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'Tunnel doctor' to have final say during Premier League trial of concussion substitutes

Owen Otasowie - 'Tunnel doctor' to have final say during Premier League trial of concussion substitutes - GETTY
Owen Otasowie - 'Tunnel doctor' to have final say during Premier League trial of concussion substitutes - GETTY

The Premier League trial for permanent concussion substitutes that begins next week will include video evidence being assessed by the ‘tunnel doctor’ who will have the power to decide whether a player must be taken off.

It means the verdict as to whether a player is able to carry on if a head injury is suffered can be taken out of the hands team doctors with, also, no time limit placed on how long will be permitted for the medical assessment to be concluded.

The decision to remove a player will not be taken by the referee. However, the Premier League will warn clubs against abusing the system, by using it for tactical reasons, with referees asked to report any suspicions they have back to league officials. In the protocols, seen by Telegraph Sport, the Premier League adds: “The refereeing team must inform the Premier League immediately after the conclusion of the match if they have a concern that an APCS (Additional Permanent Substitutions) was potentially used incorrectly”.

From the round of midweek games next week the Premier League will become the first competition to introduce permanent concussion substitutes for matches. The Premier League clubs will confirm the trial is set to begin at their shareholders meeting on Wednesday having voted on December 17 to agree to take part in the proposals put forward by football’s law-making body, Ifab.

There were two proposals – Protocols A and B. The first only allowed one concussion per team and no additional substitute for the opposing team. The second – which the Premier League has chosen to adopt – will allow two so-called ‘Additional Permanent Substitutions’ (APCS) with the opposing team having the option to “use an ‘additional’ substitute for any reason”.

In the protocols the procedure of what happens when a player suffers a head injury is set out clearly. When a player suffers a potential concussion injury the game is stopped with medical staff allowed onto the pitch. At the same time the tunnel doctor – who was introduced in the top-flight in 2014 partly to protect players from head injuries – will have an enhanced role and will review “video footage and Hawkeye” (the operator of the Premier League’s technology) with the referee allowing “as much time is needed for assessment”.

If there are clear symptoms or video evidence suggesting a concussion the player will be “permanently removed from play and concussion substitute enters field of play”. Each team will be allowed two additional substitutes regardless of how many changes they have already made up to the normal three subs.

Interestingly, Ifab suggested that teams should be allowed to have the option of bringing back on a player who has already been taken off but the Premier League guidelines state the concussion substitute should come from one of the nine replacements named on the team sheet.

If an “APCS” is used then the opposition has the option of bringing on an “additional substitute for any reason”. When a team wants to use an “APCS” in will fill in a green card – as opposed to the usual white card – and hand it to the fourth official to show it is a concussion substitution that is being made. The opposition team will then be informed of the reason.

The protocols also clearly state: “The refereeing team is not part of the decision-making process as to whether a player should be substituted or not, nor whether a player should be replaced by a ‘normal’ substitute or an APCS nor whether the injury qualifies for an APCS to be used”.

Leading neurologists, players’ unions and brain injury charities have been campaigning for temporary substitutes, as is the case in other contact sports like rugby union, so that doctors have at least 10 minutes to assess a player before making a final decision. However football appears to prefer making a permanent change. Brain injury charity Headway also wants that decision to rest with an independent medic. Although the tunnel doctor is appointed by the home club the Premier League will argue they are independent.

Telegraph Sport launched its ‘Tackle Football’s Dementia Scandal’ campaign in 2016 and has long called for football to follow other contact sports by introducing temporary substitutes so that proper assessments can be made on injured players.

At its shareholders meeting of the 20 clubs the Premier League will also discuss a plan if the season needs to be curtailed due to the Covid-19 pandemic. The expectation is that a majority of clubs will want at least three quarters of the games complete (29 out of 38) before a points per game system could be used. An alternative is for just two-thirds of the season to be completed but this is unlikely to gain any support.

The Premier League is also under pressure to take further action over the ban on hugging during goal celebrations, swapping shirts and shaking hands with several clubs failing to adhere to the new Covid-19 protocols at the weekend. Enhanced protocols were re-introduced amid fears the sport could be stopped if there was a spike in cases.

The Premier League is resisting the introduction of further sanctions, hoping that players will respond, and will remind senior figures at each club to stress the importance of following the rules. If celebrations continue action might be taken. The sport is under pressure from the government to abide by the protocols given the restrictions that the public must follow and which has led to a backlash against football.