Concussion SubstitutesConcussion Substitutes

Together with other stakeholders (medical concussion experts, team doctors, player representatives, coaches, competition organisers and refereeing and Laws of the Game experts), The IFAB identified several reasons not to trial temporary “concussion substitutes” at this stage:

• They would not remove the risk to player safety, i.e. possible misdiagnosis or a “false negative” assessment; e.g. a player could return to play with delayed symptoms.
• Assessments of head injuries following concussion events are complex and time-consuming.
• Such a system would only be operable at the highest levels of football, requiring a qualified doctor/medical staff to be in place to make the necessary assessments and decide if the player can return to play.
• Team doctors do not see concussion events very often and cannot be expected to perform a full head-injury assessment at speed.
• The recommended assessment time is constantly being reviewed by the Concussion in Sport Group, and is likely to be increased from ten to 15 minutes.
• The player may cool down and thus risk injury if returning to play without warming up.

The trial is open to competitions at any level; confederations and national FAs (on behalf of the competitions under their auspices) must apply to The IFAB for permission to take part in the trial, which will only be given to competitions using one of the two official protocols and that agree to submit the requested feedback.

Trialling two protocols with different options enables The IFAB, FIFA and their expert groups to evaluate the impact of different approaches on player welfare and sporting fairness, and to make decisions based on clear scientific, football and medical feedback.

It is not permitted to change either protocol or combine different elements of the two protocols; e.g. it is not permitted to increase the number of “concussion substitutes” in Protocol A.

The feedback to be submitted by all competition organisers participating in the trial is divided into three categories:

• General competition information
• Specific in-game information

• Medical information

The provision of all relevant data in the first two categories is mandatory for all competitions. However, the provision of medical information will depend on a competition’s medical services and infrastructure.

A “concussion substitution” can be made at any time, regardless of the number of “normal substitutes” already used by the team. This applies both where the “concussion substitute” is an extra substitute and where the “concussion substitute” is a substituted player (a player who has previously been replaced) (see below).

A substituted player can only be used as a “concussion substitute” or “additional substitute” in competitions where the maximum number of named substitutes is the same as the maximum number of “normal substitutes” that can be used.

For example:

• Maximum number of named substitutes = 3
• Maximum number of “normal substitutes” allowed to be used = 3

In this case, a substituted player can be used at any time as a “concussion substitute” or, for Protocol B only, an “additional substitute”. 

In competitions where more substitutes can be named than the maximum permitted number of “normal substitutes”, a substituted player cannot be used as a “concussion substitute” or an “additional substitute”.

For example:

• Maximum number of named substitutes = 5
• Maximum number of “normal substitutes” allowed to be used = 3

In this case, a substituted player cannot be used at any time as a “concussion substitute” or, for Protocol B only, an “additional substitute”. Therefore, even if a team has used three “normal substitutes” and two “concussion substitutes” and the other team then uses a “concussion substitute”, a substituted player cannot be used as an “additional substitute”.

This depends on the protocol being used:

• Protocol A – only one “concussion substitute” per team
• Protocol B – up to two “concussion substitutes” per team

“Concussion substitutes” are intended to protect the welfare of the players. As the symptoms of concussion can be delayed, if a player is assessed for possible concussion, returns to play and later on there is a concern about their welfare, a “concussion substitute” can be used (assuming the team has not already used its maximum number of “concussion substitutes”).

Where there is an actual or suspected concussion and a player needs to be replaced, the team can decide whether to use a “normal substitute” or a “concussion substitute”, provided the maximum number of each type of substitutes has not been used.

The substitution procedure operates in accordance with Law 3 – The Players (except where outlined otherwise below). If a team decides to make a “concussion substitution”, the referee/fourth official is informed, ideally by using a substitution card/form of a different colour.

When Protocol B is used, the opposing team is informed by the referee/fourth official that it now has the option of using an “additional substitute”.

This option may be used concurrently with the “concussion substitution” made by the opposing team, or at any time thereafter (except as outlined otherwise by the Laws of the Game).

The player is not permitted to take any further part in the match (including kicks from the penalty mark) and should, where possible, be accompanied to the changing room and/or medical facility. This applies to all competitions, including those where a substituted player can be used as a “concussion substitute” or “additional substitute”.

The referee (and the other match officials, especially the fourth official):

• must not be part of the team’s decision-making process as to whether a player should be substituted or not, nor whether a player should be replaced by a “normal substitute” or a “concussion substitute”;
• must not decide whether an actual or suspected injury qualifies for a “concussion substitute” to be used;
• should give appropriate support where a player has an actual or suspected injury, including informing the team captain/coach/medical staff if they suspect a player needs assessment/treatment;
• should support a decision by the team captain/coach/medical staff that an injured player must not continue playing – this may require the referee to delay the start of play until the player has left the field of play; and
• must inform the appropriate authorities if a concern is expressed that a “concussion substitute” was potentially used incorrectly.

Once a match has ended, the Laws of the Game do not allow substitutions before the start of or during KFPM except for a goalkeeper who is unable to continue. If a goalkeeper is unable to continue because of an actual or suspected concussion (from an earlier incident or because of a collision during the KFPM), a “concussion substitute” is allowed if the team has not used its maximum number of “concussion substitutes”. The opponents do not get the option of using an “additional substitute” (Protocol B) for the reason explained at the beginning of this paragraph.

The trial period enables The IFAB to analyse the effect of “concussion substitutes” in detail and serves as a basis for assessing whether this form of in-game management contributes to the protection of player welfare. The results of the trial will allow The IFAB to make a decision based on medical findings and feedback from all relevant football stakeholders.

The results will be assessed by The IFAB and FIFA. Each competition organiser must provide feedback to The IFAB and FIFA no later than four weeks after completion of the competition. The IFAB and FIFA may ask competition organisers for interim results, if needed.