Concussion protocol recap for clubs
All clubs are to be warned to follow the rules governing players suffering concussion following the controversy surrounding Tottenham goalkeeper Hugo Lloris.
Spurs have defended their handling of the incident where manager Andre Villas-Boas allowed the Frenchman to remain on the pitch against Everton on Sunday despite having been knocked out in a collision with Romelu Lukaku's knee and initially being unable to remember where he was.
FIFA's chief medical officer and the Professional Footballers' Association say, under current regulations, that Lloris should have been substituted.
The incident was raised by PFA chief executive Gordon Taylor at a quarterly meeting with representatives from the Football Association, Premier League and Football League on Monday, where it was decided to remind clubs of the protocol for concussion.
Taylor told Press Association Sport: "I watched the incident on television and I was surprised to say the least that he was allowed to stay on.
"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."
Taylor said the PFA wants the rules made even tougher so that any player who loses consciousness during a match should be automatically removed from the field of play rather than leaving it up to medical staff to make a decision.
Lloris was unable to remember the incident and was taken for a brain scan but given the all-clear.
Questions remain, though, over Villas-Boas' decision. Immediately after the match he told Sky Sports: "The medical department was giving me signs that the player couldn't carry on, because he couldn't remember where he was."
In a statement, however, Tottenham said medical staff were "totally satisfied that he was fit to continue playing". The club did not respond to further questions asking whether Lloris did in fact suffer concussion - under current rules that will require at least a week's rest and further tests.
Tottenham's head of medical services Wayne Diesel said: "Once the relevant tests and assessments were carried out, we were totally satisfied that he was fit to continue playing."
FIFA's chief medical officer, professor Jiri Dvorak, said if there is any doubt about concussion then the player should be removed from the field of play.
Dvorak said there was a "99 per cent probability" that Lloris would have been concussed - and pointed out that Everton striker Lukaku needed an ice-pack on his knee afterwards.
"The player should have been substituted," Dvorak told Press Association Sport. "The fact the other player needed ice on his knee means it's obvious the blow was extensive.
"It's a 99 per cent probability that losing consciousness in such an event will result in concussion."
Dvorak added that the player's view should not be taken into account in such situations.
He said: "When he has been knocked unconscious, the player himself may not see the reality.
"I do not know the details but I know that the Premier League doctors are extremely good and I can imagine that the doctor may have recommended he be replaced.
"We have a slogan: if there is any doubt, keep the player out."
Villas-Boas' decision has been criticised as "dangerous" and "irresponsible" by brain injury charity Headway.
Luke Griggs, spokesperson for Headway, said: "We are hugely concerned that a professional football club should take such an irresponsible and cavalier attitude to a player's health."
The FA has detailed regulations on head injuries and concussion and, although it is understood the governing body is not investigating Tottenham's handling of the incident, the rules state that anyone suffering unconsciousness should not play again that day.
The rules do, however, allow for "a transient alteration of conscious level" following a head injury, which says a player can return to play following assessment by medical staff.
Coincidentally, Lukaku was himself the centre of a concussion scare at West Ham earlier in the season when he suffered a blow to the head while scoring, but played on and afterwards said he could not remember anything about his goal.
The international players' union FIFPro also criticised Tottenham for allowing Lloris to continue.