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The Referee, Injury Management and Concussions

A February 2009 Program Directive from U.S. Soccer titled "Injury Management" states the following:

Indentifying "Seriously Injured" Players

Law 5 - The Referee, contains the following Power and Duty of the referee as it relates to the management of injured players: "Stops the match, if in his opinion, a player is seriously injured and ensures that he is removed from the field of play. An injured player may only return to the field of play after the match has restarted."

As a result, the referee has the initial responsibility to determine whether a player is "seriously injured." This determination can be influenced by multiple factors including:

  • The location of the injury on the player:
    • Injuries to the head, neck, or facial region should be considered serious in nature
    • Injuries to the lower extremities are often less serious and do not require immediate attention. Cramps are generally not considered a serious injury.
  • The age of the players involved. Younger-aged players require more immediate attention.
  • The immediate reaction of the player

Only when the referee has determined that the player is "seriously injured," should the referee stop play, regardless of whether the ball is in play or not.

It is important to note that there is an emphasis on the "location of the injury," with head, neck and facial injuries being considered serious, and that "younger-aged players require more immediate attention."

A possible concussion may result from forceful contact with the ground, an opponent's head, elbow, knee or other body part, or even with the ball or with a goal post. Such instances warrant the attention of the referee. The level of attention is a function of the age of the players, the severity of the impact and the player's response. As a neuropsychologist, concussions in sports have been an area of professional interest and, as a referee, something I tend to view with a different perspective.

A recent article on the OYSA website noted the new Washington State concussion law. A major concern in the area of sports concussions now relates to second-impact syndrome. Second-impact syndrome refers to the potentially catastrophic events which may occur when a second concussion is suffered while the athlete is still symptomatic from a previous concussion. The second injury may occur from days to weeks following the first. Loss of consciousness is not required.

Referees are not trained to recognize a concussion or other injuries; that is the role of coaches, athletic trainers or other bench personnel. The referee's job is to determine if the player is seriously injured, stop the game and get the player assistance from bench personnel.


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