In Sunday’s Chelsea-Arsenal game Alexis Sanchez collided with Thibaut Courtois causing Courtois to suffer a head injury. He was allowed to remain in the game for more than ten minutes before he was replaced. There are several interesting aspects to this incident, but first I will summarize the timeline.
9:22: The
collision occurs. Courtois is not
moving.
9:26: Alexis
pats Courtois’ arm. There is no response
suggesting he might be unconscious.
9:35 The Chelsea doctor and a physio arrive. Courtois is moving now.
9:37 Director cuts away to a replay.
10:02 Courtois is moving while the doctor is checking
him out.
10:13 Courtois sits up with help.
10:18 Director cuts away.
10:29 Cuts to doctor speaking to referee as
Courtois heads back towards his position.
10:33 TV announcer says referee is speaking to “trainer”.
10:49 Game restarts.
22:04 Chelsea sideline is trying to get referee’s
attention.
22:12 Courtois is on ground again being treated by
doctor. It looks like something is coming out of his ear.
22:21 Doctor makes some sort of hand gesture near
her mouth.
22:33 Doctor says something to other member of
physio team who gives the signal that Courtois needs to come off.
23:14 Courtois stands up with help and heads off
field.
24:15 Game restarts.
The first question is obviously “why
wasn’t Courtois taken off immediately?” As
reported here,
Chelsea contends that it followed the proper procedure and did everything
right. If this is true, it suggests that the rules are grossly inadequate.
The problem may be one of
interpretation. Here are the new BPL
head injury rules:
O.22. Each Team Doctor, physiotherapist,
therapist and Medical Coordinator shall, when present at a League Match or at
any other match or at training, carry the pocket concussion tool (which is set
out at Appendix 4A).
O.23. Any
Player, whether engaged in a League Match, any other match or in training, who
has sustained a head injury, shall not be allowed to resume playing or training
(as the case may be) unless he has been examined and declared fit to do so by
his Team Doctor or, if he is unavailable, by another medical practitioner. The
decision of the Team Doctor or other medical practitioner as to whether the
Player is fit to resume playing or training shall be final.
I interpret rule O.22 as not merely requiring
the doctor to carry the pocket concussion tool, but to use it and follow its
dictates. Otherwise, what is the point? The pocket concussion tool
lists as visible clues of suspected concussion “Loss of consciousness or
responsiveness” and “Lying motionless on the ground/Slow to get up.” All of these, except possibly the loss of
consciousness, applied to Courtois. The
doctor may not have seen the loss of responsiveness because it only lasted a
few seconds and, by the time she got to him, Courtois was responsive. Possibly she missed the lying motionless on
the ground as well. If so, that
demonstrates a real problem. The simple answer
would be to require examination of replays as part of the concussion evaluation
process.
In trying to understand why Courtois was not
immediately removed from the game, I reviewed the exact language of the pocket concussion tool. Maybe
they are simply interpreting it in a ridiculously literal way. Thus, when it says “Any one or more of the
following visual clues can indicate a possible concussion,” I would interpret
that to mean that if you see one of those clues, you should suspect a
concussion and act accordingly. But
maybe, it is entirely optional on the part of the doctor to suspect a
concussion. Maybe the doctor can say “Sure,
I saw several symptoms that could indicate a concussion, but I chose not to
suspect that one occurred.”
The pocket concussion tool specifically states
that “Any athlete with a suspected concussion should be IMMEDIATELY REMOVED
FROM PLAY, and should not be returned to activity until they are assessed
medically.” I would interpret that to
mean that when someone is slow getting up after a head injury, the doctor should suspect a concussion and the player must be
removed from play until assessed medically.
But maybe the doctor felt that Courtois was removed from play during the
minute he spent lying on the ground. During that minute, she assessed him medically
and then allowed him to return to play.
If so, the whole process is a complete farce or,
as Taylor Twellman, a American soccer player who career ended prematurely due to a head injury, put it:
“The new rules are eye candy,” Twellman said. “It’s b-------. Science tells
us that seven minutes gives you enough time to assess someone. Fifa have said
three minutes. That makes no sense but is at least three minutes. The Premier
League does what? Fifty-six seconds? If the protocol says suspected concussion,
somebody needs to tell me what Courtois was. He was on his back dazed. It’s
mind-boggling how he was left on the field.”
However, even if the BPL rules
are just eye candy, the new FA guidelines (found here in my earlier blog post
) are more specific: “If there is any suspicion of the player having sustained
a concussion, they must be removed from the field of play, and not allowed to
return.” The guidelines also authorize the medical
personal to seek elucidation from other players. Maybe someone should have asked Alexis what
he observed.
In this case, there were surely
reasons to suspect a concussion. Maybe the problem is still one of interpretation. Since
the FA’s guidelines are guidelines, not rules, perhaps they can be ignored at will. If so, that problem needs to be fixed.
The second question is why did
this incident capture the attention of the media when the various other
incidents I have discussed in my earlier posts did not. The incident seems fundamentally the same as
the Shane Long incident or the Shingi Kagawa incident. (It would also seem to be the same as the Koscielny
incident, except that Arsenal has stated that Koscielny suffered a cut and not
a concussion.)
I have no good explanation for
the sudden interest. This incident did
involve a goalie so it was, superficially, more like the Hugo Lloris incident
of last year. Two big teams were
involved in a nationally televised game so more people were watching the incident.
The
other incidents were not as high profile.
The Shane Long incident did not occur in a televised game and he only
plays for Southampton. The Kagawa
incident occurred in a League Cup game and he is back in Germany anyway. Maybe the increased attention arose out the
fact that some head injury advocates spoke up and drew attention to the
incident. Who knows?
Finally, I found it
interesting that the TV announcer did not know that the woman leading the
medical treatment of Courtois was the Chelsea team doctor, Eva Carneiro. It was almost as if he could not accept the
existence of a female team doctor, even though she was obviously the person
in charge of the medical evaluation. I had
no idea that Chelsea had a female team doctor, but I was not announcing a
Chelsea game, so I had no reason to research this fact in advance. However, I did do the research before making
a fool of myself on the internet.
I have received a copy of the Complaint in the Concussion Lawsuit against
FIFA. It is 132 pages long. I will read it and, probably, discuss it in an
upcoming blog post.
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