Football urged to introduce neutral doctors and warned over 'dangerous' concussion protocol

Football has been urged to introduce neutral doctors as part of an immediate and radical overhaul of its “dangerous” head injury protocol.

While rugby union has temporary replacements which allow at least a 10-minute off-field assessment overseen by an independent medic, decisions in football rest with a club doctor who must make a quick on-field call over whether a player is permanently removed.

These protocols were thrust back into the spotlight on Sunday following the sickening clash of heads between Arsenal’s David Luiz and Wolverhampton Wanderers striker Raul Jimenez. 

Luiz was bandaged up and allowed to continue for a further 40 minutes before being substituted at half-time due to the flow of blood from a gash on his forehand. Jimenez was immediately taken to hospital where he had surgery on a fractured skull.

Arsenal are adamant that they followed all existing protocols in allowing Luiz to continue - and later drive himself home - and have stressed that he has not as yet shown any symptoms of concussion.

World players’ union FIFPro, and brain injury charity Headway, however, are calling on football’s governing bodies to bring in temporary concussion substitutes, as well as neutral doctors, rather than plough on with proposed trials in 2021 for an additional permanent substitute.

According to FIFPro, the involvement with club medics of an independent doctor during a 10-minute diagnosis window would reduce the pressure and “help ensure decisions are not influenced by sporting interests”.

As is the case now in international rugby union, as well as the Premiership, Headway also wants final decisions over whether a player should continue to rest with an independent doctor.

Telegraph Sport launched its ‘Tackle Football’s Dementia Scandal’ campaign in 2016 and, as well as calling for the research which proved football’s link to dementia, has consistently advocated temporary concussion substitutes.

Current and former players were also lining up on Tuesday to call for change. "When there is a blow to the head there should be a substitution, whether the player can continue or not - you could be feeling OK but after you could feel the consequences," said Manchester City goalkeeper Ederson.

Alan Shearer, the former England captain, said it was a matter of “life and death” that football addressed the issue. “The protocols in football are not acceptable,” he told the BBC. “It needs to wake up. It needs to get serious. Not next year, not next month, not next week. Now.

“We are talking about players’ welfare here. We are talking about life and death, players’ careers. It's been going on for years. Meeting after meeting.” Of the Luiz incident, Shearer said: "If David Luiz has passed all the protocols like Arsenal say he has, how on earth is he allowed back on to the pitch with a wound that is dripping down his face?”

Football’s governing bodies were also warned that they are leaving themselves vulnerable to legal action. “Failing to take appropriate and reasonable steps to minimise a known risk leaves them open for an own goal of legal claims, should a player be injured if they would not have otherwise been had a temporary substitution allowed them to come off pitch for full assessment,” said Ipek Tugcu, a senior associate at Bolt Burdon Kemp.

Fifa and the International Football Association Board are preparing to approve trials next year for an additional permanent concussion substitute - and the FA plan to introduce that system in the men’s and women’s FA Cup. Like Fifa and Ifab, the FA says that player welfare is its priority. The proposal, however, has been branded “hopeless” and from “the last century” by Dr Willie Stewart, the neuropathologist who proved football’s dementia link.

Vincent Gouttebarge, FIFPro’s chief medical officer, has also been arguing for temporary substitutions from inside Ifab’s ‘Concussion Expert Group’.

“This trial was not well received at present - they want to try first permanent concussion substitute,” he said. “It is a move forward, but nevertheless I don't think we are going to solve the problem with this permanent substitution because it does not provide the medical team with sufficient time. I hope that football will not have to wait for a high profile case with very serious consequences.”

While FIFPro also want “neutral assistant doctors”, Gouttebarge stressed that these would not take “take the lead over the club doctors” who have a particular insight into individual players. Ryan Mason, whose own career was ended following a fractured skull, also questioned protocols which allowed Luiz to play on. “I was shocked David Luiz was allowed to play on,” he told talkSPORT. “I’m not criticising the Arsenal doctor because there’s a protocol in place and I’m sure he’s followed that. But that protocol is not enough. This current protocol we have in place isn’t okay and it’s dangerous.”