illegal and dangerous, a clear foul and therefore a penalty kick to San Jose; and two, the protocol calls for a referee to halt play immediately there is a head injury. 

This referee allowed play to continue for 30 seconds before strolling over to Cato and calling for help from the sideline. Those who follow MLS will hardly be surprised to learn that the unobservant referee was Allen Chapman.

But suppose Chapman had done his duty, had blown his whistle as soon as Cato went down, and urgently called on the medics. Would they, in turn, have done their job?  Experts I have consulted (a referee and an ex-referee) tell me that the minimum time to complete a meaningful protocol assessment is 6 minutes. I have never seen an assessment, on the field, last as long as six-minutes.

My observations are borne out by a recent study published in the prestigious Journal of the American Medical Association (JAMA) that analyzed head injuries during the 2014 World Cup. The stats are interesting right from the start, because of the number of such incidents. There were 67 players showing two recognizable signs of concussion. So, in a World Cup of 64 games, we got an average of one potentially serious head injury per game -- a stat that ought to worry FIFA. But apparently not. 

The damning conclusion of the study to which I am referring is this: “In the 2014 World Cup, we found that players received no, or very cursory, assessment for a concussion after sustaining a collision and showing concerning physical signs for a concussion.”

Of course, this is not news. It has been blatantly obvious for years now that head injuries are not of great interest to FIFA. What the study does do is to add academic authority and statistical proof to that charge. This sort of thing: 

FIFA’s protocol “says that players showing any signs of concussion should be immediately withdrawn from play and assessed by sideline health-care officials.”  

Yet the study found that of the 67 players who showed two or more signs of concussion, 11 players received no assessment and returned to play immediately. Another 42 immediately returned to play after an on-field assessment by another player, referee, or health-care worker. Only three were removed from the game. Among the 22 players with three or more concussion signs, 19 returned to play during the same game after an average assessment of 84 seconds.

Another point to notice about this study, is that it is not official. Not capital “O” Official, that is. It was not conducted by, or at the request of FIFA. An independent group of Canadian researchers has come up with unwelcome news for FIFA. 

Back in January I pointed out that FIFA’s concussion protocol was being honored more in the breach than in the observance. I had not, at that point, seen a player removed from a game after receiving a head injury. But I had seen several incidents in which an obviously shaken player had been quickly sent back into the action.

So we now have proof that my random personal observations reflect a much wider truth: the protocol is being ignored, even in FIFA’s showcase tournament. FIFA’s vaunted protocol is not being taken seriously, and FIFA does not care. The protocol is a joke. A sick joke. So we should laugh, then?

Sick jokes provoke sick laughter, fake laughter that covers some form of shame. The shame here, the shame that FIFA and IFAB should feel, is the shame of refusing to own up, to admit that soccer has a problem that needs to be faced up to.

The protocol seemed like a start -- indeed it could still be that, but only if we can be sure that FIFA itself believes in it. The evidence so far suggests that FIFA hasn’t given the matter much thought.

In practical terms, the fatal fault with the protocol is that it calls for a team to withdraw a player from the game for maybe six minutes, while he undergoes the tests. So the team is required to play with 10 men during that period -- even though the player involved committed no offense, may in fact have been the victim of a foul.

An outrageously unfair scenario that pretty much ensures either that the protocol will be ignored altogether, or that, when it is used, it will be hurried. A third, and most worrying, consequence entails the degradation of the whole protocol procedure -- it becomes a sham which is doing next to nothing to protect players from concussions.

How much thought can FIFA/IFAB have given this if they fail to understand that, if you’ve come up with a procedure that compels a team to play six or more minutes with only 10 men, you had better allow a temporary substitute during that period. If you do not, your procedure will surely fall on stony ground.

Is it beyond FIFA’s thinking ability to create a temporary “medical substitute” who will not be counted as one of a team’s three permissible subs?  This has already been suggested to FIFA by FIFPro, the international pro players union. FIFA has yet to be heard from.

U.S. Soccer is again in the forefront here. Having been the first (to my knowledge) organization to ban heading for younger players, it also allows the use of temporary substitutes in its Development Academy.

The use of temporary subs, I would say, constitutes a rule change, for which FIFA approval is necessary. Even on this issue, FIFA remains quiet. But is it possible to imagine FIFA nixing a rule change designed to protect players from concussions -- and, in particular, designed to ensure that FIFA’s own protocol is honored?  

Actually, I suppose it is possible to imagine that, such is the obtuseness that FIFA is displaying on this issue (I have long since given up hope of anything worthwhile originating at IFAB). But FIFA cannot maintain a silence much longer. It surely must be receiving legal advice letting it know that this is a high-risk situation for soccer, particularly if it is not seen to be taking steps -- much bigger steps than so far taken -- to protect its players from the far from funny consequences of head injuries.

So, no laughter at the hopeless bumbling of FIFA and IFAB. And, for the moment, no tears. No bemoaning the lack of resolve at FIFA. With the evidence we now have of the frightening damage that can be done to a player’s life by concussion, can there possibly be any excuse now for not taking head injuries seriously? Maybe, after all, there is a middle way, between the laughter and the tears. There is always hope.

24 comments about "New medical study shows FIFA protocol is being ignored".
  1. Ginger Peeler, July 3, 2017 at 12:57 p.m.

    That pretty much covers it! Thanks for bringing this up, Paul. It looks as if we're going to have to learn from our own mistakes, rather than recognizing and incorporating all the info the NFL and everybody else has discovered on concussions. A major tragedy waiting to happen!

  2. Ed M, July 3, 2017 at 2:16 p.m.

    Another misinformed, poorly written, and "fake news' style article. yes, concussions are an issue. since 2014 more has been done by FIFA. However, it is the teams and particularly professional teams that have paid a lot of money to have their property (players) perform on the field. Internationally, it is not quite the same.

    DA is a youth game and allowed to modify substitutions. To have this put into practice or devise something else could take some of the pressure off of teams when the need to remove a suspected concussion injury.

    What this all has to do with the Referees is beyond me.

  3. Bob Ashpole replied, July 3, 2017 at 3:41 p.m.

    During matches player safety should be the responsibility of the referee. I have never heard a referee say otherwise. Ed M, if he is a referee, would be the first. Injured players need the permission of the referee to enter the field. Strangely though I can find nothing that says this officially. Maybe someone is afraid of lawsuits. There ought to be at least an implied responsibility for player safety.

  4. R2 Dad replied, July 3, 2017 at 5:30 p.m.

    Ed M, the players won't remove themselves even if dazed and bleeding--there is a protocol for both but only the bleeding issue gets proper implementation from officials. I see the concussion protocol being more frequently required at USL/NASL level professionally, as well as at lower-level amateur (silver and below) matches where you see more mindless heading and focus on set pieces. Unfortunately, unless a profession player vomits in full view of everyone, I don't see officials doing anything different from what they're doing now. That class action lawsuit? MLS is the only target, especially since they now own all financial transactions regarding american players. Sunil and Garber better start salting away cash for that billion-dollar judgement. When you own all the upside, you also own all the downside. Karma, I'd say.

  5. Scott Johnson replied, July 3, 2017 at 11:05 p.m.

    As a youth league, DA is permitted, under the Laws, to modify the substitution rules. IIRC, DA rules require that every active player on the roster be subbed in, that subbing can occur only in three "moments", and that (excluding temporary medical subs) a substituted player may not return.

  6. Allan Lindh, July 3, 2017 at 2:40 p.m.

    Well played Mr. Gardner. But from the examples of the NFL and NHL, we know when FIFA will live up to their responsibilities -- some time after a massive class-action law-suit is filed against them. Then when the lawyers tell them they have a problem, they will take real action. All the while claiming that they took action many years ago. Of course players, and teams could take action on their own. When a player is taken to the sideline for a real exam, the opposing team could have a player walk to the sideline, and remove him/her self from play until the player returns, or is subbed for. Of course when a player is removed for a head injury, his/her team should be allowed an extra sub.

  7. Bob Ashpole, July 3, 2017 at 3:43 p.m.

    Ed M is correct that permission is not needed to modify substitution rules for DA matches, but the article was about all levels of play, including professional.

  8. Bob Ashpole, July 3, 2017 at 3:56 p.m.

    For some perspective, this is the first line of NSCAA's code of ethics: Soccer is the players' game. The paramount concern of coaches is the holistic development, welfare, enjoyment and safety of their players.

  9. Ric Fonseca, July 3, 2017 at 4:40 p.m.

    Bob, I;ve been an NSCAA member since 1979 and quite frankly, I don't remember reading in the NSCAA code of ethics that which you cite above. Have I missed this statement for the past 38 years? As for PG's article, I don't think it is "fake news" as espoused above (or from the political arena) but an interesting note, yet I'd draw the line with PG's assessment that Diop "deliberately" (my term) charged out "arms flailing" and clobbered Cato on purpose. I do recall the commentators saying that he did charge out, but only and unless one, or PG for this matter, was on the field of play, I find it irresponsible for PG to paint Diop with such a blatantly irresponsible brush, jeepers, he'd might as well have called him a "all-dirty-no-good mugger of a player!" I've seen worse, while on the field as a former center official, AR, and assessor, as well as coach at several levels, and yet ONCE AGAIN, I ask, has PG ever officiate any game at any level? This is NOT to minimize the danger of head trauma in ANY sport, especially ours, but I implore PG to make sure his boots are tied before stepping on the pitch.... get my drift???

  10. Bob Ashpole replied, July 3, 2017 at 10:52 p.m.

    Ric, that was a cut and past.

  11. Bob Ashpole replied, July 3, 2017 at 11:01 p.m.

    It was adopted in 2001.

  12. Mark Headley, July 3, 2017 at 5:03 p.m.

    Bravo! I regard it ludicrous, too -- having played high school soccer; a LT fan -- to insist heading to be the major cause of soccer head trauma. From my perspective, collisions w/ opposing players are far worse -- including head-to-head.

  13. Dennis Mueller, July 3, 2017 at 5:07 p.m.

    FIFA could go a long way to reduce head injuries by making it a yellow or red card offense to collide with any player positioned in the direct path of the ball's flight. We have all seen players launch themselves form 2, 3 or more yards away as they try to overpower a player who is already in position to play the ball. It is a classic case of "jumping at" a player, but one that is seldom to never called. It is pretty much like a late tackle, but with more serious injury implications. Sure there will still be those times when 2 players are both travelling at some speed and collide in attempt to win a header. So maybe a simple rule like no jumps that cover more than 2 vertical yards, with a caution for just that, pretty much like a card for a studs-up tackle even if it does not touch the opponent. Players would be quick to keep themselves in check after a few cautions and a history of players getting red cards. PG is right, FIFA does not seem to be taking this seriously, else some rule changes aimed at avoiding head-injuries rather than simply trying to "treat" them.

  14. Bob Ashpole replied, July 3, 2017 at 10:58 p.m.

    I agree with Dennis. Jumping into a player (compared to jumping up) is a dangerous charge and should be treated as misconduct.

  15. Nick Daverese, July 3, 2017 at 6:28 p.m.

    Let's follow the usual progression. Player gets injured what happens next. Does the official examine him or ask him questions. I don't think so it the team physician or the team medical trainer or maybe it is a coach who does it.

    So when a player is down. Some on on that team or the other team put the ball off the field. So the player can be looked after. There are physical signs or question asked at that time. If the player does not pass that it. He doesn't go back in the game he is out of the game. Even if the player says he wants to go back in. If a coach lets him go back that coach is an animal because he does not care about the player. If he does I would suggest that is when the official should take charge and not let him come back in the game. So one of the officials the alternate should watch the injured player treatment then he does not pass he is out.

  16. Ron Benson replied, July 3, 2017 at 8:38 p.m.

    Cut to the Crux ,we don't need heading to have a beautiful game .
    I watched US under 12 kids play for one season with no heading .
    It was entertaining soccer .
    No head to head , elbow to head

  17. Ron Benson, July 3, 2017 at 8:41 p.m.

    Plus , using the head as a bat/club to hit driven balls makes no sense .

  18. beautiful game, July 3, 2017 at 9:25 p.m.

    When are these balls "driven" except on a shot or "panic" clearance? And heading is an art, not a "bat/club". Besdes, U-12 players need to concentrate on chesting and controlling the ball instead of heading it to whomever.

  19. Scott Johnson, July 3, 2017 at 11:08 p.m.

    It also depends on coaches. Some really care about the health of their players, and will remove injured players even if it costs them the game. Others, not so much.

  20. Nick Daverese, July 4, 2017 at 9:33 a.m.

    I think coaches who think lose one player and they will lose the game is a loser himself. What about bookings and other things. If they really think that the players will know it and they will give up.

  21. Nalin Carney, July 6, 2017 at 10:08 a.m.

    3 cheers for the canadian researchers. I find it unconscionable that these protocols are not strictly adhered to. Let compassion for another human being prevail and then let the short handed team substitute a player until the assesment is completed (6 minutes). or let the offending player leave the field at the same time the assesment is being performed.

  22. Brian McLindsay, July 6, 2017 at 8:56 p.m.

    This is a link to a LCB play-up a few years ago (we had a number of play-ups at this game to fill the roster). If you go to 29:00 you will see a strong ball to the head and I believe it was handled well by the Ref. What say you?

    The player later said he was a little fuzzy for about a minute.

  23. Jose Melero replied, August 13, 2017 at 9:13 a.m.

    Absolutely agree with how the referee handled it. It amazes me that there are arguments and discussions regarding what the referee is allowed to do and not do. Certainly in youth games, it is the responsibility of the adults to keep the game safe. The discussion regarding what to do in the professional game is certainly up for debate, with kids, this is clear!

  24. Nick Daverese, July 7, 2017 at 8 a.m.

    Yes they have the protocol but do they ban heading for kids in England and in Germany? Like we do here in the United States.

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