Why introducing temporary concussion substitutes in football would be the right move

The Athletic

January 17, 2023

In a World Cup full of notable moments, there was one early in the tournament that grabbed the attention more than most. Iran goalkeeper Alireza Beiranvand, in his team’s opening game with England, suffered a violent and high-speed clash of heads with a team-mate. Sitting on the turf with his swollen nose heavily bleeding onto his kit, Beiranvand was treated for several minutes on the pitch by medical staff. Despite clearly being in serious discomfort, he was allowed to continue.

The game had barely restarted before Beiranvand took matters into his own hands and signaled to the bench that he would need to be replaced (top image). A global television audience, taking to social media, had one question: how has that been allowed to happen? That event, along with a series of other high-profile head injuries and concussion incidents on football’s biggest stage, has focused minds on the need to look again at how the game best protects player safety

The International Football Association Board (IFAB) will meet for its Annual Business Meeting in London today (Wednesday). IFAB, the body responsible for agreeing changes to the laws of the game, is made up of the Football Associations of England, Wales, Scotland and Northern Ireland. FIFA provides the final board member.

At that meeting, members will consider an application to allow the commencement of trials of temporary concussion substitutions. The application is backed by several leading leagues and player unions, including the Professional Footballers’ Association (PFA) and the Premier League, and their global organizations, the World Leagues Forum and FIFPRO.

The application reflects the view that more can be done via the game’s concussion protocols to protect players and support medics. As the players’ union in England, the PFA has long campaigned for the introduction of temporary concussion substitutions, where a player with a suspected concussion could be removed from the field for checks and temporarily replaced. If, after an off-pitch assessment, medical staff felt the player was safe to return to the game, their team would have the option of bringing them back on, with the temporary substitute coming off. Following a previous series of concussion incidents, the PFA wrote to IFAB back at the start of 2021 urging them to make that change.

Under the current protocols, if a player leaves the pitch for a concussion assessment the game continues, with either the player having to be permanently replaced and unable to return, or with their team playing at a numerical disadvantage.

The consequence of that approach is that concussion assessments take place on the pitch as play is stopped. Medical teams, managers and players are required to make decisions under time pressure as a game is put on hold in front of packed stadiums and, potentially — as we saw in Iran v England — a massive television audience watching at home.

The theory behind a preference for permanent concussion substitutions is that it provides a more clear-cut approach. The message is “if in doubt, sit them out”.

That is absolutely right and it should continue to be the underlying principle of any player assessment.

However, in pursuing that objective, should we not give those involved in that decision all the tools they need to make it? That includes working to eliminate, as best as we are able, the “game factors”, environmental challenges and human behaviors that can currently play a part.

The PFA believes allowing players to be removed from the pitch for assessment through a temporary concussion substitute system is an effective way of reducing those pressures. It’s an approach already adopted by other sports.

A concern that is sometimes raised about the introduction of temporary concussion substitutions is that the resources and structures needed, in terms of factors such as medical support and facilities, could not be implemented across the game but only at the elite level.

There would, of course, need to be a pragmatic and sensible approach to how new protocols could be introduced effectively at different levels of the game, with consideration given to resources and facilities available. But these are not unbridgeable. Ultimately, in all areas, the game has to adapt to what it believes to be best for player safety, not the other way around.

In a world where VAR and other game technology is limited to only some leagues and divisions, it is also increasingly difficult to argue that not being able to achieve uniformity across football should be enough to stop change in its tracks.

That’s especially true on a player safety issue. The momentum behind temporary concussion substitutions is now as strong as it has ever been, with consensus from player unions and leagues. The football associations that make up IFAB now have a chance to be proactive in addressing this.

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