Why do coaches keep players who clearly have a concussion on and how do you approach this?

Advice Request

I was AR tonight and had to stop the game after the goalie, in a clean 50/50 got a kneecap to the face.

Centre didn't see it so I spoke with the goalie as the official who saw the injury. I told centre it was a clean hit.

Now he's holding his nose and a little unsteady. Centre and I exchange looks and we suggest to him that he go off. He insists he's fine, and policy is we can't make him.

Broke our hearts to watch as his skills went out the window and the game was lost. It was clear to anyone looking, that he was injured and should sit down. Why do coaches not pull a player after a good hit to the head?

It's not the first time either, I've had to tell at a coach who refused to pull an 7 year old off after he was screaming after a head collision with another player's head. Coach said "he's fine." I just stared at the coach with a 'are you serious?' look. Most times coaches will pull when I strongly suggest it. Your head gets rung, you usually just need a few minutes to sit and refocus. It happens.

I'm just wondering why and if anyone has feedback about how to approach players who should be sent off to be assessed.

Thanks

in Refereesby Deaftrav[Ontario] [level 5]

100%

26d

BlacknightEM21

USSF Grassroots, NISOA, ECSR, NFHS

26d

You can absolutely make a player leave the field and ask for a qualified medical personnel to check for concussion. You are responsible for the player’s safety, every player’s safety!

If you think a player has a head injury, tell them to leave. If the coach is not gonna be an adult, you have to be one!

amfa

-6

25d

You can absolutely make a player leave the field and ask for a qualified medical personnel to check for concussion.

And what are you doing meanwhile? Especially if it is the goalkeeper? And if no medical personnel is at this game? How long do you wait for the player to be cleared (or not). And what are you doing if they just refuse to do so?

I don't know how this is handled in the US, but in Germany in the grassroots/amateur leagues there is just no medical personnel present.

And here we can not force someone to substitute a player. And I don't see it as the responsibility of the referee.

If the player says he is OK and his coach says he is OK I (have to) let them play.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

Asking a player with any kind of head injury if they are “ok” is an exercise in futility. For one, athletes are programmed to respond one way to this question and for another, the nature of the injury prevents sound rational decisions from being made.

You need to read what you have written and reflect here because this topic is deadly serious. You’ve provided 5 justifications for keeping a potentially injured player in a game which dismiss the seriousness of head injuries. Let’s say that you do bypass reason and keep this player in the game. Later, let’s say that they go into the air to contest a header (clean, routine kind of challenge in the box) and end up making contact with an opponent with their head and they go down to the ground and have to be taken away in an ambulance for brain swelling…someone’s going to ask why this player was permitted to stay in the game and you are going to have to live with that (you may also need to get a lawyer as association insurance generally does not cover negligence).

amfa

25d

I'm not talking about what would be better.

I as the ref have (at least in Germany) no rules that would allow me to force a player out.

That's why I ask what you do if the refuse. In the end the only way to handle this would be to abandon the match. But on what rules?

I know about the seriousness of head injuries. But As the ref I'm not only partly responsible for the health of the players.

I just want to know how you handle this? Do you always have medical trained personell at your games?

Depending on the level you can not re-substitute a player. If he is out, he stays out.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

If I sincerely suspect that a player has any possibility of a concussion, I tell the coach to substitute them. Honestly, I’ve never heard “no”. Everyone in my immediate area takes this risk very seriously. We don’t have medical personnel at every match. If I ever get a no, the game is over. This is an easy hill to die on because everyone will have your back.

BeSiegead

🍰

25d

US:

Suspected head injury: out until cleared by a medical personnel (whether or not at field)
Suspected head injury: waives any substitution restrictions
Stop play, essentially immediately, on suspected head injury to check on player -- drop ball restart -- send player off if you are uncertain, suspect, and/or have confidence that there is a potential concussion

QuantumBitcoin

25d

When the ball gets kicked into a player's head at high rate of speed causing a suspected head injury--to whom do I drop the ball? The team of the player that got hit in the head or the team of the player that kicked the ball into the player's head?

BeSiegead

🍰

25d

Law 8:

2. Dropped ball

PROCEDURE

The ball is dropped for the defending team goalkeeper in their penalty area if, when play was stopped:

the ball was in the penalty area or

the last touch of the ball was in the penalty area

In all other cases, the referee drops the ball for one player of the team that last touched the ball at the position where it last touched a player, an outside agent or, as outlined in Law 9.1, a match official

All other players (of both teams) must remain at least 4 m (4.5 yds) from the ball until it is in play

The ball is in play when it touches the ground.

E.g., drop to the team whose player whose head was hit by the ball -- if there was no other touch prior to your decision to whistle for the potential injury.

QuantumBitcoin

25d

In the USA we have special head injury rules for youth.

For both youth and high school officiating (which in the USA are different certifications) we have to take an online course about concussions. We are instructed to immediately stop the game and take the player out. High school rules and low level youth play allow unlimited substitutions. High level youth play have exceptions carved out into the rules for head injury substitutions.

At 50+% of high school games there is an athletic trainer (low level medical personnel) at the game itself and 95% of the time there is an athletic trainer on site, perhaps at a different sporting event.

At soccer tournaments there is 98% of the time an athletic trainer at the site who gets shared amongst the fields.

The problem is at local one off youth games. High level youth club teams often have athletic trainers that are at the fields. For low level games I'll generally just sub out the player anyway.

v4ss42

USSF Grassroots / NFHS

25d

How do you handle a player with a bleeding nose who refuses to leave the field? You can use the same procedure for any kind of injury.

amfa

25d

Yes but for bleeding players there is at least a clear rule in the laws of the game under Law 5

The Referee [...]

ensures that any player bleeding leaves the field of play. The player
may only re-enter on receiving a signal from the referee, who must be
satisfied that the bleeding has stopped and there is no blood on the
equipment

the same is missing for head or any other injuries.

v4ss42

USSF Grassroots / NFHS

25d

Earlier, Law 5 also says:

stops play if a player is seriously injured and ensures that the player is removed from the field of play.

amfa

25d

But only for treatment.

An injured player may not be treated on the field of play and may only re-enter after play has restarted;

Nothing here says that he can only reenter if he is medical cleared.

And please don't get me wrong OF COURSE a player with a severe head injury should not participate any further in the match. I agree with this. But with the current laws of the game this is not incoporated.

I think the new laws will add an additional substitute for head injuries. Which is a step in the right direction.

Would you also abandon a match at adult level?

If you in the US do have special rules for possible concussion: Great. But nothing of this is currently covered by the laws of the game.

v4ss42

USSF Grassroots / NFHS

25d

You’ve had several people here provide you with ways you can use the LOTG (not to mention common sense) to deal with this scenario. At this point it sounds to me like you’re just finding (weak) excuses not to deal with a serious safety issue.

QuantumBitcoin

25d

I think that's a bit harsh.

It seems it's a difference in culture/education and that currently the USA is in forefront of dealing with this issue.

Continue thread...

ilyazhito

25d

If the player is "exhibiting signs and symptoms consistent with a concussion", he is to be removed to be evaluated by a medical professional. Granted, this guidance is in the NFHS rules. NFHS rules games generally take place at schools, where an athletic trainer is available. That said, in the absence of a medical professional, players who are suspected of having a concussion are to be removed from the game.

If a coach gives grief about this, treat him as if he is dissenting.

BeSiegead

🍰

25d

In the United States, under the guidance and training we've received, the referee doesn't just have the right but also the responsibility to require a player to leave the field with a suspected concussion. This has become a rather serious focus over the last decade or so. Our "Safesports" training has extensive material re concussions. Youth coaches, I believe, are required to go through the same certification. What I have seen, here, is an increasing alignment of coaches and referees in terms of concussion risks and how to handle re the concussion protocol.

Jay1972cotton

25d

And for school sanctioned teams, if the coach is refusing to sub out for head injury and a second head blow occurs, then the coach has exposed his school to a world of liability. That should be reported to the assignor and related through appropriate channels to whichever Association the school belongs to as well as the school's AD and headmaster.

ArtemisRifle

USSF Regional

25d

As long as needed. The result of some u13 game is less than secondary to the welfare of a child. Keep the big picture in mind.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

26d

This was a child that took a knee to the face? You don’t continue to allow a player with potential head injury to continue playing. The risk of cerebral edema is very real. I’ve noticed a trend that the new protocol for coaches checking in on potential concussions is “You good?” and I have not once heard a player say “No, Coach…I need to come out” and that’s the nature of head injuries…you aren’t in a capacity to make sound decisions afterwards.

Honestly, I don’t give a fuck what the policy is…if a child has even the smallest potential for a head injury, they are coming off of the field to be examined at a minimum. Usually, once a new goalie is dressed and gloved and in net, the impetus for the first keeper to “tough it out” is diminished. I’ll stop the game, send both teams to get water, tell the coach I will add time…anything to advocate for the player. Consider that the potential for severe brain trauma goes up exponentially if a player has two successive concussions and that’s to say nothing of skull fractures.

Deaftrav

[Ontario] [level 5]

26d

I agree. I usually just look at the coach who objects (when I'm centre) like they're a moron. Most times they back off, muttering. I still get some who are adamant about letting the kids play.

I'm told looking at them like they're morons isn't professional and I need to stop that. (My reply was "I can't help it when they're morona but I don't say it.")

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

26d

Coaches OBJECT?!

Ill-Independence-658

USSF Grassroots, Assignor, NFHS, “a very bad ref”

26d

Collina would look at players and coaches like they are idiots and it was super effective. Because sometimes they are.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

Collina could convince the Pope he was wrong.

Deaftrav

[Ontario] [level 5]

26d

Yeep.

Usually leads to me giving them my infamous face that most sane people go "yeah not worth it. I'm gonna sit down and shut up" but there's always a few.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

26d

There is a section in SafeSport for coaches on physical abuse that covers keeping a potentially injured player in the game.

Deaftrav

[Ontario] [level 5]

26d

Yeah. Seems my area is behind it. Sorry I should add a part to my profile for Ontario referee, Canada.

I'm learning a lot here and I'm glad to see if I get called out, I'll have a lot of support.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

We need to see this face…please post.

Deaftrav

[Ontario] [level 5]

25d

Think the news guy who interviewed Trump meme... With my mouth open a little and my hands out like an Italian mobster palms up.

dangleicious13

26d

and policy is we can't make him

What?

Deaftrav

[Ontario] [level 5]

26d

High school soccer in Ontario. I've been told repeatedly that I can't send players off because I don't have medical training. I usually ignore that when I'm centre. (FYI I do have first aid, advanced. I can spot the signs)

Clearly the Americans have better CTE policies.

stateworkishardwork

26d

Yeah I ref high school. Unless a certified trainer says they're OK, if I sense any type of concussion symptoms they're not coming back in. All of the coaches I've talked to about this know that this is the protocol and are fine with it.

SARstar367

26d

Ask to see the policy in writing. Not in writing? Then it’s not really the policy. Bench away. If it is in writing I would ask the ref association if they have discussed the liability of being paid to keep a game safe and having a policy that specifically allows teens with a head injury symptoms to continue play. (You can probably guess my day job. 😉)

Deaftrav

[Ontario] [level 5]

26d

I pulled the policy in writing after reading this. While it says head coach has final say, it does also say a medical professional does have to check the player first.

SARstar367

26d

Got it- now ask your association about their liability. You are PAID to keep the game safe. Having a policy like that is “Exhibit A”. Your board (or whatever) needs to sit down and think about this one.

Deaftrav

[Ontario] [level 5]

26d

I agree. I think it's people not reading it carefully or it not being well written to make clear that the referee has final say for the game, and head coach for AFTER the game. That's my interpretation.

grabtharsmallet

[Association] [Grade]

26d

Sounds like if they don't have a licensed medical professional on site, the head coach cannot return the injured player to the game.

Which is how it should be.

formal-shorts

24d

Submit an SIR outlining what the coach did and didn't do. Let the league handle it if they feel it was handled poorly.

Breaker023

USSF Regional

26d

I would see clarification from the governing body. High school sports, at least in the US, is an extension of the classroom and they're very cautious about head injuries.

We're taught the concussion symptoms (one of which is simply holding their head in apparent pain) and we can say "I see a sign of a concussion. He need to go out until a medical professional tells me I'm wrong."

Ill-Independence-658

USSF Grassroots, Assignor, NFHS, “a very bad ref”

26d

You can also abandon the match.

relevant_tangent

[USSF] [Grassroots]

25d

Exactly. If a match cannot be continued safely for all participants, it must be abandoned.

Sturnella2017

USSF Grade 6/Regional/NISOA/Instructor

26d

Finally, something where the US is ahead of Canada! Seriously though I’m surprised that there isn’t a policy on this in ON, or all of Canada. But I’m even more surprised that the coach insisted on playing him. That makes my blood boil…

Deaftrav

[Ontario] [level 5]

26d

There's a policy... But Ontario seems to be head coaches have the final call.

I'm trying to find something for Ontario where we can kick them off.

Canada is moving toward removal from the field. Coaches who object usually point to that the coach has final call. My feeling is that the author means that the player can't come back, after the game with the injury until checked out.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

Can you post the verbiage you are referencing? Is it “final call” or “sole responsibility”? Final call implies the judgment of any coach can override good sense.

Deaftrav

[Ontario] [level 5]

25d

https://www.ontariosoccer.net/concussion-resources

Remove from sports pdf. I'm going to read through this more.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

The summary on page three is consistent with the rest of the civilized world.

Deaftrav

[Ontario] [level 5]

25d

So it's just jackasses who read the first part and ignored the rest?

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

It’s jackasses that never read nuthin’.

beagletronic61

[USSF Grassroots, NFHS, Futsal, Sarcasm]

25d

Been told by whom?!?! The rationale that only a person with medical training can diagnose a knee to the face is beyond bizarre. This sounds like something an old head would just repeat anecdotally to avoid upsetting a coach. Please get the facts here. And if your understand is true, then please ignore it and let good sense prevail.

Affectionate_Age9249

26d

Does the Canadian FA not have a concussion protocol? Other people have commented, and it is the first thing that you should be telling any objecting coaches, you should threaten, and carry out a safeguarding report to their club, with your local, or national FA copied in.

Breaker023

USSF Regional

26d

You can tell a coach that you suspect a head injury and that he needs to be cleared by a medical professional before he can be permitted to return to play. That's well within your responsibility as a referee.

There should be guidance in the US Soccer learning portal on this, and there's a while concussion section of the SafeSport training.

If they say he's been cleared by a medical professional but you see them exhibiting signs of a concussion (also detailed on SafeSport) then you can send them right back out to get rechecked. This is absolutely a hill you should die on. Safety is our number one concern.

Edit: Would also like a bit more info on the clean knee to the face. Not saying it's impossible, but I'm probably finding a foul coming out in that case...

scrappy_fox_86

25d

Important detail: the qualified medical professional must be identified before kickoff. In practice, at most youth games, this means there will never be someone who can clear the player.

the_real_slanky

26d

In the situations you have described it is literally your job to:

Stop the game. Get the injured player safely off the field. If you suspect a concussion or other injury, do not let the player back on the field until evaluated by a health care professional.

http://www.recognizetorecover.org/head-and-brain

Deaftrav

[Ontario] [level 5]

26d

I looked up Ontario policy. Head coach has the call to remove a player with a suspected concussion.

However I see that it's the outlier.

So I feel I can tell the coach to sit down, because the Canadian regulations say the player has to be removed.

Sturnella2017

USSF Grade 6/Regional/NISOA/Instructor

26d

That’s horrible. Where are you and what age is this? (You write “centre” so I assume not the US). USSF has really been hammering home concussion protocol, and they make it very clear that when there’s a suspected head injury, the player doesn’t play again until cleared by a medical professional -NOT the coach! USSF also makes it clear we referees have the power to keep a player off the field if they haven’t been cleared and we think they’ve had a concussion. So it’s infuriating to hear a coach insists that the player stay on the field when clearly they’re suffering.

Sorry this happened. I’m not sure where in LOTG gives us the power to do something (and I suspect maybe the local soccer culture might be different as well), but off the top of my head there are two approaches: first, the friendly approach. Blow the whistle, stop the game, kindly approach the coach and stand side by side if it a male (face to face is confrontational, standing side by side deescalates) and saying something like “coach, are you up to date with the latest concussion protocol? Cause your player clearly looks to be suffering. Concussions are really serious stuff that could affect him the rest of his life/force them to quit playing/etc etc. Are you willing to risk this players health for this game?” Etc etc.

Then the not so friendly approach:: confront the coach, say the player is clearly suffering and you will not risk their health in your game. If coach insists in playing them, YC for “failure to act in a coaching manner” (or whatever the verbiage is for that YC). And if the coach still insists, then it’s A second YC. Immediately after the game call and explain the situation to the assignor and anyone else you need to talk to. No reasonable adult should think that keeping a player with concussion symptoms on the field is reasonable. Hell, I’d charge the coach with child endangerment.

Also, just to add, my level of rage on this topic intensifies exponentially the younger the player is. If you tell me this was a U9 game, I’ll fly over to wherever you are and personally RC the coach myself.

/rant

Sorry that happened. Hope you get some good answers here.

Deaftrav

[Ontario] [level 5]

26d

High school. 16 years of age.

Canada is getting aggressive now but Ontario seems to be lagging. We're told we aren't medical professionals and it's not our call.

I didn't give a crap with the 7 year old kid or those who are in the younger leagues. Tossed the kid off to go sit down and get something to drink. But the high school? I wasn't centre.

analmartyr

26d

In the US there are guidelines that “should” be followed after a suspected concussion.

As a coach, if somebody is suspected of concussion that player comes out for the remainder of the day and should not return to play until evaluated by a medical professional. I don’t ask for documentation when the player returns.

As an official, I have not restarted games until a player was removed. I will let the coach know that there is a suspected concussion and the player is done for the game.

I have not run into it in a tournament, but if there was not a medical professional onsite to evaluate I would inform the tournament staff of suspected concussion and that the player should need to go somewhere to be evaluated and I would want it documented that I had done so.

In the end it is just a game and regardless of the outcome I couldn’t handle letting something like that go and have a player have a worse outcome.
As I said I’m in the US and there could be a strong possibility of a lawsuit by letting a concussed player continue to play

Denver1970

26d

As a coach, we have to pass a concussion recognition/protocol test every year. That player not only should have been benched, but sent for neuro exam.

grabtharsmallet

[Association] [Grade]

26d

I have permanent problems due to a traumatic brain injury. I have been in pain for fifteen years, with both Persistent Daily Headache and chronic migraine. This limits what I can do in many parts of life, or imposes steep costs for pushing myself. (If anyone has questions, I don't mind answering them here or in PMs.)

A person with a concussion is at much greater risk of further injury. They are not safe, and our biggest charge is to make play reasonably safe. I have zero doubt that this policy is being misinterpreted, and these coaches are risking the health of minors and bringing legal liability onto themselves and onto you by pushing players onto the field who should not be there. Contact your governing body's office for clarification.

Wooden_Pay7790

25d

My protocol is stop play immediately. Send player to sidelines for assesment/observation. If they come back on and still look affected, I'll restart play..stop immediately and send him back to the bench with the admonition, "Coach, he/she's not fit to play & I can do this all day. Sub, please." Has always worked!

Deaftrav

[Ontario] [level 5]

25d

Ohhh. I can do this all day. I like that response.

phukovski

25d

The guidelines for UK grassroots sport is "if in doubt sit them out".

One of the catalysts for this was a teenager playing rugby who died after repeated head injuries: https://www.theguardian.com/sport/2021/feb/01/peter-robinson-schools-rugby-brain-injury-concussion-campaign

Deaftrav

[Ontario] [level 5]

25d

I've played too much soccer and hockey to know the consequences. My son slipped in a hallway and slammed his head into the corner... Took him years to recover.

And some of those friends I grew up with, I see them today and they're a shadow of themselves.

tonydonut34

USSF Assignor, USSF Grassroots, NFHS

25d

You can send a player off you suspect for a head injury. You cannot refuse to let them back on. But if they show signs that are of a concern, you can have him removed from the field.

iron_chef_02

24d

Depends on the association. For example, if a medical professional for the team, identified before kickoff, clears the player to return, they can come back on. Barring that, they’re done for the day, ref files a report, and that player is automatically redlined on all future game day rosters until evaluated and cleared by a doctor.

UK_Pat_37

USSF Grassroots, NFHS, NISOA

25d

Thankfully here in the USA we have a lot of power on this. For a USSF sanctioned game you have the authority to inform a coach that a player cannot re-enter the field without explicit clearance from an on-site medical professional. At high level youth games and most tournaments they will have personnel on-site for this very reason that are identified. For NFHS the school's athletic trainer should be there to clear, and you can refuse the player re-entry until that trainer has had the time to come and assess them.

It gets a little more difficult in the rec league settings - not all rec leagues will have one. If you're very confident that there is no professional on site, and the kid has a concussion, you can ensure that kid does not come back on the field and your assignors will back you 100%.

Most of the competitions are backing their refs to ensure that a player is not allowed back on without approval from a medical professional now - especially as FIFA are about to incorporate concussion subs in to the laws.

Deaftrav

[Ontario] [level 5]

25d

I like that policy and hope that's the law when it's released.

ArtemisRifle

USSF Regional

25d

The federation and IFAB have spent a lot of time and money over the past 5 years trying to hammer it in referees heads that its not only within our power, but our responsibility to have replaced a youth player we suspect of a head injury. This post is surprising considering the videos were made to sit through every year we re-certify.

estockly

25d

I have sent injured players off the field, overuling the coach and the player. And, once they have left the field, they need the referee's permission to return, and if I have doubt about their head injury I refuse to give permission. "You're done for this game"

And it's not just head injuries. Years ago I was an AR when a player injured his ankle. Referee stopped play and checked on him and he said he could play. Referee started play and the injured player took one step and collapsed in pain. Turns out it was a severe sprain and he was out two weeks. Ever since, after a knee or ankle injury I won't let a player go back to play if they can't show me their fit by running in place a few steps. More than once that has helped a player realize they had to leave the game, and possibly avoided a more serious injury. Most of the time there's no issue.

Deaftrav

[Ontario] [level 5]

25d

Good tip. Thanks

Abu_Garcia3

25d

AR or center, it does not matter, as soon as you even suspect it, stop that game and get that kid off the field!

Refuse to restart the game, refuse to partake anymore in the game, or even end the game if you have to.

The coach, the kid's momma, administration, even your assigner can bitch all they want; it does not matter!

Get that kid off and do not let them back on until they have been checked and cleared by a qualified professional.

And explicitly mention any coach's refusal in your game report.

scrappy_fox_86

25d

I agree, but the part about letting them back in after seeing a qualified medical professional applies only if that person has been identified prior to kickoff. Typically you won’t have such a person identified, so you will just have to tell the coach to bench the player for the game.

bemused_alligators

[USSF] [regional] [assignor]

25d

policy is we can't make him

What policy is this? I've never seen a policy that doesn't allow the referee to require a player with suspected concussion to get checked by a medical professional before they can return to play.

formal-shorts

24d

This might help:

https://www.ontario.ca/page/rowans-law-information-sports-organizations-and-schools#section-0

Kimolainen83

25d

I always find it weird that people calm it center ref (off topic I know) but yeah no I stop the match and tell them get him off or the game will be fully stopped end off

ConservaTimC

-1

26d

Can’t believe I am saying this… How can you watch that awful and useless Safe Sport EACH and EVERY year and not get the one single item that is relevant to being a Referee, the concussion segment???

BlacknightEM21

USSF Grassroots, NISOA, ECSR, NFHS

25d

They could be a referee in any other country in the world. I agree that the Safesport video is a pain to watch every year, but if it wasn’t for that video, we probably have a lot more questions like this.

ConservaTimC

25d

I know, I said I reluctantly agree to praise Safe Sport. True the ref might be multinational also, good point

BuddytheYardleyDog

25d

Blame Canada.

ConservaTimC

25d

Like the way you think

5 missing replies