FIFA's head injury treatment program criticized after World Cup incident: 'Players are in danger'
FIFA's head injury treatment program is under fire after United States defender Alex Freeman was hit in a match against Australia, raising concerns about player safety and medical assessments.
U.S. defender Alex Freeman had a head-to-head collision with Australia's Paul Okan-Engstler during a World Cup Group D match on Friday afternoon. This incident has led to FIFA's head injury treatment program being criticized by leading experts. Chris Nowinski, a neuroscientist and co-founder of Boston University's CTE Center, said that FIFA's policy of allowing on-field head injury tests "puts players at risk and does not ensure optimal medical diagnosis."
A FIFA spokesman disputed the claims, asserting that the organization has implemented a "robust head injury strategy" with "an evidence-based assessment for any player" based on "recommendations from head injury experts."
Defender Freeman had a head-to-head collision with Paul Okan-Engstler in the final minutes of the first half, lay on the field and appeared dazed after the incident. He was then briefly examined on the field by US medical staff before being allowed to continue playing. Freeman scored the second goal for the United States soon after, in the 43rd minute, after a lengthy VAR check.
Nowinski, along with leading brain injury charities such as Headway, is calling for the use of temporary head injury substitutes (TCS), allowing more comprehensive tests to be carried out when players are taken off the field. Many organisations, including the Premier League, EFL and FIFPRO have also called on IFAB, football's global legislature, to trial the TCS system.
However, FIFA is yet to act, with sources saying that internal scientific research has shown that permanent head injury replacements in FIFA competitions have the lowest rate of false positives in any sport.
In FIFA competitions, according to IFAB rules, a permanent head injury substitution is allowed—meaning a team receives an additional substitution if a player is suspected of having a head injury, but that player is not allowed to return to the field. The opposing team will also receive an additional substitution.
In practice, this led to head injury tests being carried out on the field, with teams hesitant to substitute a player who could pass a head injury test, which could have given opponents a free replacement.
"The current problem is that doctors are forced to perform hasty head injury assessments on the field," Nowinski added. "FIFA's position puts players at risk and does not guarantee optimal medical diagnosis and outcomes when it comes to the most important organ in their body.
"Instead like we saw in the US game, players are allowed to lie on the field for as long as they want, so if they have symptoms, they will gradually subside — if they feel bad, if their balance is affected, it will go away. Putting time constraints on doctors also ensures that the test will be rushed and inaccurate if they are performed offsite.
"To assess a head injury, doctors should have at least ten minutes and not be pressured to be on the field, watched by fans. They should be allowed to take players off and examine them in an environment that allows privacy, allows them to listen to the player. If we don't allow that, we will have more players continuing to play with head injuries than if we took them off the field."
In response, a FIFA spokesman said: "FIFA has (first) implemented a robust head injury strategy at the 2022 FIFA World Cup, including an independent head injury assessment and rehabilitation service to provide an evidence-based assessment for any player who has suffered a brain injury, along with recommendations from head injury experts on return to play.
"Additional measures have been established including a medical replay tablet for each team doctor to review injury mechanisms, a FIFA medical coordinator overseeing on-field services in each stadium, and an injury monitor, along with additional permanent replacements for actual or suspected injuries."
The spokesman added that the team doctor also has the ability to stop play for up to three minutes to complete any assessments, arguing that the examination is not limited in time, with the team doctor allowed to continue pitchside work for an unlimited period while the match continues.
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