David Ospina is a footnote for most Arsenal fans. Short of stature and short on authority, he was one of the many post-Seaman/Lehmann goalkeepers under Arsène Wenger who simply failed to step up to the mark for a team that was supposedly aiming to be title challengers. But last week, he entered the news for reasons other than his middling ability.
Ospina, currently on loan at Napoli, sustained a head injury in a clash with Udinese’s Ignacio Pussetto during the first half of their game last Sunday. After minimal checks, he stayed on the pitch, only to collapse shortly before half time. Mercifully, scans have shown no damage, but the incident demonstrates the inadequacy of football’s current rules on head injuries and concussion. Allowing Ospina to stay on the pitch, perhaps even risking a further blow to the head, could have been extremely dangerous.
Ospina prone on the ground after his injury
Rugby Union has a mandatory health impact assessment (HIA) for all players who sustain blows to the head. The process is as follows:
-
When there is a suspected incident of head impact by a player or players, this should be identified by match officials on the field, team doctors or independent match-day doctors who have access to video replays. If the independent match-day doctor decides an incident may have occurred, the player(s) involved must be removed, either permanently or for further assessment.
-
Players displaying obvious on-pitch signs of concussion must be immediately and permanently removed from play, without further assessment.
-
When not showing clear on-pitch symptoms or signs, players must undergo an off-field assessment consisting of a clinical evaluation by an attending doctor (the team doctor does this or they can delegate to the match-day doctor) who is aided by screening tools and video reviews. Players cannot return before ten minutes for assessment has elapsed. Players taken off for HIA can be replaced, and any replacement can take a kick.
-
After the match every player entered into the HIA protocol must undergo another evaluation within three hours. This is done using a check of symptoms, memory assessment and balance evaluation – compared with previous player baselines.
-
At 36-48 hours post-head impact event, the player(s) will be assessed again, going through a symptoms check-list, studying a player’s balance and using a cognitive assessment tool like CogSport or Impact.
-
Each union and/or competition must appoint trained HIA review processor(s) to look over the process used in every head injury event.
-
There will be a post-game video review process. Depending on the findings, the reviewer may recommend further education and training for the club or team medical personnel or recommend that the process moves to HIA review.
-
The HIA review group will formally investigate the incident and make recommendations for: further education and training for the club or team medics; a request to World Rugby’s HIA working group to consider a change to the process, education and/or training; or a referral to the appropriate disciplinary group to consider disciplinary action in line with competition rules.
Nigel Owens sends Jamie Cudmore for a HIA
The mandatory element of this process is key – witness Christoph Kramer in the 2014 World Cup final. Despite being evidently concussed, he had no wish to leave the field voluntarily (understandable, in some senses). HIA takes the decision out of the hands of players and management; a robust, clear process is followed and cannot be deviated from. The health of the player is paramount as opposed to any tactical considerations. The Ospina incident shows football’s current legislation as woefully inadequate; the risk in leaving potentially concussed players on the field and not adhering to proper medical procedures is a real danger.
A potential solution could be for FIFA to include the provision for a short term injury replacement while a player is being assessed, as in rugby. In Napoli’s case last week, they would have been able to send on their substitute goalkeeper for 10 minutes while Ospina was being assessed, and should he have been cleared to play (although evidently he was in no condition to carry on, and proper medical intervention would have determined this) he could have returned to the field. Player safety has to be the number one concern at all levels and should come above the outcome of any game.
Football also does not currently enforce a mandatory period where a player who has sustained a concussion injury must be restricted from playing. Earlier in the season, Glenn Murray was allowed to play a mere week after suffering such an injury. Once again this goes against all contemporary medical advice and guidelines. Just this weekend, Switzerland’s Fabian Schär was allowed to continue playing after being knocked out. As the highest profile global sport, football should be taking the lead on these matters rather than being reticent to change procedure.
It is time for the governing bodies to take a firm stand and ensure that from the World Cup down to parks level, all participants are adequately protected and receive the correct level of treatment. Failure to do so could have the gravest of consequences.
