Concussion management at the FIFA World Cup 2018 compared to club football

The FIFA World Cup in Brazil was notable for many things including Germany’s extra time victory and Tim Cahill’s amazing goal. On the negative side we saw the challenges of managing concussion on the world stage. This has resulted in FIFA making significant changes to its concussion rules for the 2018 World Cup in Russia including a 3 minute mandatory assessment period for concussion and video access for team doctors.

Perhaps controversially, video assistance refereeing (VAR), will be available but the use of video for concussion assessment is an important addition to allow the team doctor to more easily detect signs of concussion and act appropriately. It is easy to appreciate that a doctor sitting at pitch level watching a game in real time may be unable to see all incidents. The elbow to head of the Liverpool goalkeeper in the recent Champions League final was a good example of this. In Russia a second doctor will be seated in the stand with access to video replay technology to look at such incidents and observe any signs of concussion, reporting these to the team doctor on the bench. This technology is in current use in the AFL and professional rugby with great benefit to medical staff and it is long overdue.

Discussing with Socceroo team Dr Mark Young he appreciates this innovation to help him perform his role and protect his players health. There will be a trained medical observer in the communications area monitoring footage and reporting directly to him on the bench. This then will allow the team doctor to perform the appropriate assessment pitchside to determine a diagnosis of concussion.

What does this mean for concussion in community football this weekend? 

The rules are the same. Remember the 3 ‘Rs’:

• Recognise – You don’t need a video but look for signs of concussion including visual cues (eg: lying motionless, slow to get up after head knock, balance difficulties), symptoms (headache, drowsiness, nausea) and memory issues. Use the Concussion recognition tool (1).
• Remove – Any player with a suspicion of concussion should be removed from play until cleared by a suitably qualified medical practitioner.
• Refer – All players removed with a suspicion of concussion should be referred for medical assessment, management and clearance prior to return to sport.

The subsequent management under the guidance of a medical practitioner also follows the 3 ‘Rs’:

• Rest – An initial period of cognitive and physical rest is appropriate however recent evidence suggests this should be brief (24-48 hours) and the resumption of light physical activity is both safe and aids recovery.
• Rehabilitate – A graded return to sport programme should be followed with a 24 hour break for assessment of any symptoms before progressing to the next level. The final session should be at game intensity and include contact drills. This must be completed without recurrence of symptoms of concussion.
• Return to sport – Requires medical clearance and should only be considered when patient is symptom-free and has completed a full rehabilitation programme.

For further information see the AIS/AMA website supported by the Australian Concussion in Sport Collaborative at http://concussioninsport.gov.au 

Footnote 1 – http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097508CRT5.full.pdf

Learn more about Dr Andrew Jowett by visiting http://www.opsmc.com.au/person/dr-andrew-jowett/