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FIFA medical chairman confirms concussion substitute discussions

Jan Vertonghen struggles to leave the pitch after a head knock during Tottenham's clash against Ajax

FIFA medical committee chairman Michel D'Hooghe confirmed the governing body is awaiting a decision on the proposed changes to the concussion rule, including the introduction of a temporary substitute.

FIFPro has led calls for change to the current three-minute assessment and treatment of head injuries after high-profile incidents since the 2014 World Cup in Brazil.

The issue of concussion and head injuries dominated headlines last season – a sickening incident involving Tottenham defender Jan Vertonghen in the Champions League semi-finals of particular concern.

Vertonghen required extensive treatment after colliding with the back of Spurs team-mate Toby Alderweireld's head in the first half of a first-leg loss to Ajax in London, where he was initially cleared to return as per the current concussion protocol.

The 32-year-old, however, had to be helped from the field moments later in worrying scenes on the sidelines. While he was cleared of concussion following days of assessment, Vertonghen had been advised to undertake a "brief period of rehabilitation" before returning to training.

It was one of many head-related incidents in 2018-19 amid calls for the introduction of an independent doctor as well as demands for 'temporary concussion substitutions'. Switzerland defender Fabian Schar, Napoli goalkeeper David Ospina, Lyon keeper Anthony Lopes and United Arab Emirates' Fares Juma Al Saadi were cleared to return under the current guidelines.

The International Football Association Board (IFAB) is now set to decide on changes following talks with FIFA, with the main proposal to increase the current three-minute assessment window for a suspected concussion to a mandatory 10-minute test.

"It's an actual problem," D'Hooghe told Omnisport about concussions and head injuries. "In my medical business, it's the number one problem.

"I had a meeting 14 days ago in Zurich with the members of FIFA's medical committee and also with people from the diverse federations. We came to conclusions that have to be confirmed by the FIFA Council and by the IFAB. 

"We think the doctor must be on the top level like players. That means we will introduce a new chapter in the FIFA medical diploma and we propose that each doctor on the bench in an international match would have proved to have followed this chapter of the medical diploma, so we don't have a doctor who isn't completely aware of the medical situations on the bench.

"Secondly, we introduced the team doctor can be approached not only by the second medical person but a neutral doctor, who has also the repetitive view of the incident, so he can also inform the team doctor and fourth official by saying for instance 'I've seen this player has been unconscious'. That is the second new rule. If a player has been unconscious, even for a short moment, then we want absolutely that he leaves the field.

"Then there's the last point. We have received proposals from FIFPro and some associations, asking why don't you let the doctor do the famous necessary 10 minutes for the SCAT5 examination, and why don't you allow a temporary substitute during this 10 minutes?

"First of all, I can tell you one of the mistakes is that people think this 10 minutes would replace the three minutes. That's absolutely not true. The three minutes aren't there to do a complete examination but just to ask if they player can continue or not. Not more than that.

"That last proposal can have consequences for the refereeing and the rules of the game. That's why our medical committee before deciding asks advice to the IFAB about what they think about the proposal before coming to conclusions that we could eventually take into our next medical commission of FIFA."

FIFA has previously had concerns about managers abusing the temporary substitute rule but D'Hooghe added: "I think that since we leave the decision essentially and exclusively to the team doctor, that in fact the manager has no more role in that.

"Of course I'm not naive, I can think that he will put the team doctor under pressure. But that is why the team doctor, if he has any hesitation, can call the neutral doctor who has the direct images to give his advice also. But for me, the responsibility must always remain in the hands of the team doctor because he knows the player better than anyone."

Reports suggest the proposed changes could be implemented next season but D'Hooghe said: "I think we have to wait for the next meeting of the medical committee to receive the answers. So that means that the first decisions could follow in March 2020."

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