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Leeds United's Tyler Roberts in action with Sheffield United's George Baldock. - REUTERS

Leeds United’s Tyler Roberts in action with Sheffield United’s George Baldock. – REUTERS

The football authorities have been urged to immediately end their “shambolic” trial of permanent concussion substitutes and instead bring in the sort of temporary head injury replacements that are used in rugby.

The limitations of football’s new protocols were again apparent on Saturday when Sheffield United defender George Baldock was allowed to continue after taking a blow to the head before later being removed when he complained of blurred vision.

What happened?

Baldock, the Sheffield United defender, was allowed to return to the field after a concussion check – only to then go off again, substituted, after he himself soon complained of blurred vision shortly before half-time.

Baldock sustained the problem while committing a challenge he could have been sent off for. He produced a reckless-looking scissor tackle on Tyler Roberts and Baldock himself took a head knock in the process.

Tyler Roberts of Leeds United is tackled by George Baldock of Sheffield United during the Premier League match between Leeds United and Sheffield United at Elland Road on April 03, 2021 in Leeds, England.  - GETTY IMAGESTyler Roberts of Leeds United is tackled by George Baldock of Sheffield United during the Premier League match between Leeds United and Sheffield United at Elland Road on April 03, 2021 in Leeds, England.  - GETTY IMAGES

Tyler Roberts of Leeds United is tackled by George Baldock of Sheffield United during the Premier League match between Leeds United and Sheffield United at Elland Road on April 03, 2021 in Leeds, England. – GETTY IMAGES

Paul Heckingbottom, Sheffield United interim head coach, explained: “George appeared fine then reported some blurred vision.”

After Baldock spoke himself about his vision, the protocol went in to the hands of medical staff.

Sheffield United's English defender George Baldock goes off after taking a knock in a challenge during the English Premier League football match between Leeds United and Sheffield United at Elland Road in Leeds, northern England on April 3, 2021.  - AFPSheffield United's English defender George Baldock goes off after taking a knock in a challenge during the English Premier League football match between Leeds United and Sheffield United at Elland Road in Leeds, northern England on April 3, 2021.  - AFP

Sheffield United’s English defender George Baldock goes off after taking a knock in a challenge during the English Premier League football match between Leeds United and Sheffield United at Elland Road in Leeds, northern England on April 3, 2021. – AFP

What are the current protocols?

The guidelines allow teams to replace a player permanently but not come off the pitch, as in rugby, so that they can be assessed over a period of at least 10 minutes before final decisions are made.

Following a potential concussion, a match will be stopped. Medical staff will assess the player on the field of play during an unlimited time period and, as is the case currently, the tunnel doctor will also review video footage with Hawk-Eye.

If there are clear symptoms or video evidence suggesting a concussion the player will be permanently removed from play and a concussion substitute can come on. Each team will be allowed two additional substitutes regardless of how many changes they have already made up to the normal three subs.

Concussion substitute should come from one of the nine replacements named on the team sheet. Once a concussion substitute is made, the opposition team also has the option of an extra substitute.

Critics of football’s protocol believe that nothing of substance has changed in football for the injured player, who still generally continues unless concussion symptoms are instantly apparent, and is therefore at risk of the potentially devastating consequences of a second impact.

What was the reaction to the incident?

Dr Willie Stewart, the neuropathologist who proved that former professional footballers are at a dramatically increased risk of dementia in later life, called the new protocol a “shambles” and said that football simply needed to bring in a system similar to the tried and tested head injury assessment in rugby.

“Still beats me why IFAB (football’s rulemakers) believe football needs to be different and decides no need for temporary substitution to allow adequate concussion assessment,” he said.

The Professional Footballers’ Association, which had lobbied for the temporary concussion substitutions before cautiously welcoming the permanent version, also reiterated its call for change. “Head injuries in yesterday’s game between Leeds United and Sheffield United again highlighted the case for temporary substitutions.

“Temporary replacements would give additional assessment time and allow medical teams to conduct assessments in an appropriate environment.

“Temporary substitutes would mean that a match can restart with neither side numerically disadvantaged, reducing pressure on players and medical teams to make quick decisions.

“We call on IFAB to add temporary concussion substitutions to the trial for the start of next season.”

Brain injury charity Headway now fears that it will take a serious injury before football reconsiders a trial that began in January and is not scheduled to end until after the 2021-22 season. “How many times will the health of players be risked before football finally listens?” said chief executive Peter McCabe. “What is it going to take? Yet again, our concerns regarding the fundamentally flawed concept of permanent rather than temporary substitutes has been graphically illustrated.

“Time and time again we have called for football to stop finding excuses and finally accept it needs to change. It has to happen, now.”

Former England striker Alan Shearer also asked “when is football going to learn?” following the incident. McCabe stressed that the problem lay not with Sheffield United’s medics, who were forced into an almost instant assessment, but the protocols that they must operate under.

“The medical teams have an impossible job,” said McCabe. “You cannot expect them to be able to make a considered opinion in a two or three minute on-pitch concussion assessment.

“We know that the signs of concussion can be delayed in their presentation, as shown by George Baldock reportedly suffering from blurred vision just a few minutes after passing the assessment. A 10-minute off-pitch assessment, with a temporary substitute on in his place, would have seen his concussion symptoms identified in the safe confines of the treatment room. Instead, he risked a secondary and possibly more serious brain injury while remaining on the pitch.

“Ten minutes will not pick up all concussions – but temporary substitutions would be a significant step forward for a sport that continues to drag its feet on concussion.”

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