What FIFA Can Learn From the NFL

John D. Watson

Disclosures

October 15, 2014

In This Article

FIFA's Failures

When Argentina and Germany's national teams took the field in this past summer's World Cup final, in what will undoubtedly have been the most-watched television event of the year, global soccer fans were treated to an especially suspenseful match decided by a last-minute goal. They were also witness to the latest instance of negligence from the Fédération Internationale de Football Association (FIFA), the international governing body for the sport, when Germany's Christoph Kramer took a blow to the head from the shoulder of an opposing player and quickly crumpled to the ground.

Though in obvious distress, Kramer was allowed by the team's physicians to remain in the match for nearly 15 minutes before finally being substituted. Kramer later said that he had no recollection of the first half of the match, and was reported to have asked the referee whether he was actually playing in the World Cup final. The incident was no outlier, but rather one of several moments in the tournament where players with clear symptoms of concussion were allowed to continue playing despite the risks.

"It's atrocious," said Robert Cantu, MD, a neurosurgeon who is co-director of the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine. "FIFA was terrible, allowing players and coaches to override medical personnel on the field."

The injuries underlined the considerable flaws in FIFA's then-policy of relying on team doctors, often acting on information obtained from player self-reporting, to determine who can continue on the field after suffering a head injury. In late September, FIFA announced plans to implement a revised policy in which referees can stop matches for 3 minutes while team doctors conduct on-field assessments, with players allowed to continue playing only after the doctors grant their approval.[1]

The plan falls short of the one proposed by FIFPro, soccer's international players union, which among other things had sought such decisions to be placed in the hands of independent medical professionals operating on the sidelines during matches.[2] The relatively minor adjustment to FIFA's policy has garnered considerable criticism, with former players and concussion awareness advocates labeling it as "ridiculous" and "[unlikely to] address anything" in a recent article in USA Today.[3] It also suggests that international soccer is one of the least effective professional sports organizations at dealing with return-to-play issues.

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