Concussed players should by law be substituted, urges PFA after Tottenham fail to take off Hugo Lloris

Spurs deny any wrongdoing in keeping Lloris on at Everton but calls grow for automatic replacement

Hugo Lloris: Tottenham said their medical staff judged the goalkeeper fit to continue playing (PA)

The Professional Footballers’ Association and Fifpro has night led the calls for a change to the laws to ensure that any injured player who has lost consciousness is immediately substituted.

The Tottenham goalkeeper Hugo Lloris was knocked unconscious on Sunday at Everton but, after a stoppage, was allowed to carry on. While no rules were broken, as Spurs confirmed on Monday that their medical staff agreed Lloris could continue, the PFA argued that in future such situations should lead to a compulsory substitution.

“When treating a player on the pitch, it can be very difficult to determine the severity of a head injury,” said the PFA deputy chief executive, John Bramhall. “It is important to take the pressure off the players, club medical staff, and the manager – removing the need for them to make a very difficult decision. If anyone suffers a severe trauma to the head and loses consciousness, then they should be required to leave the field of play automatically.

“The PFA will continue to work with the stakeholders within the game, to evaluate what guidelines are currently in place and to see if and how they need to be improved to provide better protection for all those involved in the game.”

The PFA chief executive, Gordon Taylor, revealed his surprise and concern at what happened, and reminded the clubs of their responsibilities. “I watched the incident on television and I was surprised to say the least that he was allowed to stay on,” Taylor said.

“We are very concerned that the protocol that involves concussed players was not adhered to and I raised this at the meeting with the professional game’s stakeholders today, and the decision was taken to remind all clubs of the protocol. Managers should not take these decisions in the heat of the moment and that needs reinforcing.”

Fifpro, the international players union, said that allowing Lloris to stay on “goes against international medical advice” and it was “alarmed” that he played on.

The Fifpro medical advisor, Vincent Gouttebarge, demanded a strengthened role for medical professionals. “Fifpro condemns that the health and safety of players are left to coaches/trainers or even to players themselves,” he said. “Medical professionals should be aware of any relevant medical guidelines and apply them in order to empower the health and safety on the field.”

Tottenham insisted on Monday that they acted within the rules, that Lloris returned to playing only after he was cleared by the medical team. “Once the relevant tests and assessments were carried out,” said Spurs head of medical services, Wayne Diesel, “we were totally satisfied that he was fit to continue playing.”

Premier League and FA guidance states that players need the agreement of a medical professional to return to the pitch. Having got that Lloris could play on. All Premier League club doctors have to have completed the AREA (Advanced Resuscitation and Emergency Aid) training course, which includes specific training regarding on-pitch head injuries.

Lloris underwent a precautionary CT scan on Sunday night and was given the all-clear. Romelu Lukaku was in fact substituted, such was the impact on the striker’s knee when he collided with the keeper.

Fifa’s chief medical officer, Professor Jiri Dvorak, argued that Lloris should have been taken off. “The decision was not right,” said Dvorak. “We have a very clear recommendation for doctors if concussion occurs or even if there is a strong suspicion of concussion then the player should be taken out of the play. This injury could have led to more severe complications.

“The player should have been substituted. The fact the other player needed ice on his knee means it’s obvious the blow was extensive,” he added. “It’s a 99 per cent probability that losing consciousness in such an event will result in concussion. We have a slogan: if there is any doubt, keep the player out.”

Headway, the brain injury charity, said the club had showed an “irresponsible and cavalier attitude” to Lloris’s health. “By continuing to play, the player may have caused greater damage to his brain,” said a spokesman. “Mr Villas-Boas’s comment that his player’s determination to play on was proof of his ‘great character and personality’ is simply wrong and dangerous.”

It emerged on Monday that not enough football clubs follow internationally-agreed guidelines on concussion. The British Journal of Sports Medicine has published research stating that 44 per cent of clubs did not comply with the Consensus in Sport (CIS) guidelines on the stepwise reintroduction of players after a head injury. These state that a player should only return after at least six days out.

Just 44 per cent of Premier League teams carried out the routine advised cognitive assessment before the season began, the BJSM added, and 28 per cent of teams across all leagues had not even heard of the CIS guidelines. The CIS guidelines were last agreed at the Fourth International Conference on Concussion in Sport in Zurich last November.

Concussion concern: recent incidents

Romelu Lukaku, Everton

Six weeks before his collision with Hugo Lloris, the Belgium striker was knocked out in the process of scoring the winner on his debut against West Ham. After receiving treatment on the pitch, he played on.

Mathieu Flamini, Arsenal

Midfielder clashed heads with Norwich’s Alex Tettey during the League match at the Emirates last month and was taken off – only to come back on. He was clearly groggy and was then taken off again. He missed Arsenal’s meeting with Borussia Dortmund under the League’s five-day rule.

Andros Townsend, Tottenham

Spurs winger needed oxygen from paramedics after falling into a photographers’ pit at White Hart Lane last week. “The medical team assure me he will be OK, but he was unconscious when they arrived to treat him,” said manager Andre Villas-Boas.

Robert Snodgrass, Norwich

Scotland international was taken to hospital after a clash of heads with Manchester United defender Rafael da Silva in the Capital One Cup. He sat out Saturday’s defeat to Manchester City as a result.

Hugo Lloris, Tottenham

Knocked unconscious by his clash with Lukaku but the France international stayed on the pitch, having received treatment from Spurs’ medical staff.