Premier League footballers are to be reminded to leave on-field emergency procedures to trained medical staff after cases where players have intervened in the belief they are assisting colleagues knocked unconscious on the turf.
The Premier League Doctors’ Group will discuss players’ reaction to injuries, however well-intentioned, at their routine meeting later this month and members will return to their clubs to reiterate the dangers of moving players who have suffered head trauma.
Rather than seeking to check and open airwaves or even to shift the injured player on to his side, players are urged to wait until medical staff arrive from the bench as soon as they can.
Advice on the issue has been confused by medics on the continent praising players for intervening after clashes of heads, most notably following an injury sustained by the former Liverpool and Chelsea forward Fernando Torres, now with Atlético Madrid, last week.
Torres was knocked unconscious after falling heavily five minutes from time after an aerial challenge with Álex Bergantiños in the 1-1 draw at Deportivo la Coruña. Players from both teams had intervened before medical staff arrived on the scene, with the Deportivo club doctor, Carlos Larino, going so far as to praise Gabi and Sime Vrsaljko for their reaction. “Gabi even took a bite from Fernando when opening his mouth,” Larino said. “What he and Vrsaljko did was perfect.”
Similar praise was given by Martin Vavra, one of the medics at the Czech club Bohemians 1905, for the Slovacko forward Francis Koné after the Togo international prised open Martin Berkovec’s mouth seeking to clear the goalkeeper’s airwaves following a clash of heads in a league match last month. It was the fourth time Koné had felt compelled to react like that in his eight-year career. While the quality of medical care may vary markedly from the English Premier League to exhibition matches in Africa or league games in Thailand – where Koné’s three previous interventions had taken place – moving a player who has potentially suffered head trauma is considered unwise and dangerous.
“Footballers need reminding of this on a constant basis,” said Dr Zaf Iqbal, club doctor at Crystal Palace after previous spells with Tottenham Hotspur and Liverpool, and a leading member of the Premier League Doctors’ Group. “They think they should react but, in Premier League games, medics should always be waved on by the referee and able to reach a player within 10 seconds. The best thing the players on the pitch can do is stand back, call for a medic and let the professionals do their jobs.
“For a medic, the priority is always the airway, then the breathing, then the circulation. When Torres went down last week you could see he was out cold before he hit the ground. His jaw was clenched and his arms outstretched. The dangers in pushing your fingers into the player’s mouth are that you could be bitten but you could also push any obstruction, for example chewing gum, further into the throat or cause more bleeding.
“The idea a player can ‘swallow his tongue’ is extremely unlikely, unless it has been torn from the bottom part of the mouth. I’ve never come across it though that term has almost become a cliche in English football. If a player has been knocked out then the soft bit at the back of the tongue could potentially fall backwards and block the airway but the safest option is always to perform a jaw thrust to open it up.
“Forcing your fingers into the player’s mouth risks causing further damage, not least if the injured party has suffered a neck injury. That also applies to trying to move a player on to his side. There is a risk of aggravating an injury and potentially causing paralysis.”
There has been criticism that Torres, while sporting a neck brace, appeared to depart the turf carried on a foldable stretcher rather than a spinal board. It later transpired the striker had not suffered a neck injury.
Procedures have tightened up appreciably in the Premier League since Petr Cech suffered a depressed fracture of the skull after a collision with Reading’s Stephen Hunt in October 2006. There was widespread praise for the way medical staff reacted when Hull’s Ryan Mason was knocked unconscious after a clash of heads with Gary Cahill earlier this season.
It is mandatory to have a doctor from each team, and a neutral tunnel doctor, present at top-flight games with staff also able to review incidents instantly on screen in the medical room. Doctors also have to undertake annual refresher courses on procedure and an advanced resuscitation and emergency aid (Area) course every other year, overseen by the Football Association.