FIFA resists calls for concussion change amid threat of 'catastrophic' injury

Michel D'Hooghe – the chairman of FIFA's medical committee – played down the idea of independent doctors as concussion dominates headlines.

Published : Apr 02, 2019 12:10 IST

There were grave concerns for Fabian Schar as both sets of players rushed over to the motionless Switzerland defender during last month's Euro 2020 qualifier.

Schar was knocked unconscious after clashing heads with Georgia's Jemal Tabidze — opponent Jano Ananidze using his fingers to prevent the Newcastle United star's tongue from obstructing his breathing.

Napoli goalkeeper David Ospina also suffered a serious head injury and received on-field treatment during a Serie A match against Udinese.

There was also the incident involving Anthony Lopes during Lyon's Champions League clash against Barcelona — the keeper injured as he dived at the feet of Philippe Coutinho.

In all three scenarios, the player was cleared to return to the field by team doctors after a three-minute assessment as per FIFA and UEFA protocol — not before Ospina collapsed unconscious during the game and Lopes left Camp Nou clearly struggling – with Schar playing on, much to the dismay of brain injury charity Headway.

FIFA medical committee chairman Michel D'Hooghe has previously dismissed the idea of a 'concussion bin', which would allow teams to make a temporary substitution for up to 10 minutes while a player is assessed – fearing it would be abused by managers.

As FIFPro's calls for change grow louder, attention has now turned to the introduction of independent doctors, rather than team doctors, to decide whether a player with suspected concussion should continue.

"We have been discussing that. In theory this is beautiful. But you must note, an independent doctor does not know the player," D'Hooghe told Omnisport. "For example, if a player reacts slower than he does normally, how can a neutral doctor judge that? That's why we talk about competence and responsibility.

"There is a matter of responsibility, and that remains with the team doctor. We can never take over. If we were to take the responsibility, the team doctor could say 'they didn't want to take my advice'. That's not what we want. We want to assist the team doctors as much as we can – with the three-minute rule and the video assistance. But the judgement must be done by someone who knows the player – team doctor."

As talk about concussions and head injuries dominate headlines, D'Hooghe said: "The problem is not as big in our football as some other contact sports. For instance, in all the World Cups since 1998, we found one concussion on 20 matches.

"I was looking at the Premier League where they play more than 400 matches. They have about 20 concussions every year. Concussions and head lesions are for a total of four per cent of all the injuries in England. In Germany, 10 concussions on 300 matches. If you compare that to the NFL, where they have 330 matches and 200 concussions. When you compare it to the AFL, where it's played by 18 teams and they have 120 concussions.

"The problem is real but it's not to be compared to some other contact sports. It's also interesting to note, in female football we have twice as much concussion problems as male football. It happens 13 times more on match level than on training level."

Brendan Schwab — executive director of the World Players Association — warned "this is a battle FIFA cannot win" amid the risk of a "catastrophic" secondary injury if a player who has sustained a head injury returns to the game.

"When concussed, it's not the time for the player to make a decision as to whether they should continue in a game. That is a decision that needs to be placed in the hands of independent medical assessors who have no duty other than to act in the best interests of the player," he said. "There needs to be independent medical assessors on the sidelines. But we do expect this to be resisted because it is resisted in other sports. We now have independent medical assessors on the sidelines of the NFL and it's only because the NFLPA fought for that right. It was a battle.

"Now the suggestion that the club doctor knows the player better than another doctor, again, is not a medically-based comment. What we do know, however, is that the club doctor who is employed by the club has a conflict of interest. That conflict of interest needs to be minimised and voided in circumstances when dealing with head injuries.

"If FIFA doesn't change, what we will see is football leagues at the national level collectively bargain their own variation of the laws of the game. In Australia, the knowledge is clear that the clubs as employers would be in breach of health and safety requirements, and acting against the wishes of the unions, by putting players back into the game when they're clearly in a vulnerable position. What's to prevail there? Laws of the game or national health and safety laws? National health and safety laws have to prevail. It won't be a defence to any action for an employer to say 'we were simply providing an unsafe work practice at the behest of FIFA'."

Schwab added: "Teams should not be disadvantaged because they are adopting best practice when it comes to treatment of players who have suffered a head injury. A basic concussion protocol will take anywhere between 10-30 minutes. Now, it's essential temporary substitutions are permitted to enable a player to be properly diagnosed.

"Any concerns that the system could be abused are immaterial when considered against the knowledge we now have and the risk we are continuing to see players submitted to in circumstances where that risk is easily avoidable."

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