Mai Chau, Vietnam
Monday 4th November 2013
Following yesterday's English Premier League game between Everton & Tottenham, the concussion debate returned with a vengeance. With the game in its closing stages, Spurs' goalkeeper, Hugo Lloris collided with Everton striker Romelu Lukaku as they both went for the ball. Lloris apparently lost consciousness & was subsequently assessed on the pitch by the club's medical team.

Despite appearing to suggest that Lloris was not fit to continue, Spurs' manager Andre Villas-Boas was seen to overrule that initial decision after deeming that the player looked capable of continuing. This point was reinforced by Villas-Boas in the post-match interview, where he stated that the goalkeeper had looked "confident, driven & focussed have made the call not to consider replacing him".

Click on the image below, to watch a video of the incident

Click on the link below from the Daily Mail's sport site to watch the complete interview (the debate on the Lloris decision starts at 1 min 50 secs)

The subsequent outcry from football world governing body, FIFA, the Professional Footballers Association, medical bodies & special interest groups alike was, not surprisingly, swift & unified in condemning the decision to keep Lloris on the field of play.

FIFA'c Chief Medical Officer, Professor Jiri Dvorak, declared the "decision was not right", quoting the FIFA Medical Department slogan "if there's any doubt, keep the player out" in arguing that the player should have been removed from the field of play.

Fifpro, the World Players' Union voiced their disapproval of the series of events, with Fifpro medical adviser, Vincent Gouttebarge, dismissing the decision as "unacceptable", before continuing to state that "Fifpro condemns that the health & safety of players are left to coaches, trainers or even to players themselves".

Professional Footballers' Association spokesman, John Bramall, supported the Fifpro stance taken, following on to cite the suggestion of the Zurich consensus, which recommends the removal of a player from the field of play following a loss of consciousness.  Bramall added that "It is important to take the pressure off the players, club, medical staff & the manager, removing the need for them to make a very difficult decision".

Meanwhile, head injury charity, Headway, released a statement voicing their concern that a "professional football club should take such an irresponsible & cavalier attitude to a players' health."

The response from Tottenham has been inconsistent, with Villas-Boas initially admitting he made the call to overrule the medical team, whereas a later statement from Wayne Diesel (Spurs' Head of Medical Services) disclosed that "Once the relevant tests & assessments had been carried out, we were satisfied that he was fit to continue playing".

Technically the FA rules state that if the supposed "unconscious state" is actually deemed a transient alteration of conscious level & non-concussive following SCAT 3 testing, the player can be deemed fit to return to play.  However, any true loss of consciousness dictates that the player should not play again that day.  

The video footage would appear to illustrate a substantially violent, yet accidental, blow to the head as Lloris collides with Lukaku's knee & there is video evidence that clearly shows Lloris sprawled prone, seemingly out cold for several seconds.  As a result, it would be surprising if a suspected concussion wasn't incurred, which given the experience & training of the Tottenham medical team, one expects would have been identified on testing.

This conclusion was also obviously reached by Karim Khan, who penned an open letter to Andre Villas-Boas on behalf of the British Journal of Sports Medicine.  Khan's message was clear:  the call on concussions always belongs to the doctor, not the coach.

Whilst the debates continue, again, in the full glare of the sporting & medical media, there is a necessity for a consensus to be reached by sports' governing bodies.  The controversy with the rugby concussion rulings & the NFL cases further underline the potential benefit of a collaborative approach between sports in addressing the issues.  

Meanwhile, planning continues for the inaugural Asian Sports Emergency Medicine Conference, which will take place in Hong Kong next year.  I expect the Sports Concussion Management Symposium to discuss many of these issues.

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