The Premier League has announced new medical rules and policies regarding head injuries suffered on the pitch.
During the 2013/14 season the Premier League Board set up a medical working group to look at existing rules and policies regarding head injuries.
The working group was led by Premier League director of football, Mike Foster, chairman of the Premier League Doctors’ Group and Arsenal club doctor, Dr Gary O’Driscoll, FA head of sports medicine, Dr Ian Beasley, and members of the PFA, LMA and Football League.
The group was asked to review existing rules and policies and consider ways that medical professionals could be further assisted in carrying out their duties. It consulted with a wide range of experts, including senior medical practitioners from the Rugby Football Union and British Horseracing Authority.
"With regard to head injuries there has been a perception in the past that you can tough it out, you can play on, you can be brave"
Their recommendations have already been addressed by Premier League clubs who agreed to new rules and policies being introduced for the 2014/15 Barclays Premier League season, including:
- Premier League rules making clear that when a serious head injury is suffered on the pitch (in matches or training) that the ruling of the doctor/medical practitioner is final.
- The role of “tunnel doctors” (it is a new requirement for all Premier League matches to include a tunnel doctor) will include supporting the home and/or away team doctors in helping recognise the signs of concussion.
- Making it mandatory for all Premier League medical staff to carry the concussion recognition tool
- Annual baseline testing should take place on each Premier League player
Premier League director of football, Mike Foster, said: “Player safety is paramount in all sports and the Premier League has a strong track record of introducing new medical rules and provisions as top-level football has evolved and new challenges emerged.
“The medical working group that we set up to look into concussion and serious head injury protocols included valuable contributions from the Premier League Club Doctors’ Group, the FA medical team, the LMA and PFA, and other sports, including rugby union and horse racing.
“Premier League clubs have already addressed a number of recommendations by making changes to the Premier League rule book and we recognise that, with other stakeholders, we have a wider role to play in making all participants in the game aware of the signs of concussion and the importance of following the return to play guidelines.”
Gary O’Driscoll, said: “With regard to head injuries there has been a perception in the past that you can tough it out, you can play on, you can be brave.
“What we found from the working group process is that in order to inform and educate people, and to manage this as effectively as possible, you need to make sure that everybody is aware of concussion, that everybody understands that it is just as significant as any other injury and that appropriate management is critical.
“For that reason we wanted to make sure that the players, the managers, the coaches, the medical teams, the media and the parents, everybody is aware that although it's fortunately a very rare injury, it's something that must be managed appropriately and safely.
“That's the reason we have come up with recommendations, and new rules at Premier League level, and are supporting the wider game to get the message out there.”
Going forward the Premier League will appoint its own central medical advisor to work with Premier League club doctors, the FA and other stakeholders, to ensure it is at the forefront of sports medicine.
The Premier League and all clubs will be supporting a FA-led campaign to help inform all constituents in the game - including coaches, players, clubs and parents - that head injuries should be taken seriously and the opinion of a medical professional be sought should they occur.
The following is an extract of Gary O'Driscoll's interview with the BBC:
on what has been proposed…We don't need to reinvent the wheel, we want everybody to work to the guidelines that are set out. As a result of that, we have reinforced those guidelines but we've gone a little bit further by adding things that we want to specifically concentrate on within the Premier League. The first one is to make sure the doctor's decision is final and that whatever he says or the physiotherapist on the pitch with the player becomes paramount. He can't be overruled by the player or the manager or by anyone else in the team. The manager and players will listen to the final decision of the doctor.
We would like to make sure everybody is aware of concussion recognition system, again produced by Zurich which allows you the ability to try and spot symptoms of concussion. It's sometimes very difficult to be 100 per cent certain. We also want to try and promote the use of neuropsychology testing which is a standardised baseline test of cognitive functioning memory which you would do in pre-season when you're fit and healthy. You can use it as a comparative tool after the head injury.
"The advice is that you absolutely must err on side of safety. If you have a suspicion of concussion, in our opinion, that is a concussion until proved otherwise"
The other thing we are lucky enough to be able to do in the Premier League is use the help of the tunnel doctor. It's mandated that in all Premier League games there is a tunnel doctor who will hopefully have access to a monitor and be able to say 'hang on, keep an eye on this player, his injury could be a bit more significant'.
on making managers aware that it's no longer their decision…It's an extremely intense and pressurised environment and the doctor's role during that decision-making process is one that is very specialised. You would hope that in the majority of cases, the doctor would make the right decision - it's not easy but when the doctor makes the decision it has to be paramount.
I'm very lucky that I work in a club where the manager will take on board everything we recommend as a medical team but it's possible that there are other places that do need that education where it's still regarded as something that you can run off or it's a brave decision to leave a player on. All the research that is now coming out would suggest that this is not a brave decision. The long-term effects of playing through concussion are potentially very serious. Educating players and managers that this is more significant than a normal injury is very important.
on urging club doctors to err on the side of caution…The advice is that you absolutely must err on side of safety. If you have a suspicion of concussion, in our opinion, that is a concussion until proved otherwise. It can be difficult in the heat of the battle to be able to make a decision. We are in a lucky position to know our players well enough and we spend the most time with them, if we suspect concussion, we will be taking players off. Of course we won't be taking them off with simple minor head knocks but if we detect that there is problems with the player's commission or whether a player has blurred vision or is suffering from dizziness, we are advising people to take them off.
on his message to managers and players…We'd really like for everybody involved in the game to accept that concussion is a brain injury. We are acting in your best interests, and the team's best interests. To take a player off is for his short-term, medium-term and long-term benefit.
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