Question Number: 29344

Mechanics 4/23/2015

RE: Competitive Under 10

Derek of Cary, IL US asks...

This day everybody is preaching about awareness for head injuries and concussions. I wonder if I should've stopped the game earlier for such injury.

The goalkeeper took a shot to the face. He seemed unfazed by it immediately afterward. I saw no change in concentration, no change in his demeanor, and the most I can say was he was swaying side to side slightly more than usual. Had I seen anymore signs I would've stopped play immediately and asked the coach to change his keeper. A few minutes later the coach took the initiative and asked me to change keepers.

I know it is hard to make a recommendation based on hearsay, but especially with young ones, should I, as the referee, take a more proactive approach when a blow to the head occurs? I was constantly watching the keeper for any signs of a concussion afterward, but I saw no cause for alarm.

Answer provided by Referee Joe McHugh

Hi Derek
Good awareness of what is happening in the game is an important attribute in refereeing. It is not just about foul recognition or decision making and should include looking for injury situations, retribution after the ball is gone etc. Referees are not medically trained and determining concussion can be difficult. It certainly cannot be done by observation from a distance. It is best left to the trainer / medical person present to make that call.
Referees must err on the side of safety and any contact on the head results in the game being stopped and the onus placed on the team to make a judgement call on the players well being. The outfield player is removed and then requests a return. Slightly more difficult for the goalkeeper as you have to rely on the fact that the team is ready to restart as acknowledgement that the player is fully fit to continue.
In the cases of a badly executed header or ball to the players head / face those are all risk situations. Certainly at Underage the game is best stopped and the player dealt with. At open age the players normally make the call about the injury either by staying down, going down injured or signalling to the referee. I once had an adult player after a ball to the face signal to me that all was not well which required that the game was stopped. He had temporarily lost vision and needed treatment. Underage players may not be able to convey clearly that they are injured.
In your situation from your description you did well to recognise the potential injury. The appropriate decision would have been to stop play, get the GK attended to and restart with a dropped ball. Thankfully the coach was alert and dealt with it with no ill effects

Answer provided by Referee Dennis Wickham

I think you should have stopped play immediately since you saw the ball hit the player in the face.

In a youth amateur match, anytime there is contact to the head - head to ball, head to goal, head to head, or head to ground - stop play immediately. Run to the player. Call in the coaches or trainers. Safety first.

Concussions rarely involve loss of consciousness. Players will have differing symptoms and referees cannot be expected to diagnose whether a concussion has occurred. But, we can observe enough facts to suspect a concussion or head injury. That's when we stop play.

As Taylor Twellman (whose career was ended by concussion) notes, players have two arms and two legs, but only one brain. The consequences of being wrong in stopping too soon are almost non-existent in the youth game. But, the consequence of being right is stopping play is that the referee might save the life or the quality of the life of the player.

Answer provided by Referee Ben Mueller

Derek, I also work in the state of IL. The state made all referees watch the concussion awareness video this season for a reason. They want us referees to take a proactive approach when dealing with concussions. A possible concussion means we should stop play immediately and look at player in questions. If we believe a concussion may have occurred, then we need to get the player out of the game until cleared by a medical professional. That is the route that they want us to go in the state of IL now and I assume most places.

Answer provided by Referee Richard Dawson

Hi Derek,
such an important question and an astute evaluation with a cavet! 'The watching with no signs for alarm.' You CAN NOT See into the brain!
If, as my colleague Ref Mueller signifies, the soccer association of the state of Illinois has set forth a policy to have the referee authorise medical intervention in the cases of a suspected head injury/concussion. To REFUSE to permit a player to play because the referee thinks that player should see a doctor is a concept I applaud, just would like to see a clear definition of league policy in place to limit the fallout when a referee says your best player cannot enter the pitch without a doctor's note if no doctor or who they deem a (medical professional) a parent for example is immediately available to make the call?While referees are not usually medical wizards, they are charged with looking out for the safety of the players under their care. It is in fact a ...DUTY... written under LAW 5, to stop play in the case of a serious injury. How serious an injury, as it is an opinion, leaves as much room for error as good judgement! As you are talking about the wee ones best you stop play if there is ANY force applied! A ball bouncing into the face is not the same as a heavily hit ball at speed, snapping the head or neck back.
Regretfully I watched in a match many years ago two young 18 year old high spirited lassies, both refused to back down and clash heads on a high ball they were both challenging for. Together, they collapse, briefly uncommunicative, they lay splayed on the ground. Groggily, they are helped to their feet amid the smattering of applause for getting up and walking it off. A short time later due to peer pressure,the mom wanting her kid to keep playing, the young lady saying she wanted to go, the coach and teammates knowing it was one of the best players, so they stuck her back in on a substitution. Now as referee while I knew I had authority to deem a player as seriously injured to stop play I was unsure if it represented a perceived conflict of interest to say I think she should see a doctor and absolutely refuse her re entry after her own people evaluated her! Within moments of reentering, her demeanour undeterred, she out jumped all to powerfully head a long 50 yard goal mouth clearance back down the field. Within 60 seconds she ran off the field collapsing and throwing up in behind the technical area. Diagnosed with suffering a subdural hematoma, she lost her long term memory and spent two years recovering how to speak etc...
Needless to say I am leary of saying yes to even a mild knock. As a coach if my player suffers any blackout or loss of consciousness they will not play until I receive a doctors note saying they can! As a referee I have been involved in some disputes with coaches in my stopping play each time they try to reintegrate what I think could be a problem player back into the match. Not just head injuries ACL and knee issues as well. As you hinted we watch carefully for OUTWARD signs of instability after any head to head /ball, or goal post contact but as I learned, we can not see inside!We appreciate the question as it once again forces us all to prioritize our thoughts when a game of fun is involved and to carefully rethink the pressures heaped upon us when the ideal of victory at all costs is not valid at all!Cheers