In the eighth minute of their FIFA men’s World Cup match against England, Iranian goalkeeper Alireza Beiranvand collided face-first with a teammate. The impact left the keeper bloodied, unsteady on his feet and seemingly disoriented – unable to play.
But after prolonged treatment, he continued to play. Within minutes he fell to the ground and was carried away on a stretcher. He was later taken to hospital.
Former England player Jermaine Jenas, commenting on the game, said the situation was “ridiculous” and “out of order”. Given the serious nature of Beirandvand’s injury, medical knowledge suggests he should have been taken off the field immediately.
But he reportedly refused to do so, according to some reports, most likely because he knew that if he went off, he wouldn’t be able to participate in the rest of the game. This points to a problem with FIFA’s concussion protocols that arguably endangers players’ lives.
A blow to the head, like Beiranvand got, or a blow to the body that causes the head and brain to move back and forth quickly can cause a concussion, which is a type of brain injury. It’s not something that can be thrown away or played with, and attempting to do so isn’t a sign of toughness.
Playing with a concussion is extremely dangerous, especially if a player hits their head again. Suffering a second brain injury before recovering from a previous brain injury can result in what is known as second impact syndrome.
This occurs when the brain swells rapidly after a person sustains a second head injury while the symptoms of a previous head injury or concussion are still present. And it can often be fatal.
Repeated headbutts – for example, frequently heading a soccer ball – can also lead to neurodegenerative diseases such as dementia or chronic traumatic encephalopathy.
Fifa’s flawed protocols
This is the first FIFA Men’s World Cup to allow concussion substitutions. Teams may perform an additional substitution if a player sustains or suspects a concussion.
Each game also has a “concussion potter”. This is a member of the medical team who sits in the stands with access to video replays and whose job it is to identify possible brain injuries. Concussion potters have been used at rugby union games and in the NFL for some time.
FIFA’s medical concussion protocol states that after an initial examination (on the field), an examination should follow off the field or in a quiet environment. This step is vital and it is important that it is done in silence. It also takes a lot of time, especially since signs and symptoms of a concussion can be delayed — sometimes for up to three weeks.
While FIFA emphasizes the need for off-field assessment, it does not allow players to be temporarily removed to allow full assessment in a calm environment. And because coaches want their best players on the field, athletes are often pressured to play through injuries and praised for doing so.
Team doctors have even been abused by managers for treating injured players and there are also stories of players being coached to ‘cheat’ concussion tests so they can stay on the field.
Earlier this year, an open letter called on the International Football Association Board (IFAB), which sets the rules of the game, to authorize temporary concussion replacements. It was signed by former players, prominent scientists, lawyers and the families of former players. IFAB rejected this call.
As a co-founder of the Acquired Brain Injury Research Network, I believe this decision is wrong and the rules should be changed to allow players to be temporarily switched out of the game for review. Knowing that the substitution isn’t permanent takes some of the pressure off players to stay on regardless of their condition. And off the field of play, a more appropriate and thorough assessment can then take place, meaning the player can return when they are fit to do so.
FIFA responded to these accusations by saying:
If there is any suspicion of a concussion at any time, FIFA encourages all team doctors to remove the player from the match or training session and assess and treat them appropriately.
While ultimate responsibility for concussion diagnosis and management rests with the appropriate team doctor, FIFA expects all teams to act in the best interests of their players and their health.
How to recognize a concussion
While football’s attitude to concussions has improved, results are still being put ahead of players’ health. Ultimately, the decision to continue playing should not be in the hands of players or anyone involved with the team.
There is a lot of criticism in the media about the handling of Beiranvand’s injury. This is a positive change as previous posts have been full of misconceptions, misinformation and worrying attitudes – especially from former players. But there is still a lot of confusion about concussions.
Each concussion is experienced differently, so they can be difficult to identify, but there are things everyone can be aware of. The symptoms of a concussion include headache or dizziness, memory loss, sleep symptoms, and emotional symptoms such as anxiety.
There are also visible signs that anyone looking can recognize. Following the phrase “When in doubt, sit down” can save someone’s life. A player should be removed from play and medical attention sought if any of these are seen:
- problems with balance
- glassy look in the eyes
- delayed response to questions
- amnesia
- vomit
- crying or laughing inappropriately
- forgot instructions
- confusion about position or the current game or score
- loss of consciousness.
Alireza Beiranvand’s injury adds to a growing list of players who have remained in matches after a brain injury. I hope this is a wake-up call for FIFA and the International Football Association Board as the current rules do not seem to protect players.
Keith Parry, Deputy Head of the Department of Sport & Event Management, University of Bournemouth
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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