Assessing concussions at the World Cup
Congratulations to US Women's soccer as they advance to the finals in the 2015 World Cup with a great victory against Germany, the No. 1 seeded team prior to this event. It was certainly an exciting game, but what really sparked a fire in me was the collision that occurred in the first half involving USA's Morgan Brian and Germany's Alexandra Popp.
Clearly, there was significant head-to-head contact when they both went up for the ball. Popp's injury was obvious as she had a laceration that was bleeding. Popp returned to play with blood still soaking her hair. In a contact sport, she should not have been allowed to return until the blood was covered, but somehow she played again, placing other players at risk to her exposed blood. Brian on the other hand; laid on the field face down until the medical staff reported to her. After about 2-3 minutes she rolled onto her back and then slowly and appropriately proceeded to sit up and stand.
Both Brian and Popp returned to play approximately 4-5 minutes after the injuries occurred. There is no way that a full evaluation to determine if she indeed sustained a concussion occurred in that amount of time. I am sure the medical staff asked her some appropriate questions to assess some memory, they checked her eyes, but they could not have assessed everything in the 2-3 minute evaluation. From my perspective, watching the TV in my living room; I don't understand how Brian did not have a concussion. She hit her head and clearly was in pain; otherwise she would have stood up immediately to play, instead of remaining face down.
Much of this issue is directly due to the rules in soccer, which force a player to resume play or come off the field to be evaluated. While the player is being evaluated, your team plays with 1 less player, putting you at a disadvantage and forcing the medical staff to move hastily and not allowing them sufficient time to assess head injuries.
After the 2014 Men's World Cup, FIFA increased the amount of time a medical staff can evaluate a possible head injury while on the field to 3 minutes, which is outrageous. A concussion evaluation should take at least 15 minutes. It is unfair to players and to medical staffs to expect an evaluation to be completed any quicker than that. Having worked as an athletic trainer in professional sports, I understand the pressures of getting players back on the field quickly to help win the game; however a thorough evaluation must occur when a concussion is suspected.
Other leagues, such as the NFL and MLB have addressed concussions and changed rules to protect players and to help assure they are evaluated properly. Although not perfect, the rules in both leagues help prevent situations like the one that occurred in this game; such as the NFL using an independent neurologist to assess players. FIFA should consider allowing teams to substitute players, without penalty, so a qualified physician who is a concussion specialist can fully evaluate a player.
Something must be done to fix the problem. Otherwise, players will suffer long term consequences as a result of their head injuries; and those involved in youth sports watching the game will think it is normal to shake off a concussion and return to play immediately afterwards.
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