The NHS website defines concussion as a "temporary injury to the brain caused by a bump, blow or jolt to the head", which can cause symptoms such as headaches, dizziness, vomiting, memory loss, problems with balance or changes in vision. Although symptoms usually resolve within a few days or weeks, they can persist for longer and result in a condition known as post-concussion syndrome. 

Headway's Concussion Aware campaign also highlights that concussion symptoms may have a delayed presentation, which makes it difficult to assess what damage has occurred in the immediate aftermath of a head injury.

In football they highlight the risk of Second Impact Syndrome, which can occur when a player sustains another blow to the head before the brain has had a chance to recover which results in the damage being exacerbated. This is why it is vitally important that players are appropriately assessed before being allowed to return to the field of play or, as Headway's message conveys: if in doubt, sit it out!

The Concussion Charter

Ahead of the Euros 2020 (held in 2021 due to Covid-19 pandemic), UEFA introduced a new Concussion Charter to take steps to protect the health of players who may have suffered from a concussion. All 24 teams participating signed up to the charter, which crucially states that "if a player … is suspected of having suffered a concussion, he will be immediately removed from the pitch, whether in training or match play."

However, questions were raised about whether the protocol had actually been followed after an incident during France's match against Germany in the group stages of the Euros. French player Benjamin Pavard reported that he had been "knocked out" for 10 to 15 seconds after colliding with another player on the pitch, but following a brief assessment by the French medical team he was allowed to play on and was not substituted for the remainder of the game.

The chief executive of brain injury charity Headway, Peter McCabe, has criticised that decision saying it was "simply not credible to suggest that a concussion could not be suspected" and in that case, with reference to UEFA's own guidance, Pavard should have immediately been taken off the field. It was not clear why that did not happen.

Further incidents…

Two separate incidents have further put the spotlight on the protocol and also how concussion is managed within football. On 21 June Austrian player Christoph Baumgartner had a clash of heads with a Ukrainian player, but continued to play for a further 15 minutes despite holding his head on two occasions before he was substituted. He later complained that he had suffered from dizziness.  

Then at a match just two days later Portuguese player Danilo sustained a blow to the face from the opposition goalkeeper and collapsed to the ground. He was again allowed to continue in the match, but was substituted at half time with UEFA later announcing that he had suffered a "mild head trauma".

Lessons to be learned

It is crucial that a full assessment is carried out immediately in order for a proper diagnosis to be made and to ensure that the person injured is given time to rest and recover. The on-field medical teams have to make the assessment within a few minutes and are often hurried along to get the game going again. It has to be questioned whether, under these circumstances, a full assessment can properly be carried out.

Although it is of course understandable that a player will want to do everything they can to continue playing for their country in a major tournament, if there is any suspicion that they have suffered from a concussion then surely it is best to err on the side of caution and remove the player from the pitch.  The guidance on this seems clear and yet it is not entirely clear why, during these incidents, the guidance does not appear to have been followed.

Dominic Fairclough, partner in the personal injury and clinical negligence department at Russell-Cooke, and qualified football referee also commented: “Any head injury suffered while playing sport is potentially life-threatening but it has taken a long time for governing bodies to take matters seriously. At elite level, football should learn from the head injury assessment (HIA) protocol well established in rugby which appears to work well. At grassroots level, matters are more problematic without the backup of expert medical input. As a starting point, it would be helpful to make the assessment of head injury protocols part of the training to become a football referee.”

Russell-Cooke's dedicated personal injury and clinical negligence team handles a vast range of head and brain injuries and understands the importance of correct protection protocols.