The following happens in a boys U12 game. An attacker is fouled in the box, with a resulting whistle and penalty kick. The fouled attacker is shaken up and, after inspection, the referee signals his coach onto the field to treat him. (Note: there are no doctors or other medical personnel available.)

After a relatively short visit by the coach, the player is up and wants to continue in the game and take the PK. However, the referee tells him (and the coach) that he must temporarily leave the field since the injury required team personnel to be summoned onto the field.

The coach’s position is that the player does not have to leave the field for the following reasons:

1. ATR (Law 5.9) states that: “When the referee has stopped play due solely to the occurrence of a serious injury, the referee must ensure that the injured player is removed from the field….If play is stopped for any other reason, an injured player cannot be required to leave the field.”

The coach maintains that play was stopped for the foul, not for the injury, and that this wording says that the injured player cannot be required to leave the field.

2. The coach is also later directed to the following USSF wording: “A player for whom the referee has requested medical personnel to enter the field at a stoppage is required to leave the field and may return with the referee’s permission only after play has resumed even if the stoppage was not expressly for the injury.”

His position is that: (a) “medical personnel” was not summoned onto the field – only a coach; and (b) this is contradictory to the ATR advice in 5.9 that states “if play is stopped for any other reason, an injured player cannot be required to leave the field.”

It would be appreciated if you could respond to this coach’s position.

USSF answer (May 12, 2009):
Basic rule of soccer: Coaches will try in every possible way to divert your thinking from the true path. Do not let this happen!

There is no basis in what the coach says, as the player must leave the field in any event, no matter why the game was stopped. What Advice 5.9 says is this: “Players who are injured are required to leave the field under either of two conditions: The referee has stopped play due solely to the occurrence of a serious injury or the referee signals approval for anyone (team official, medical personnel, etc.) to enter the field to attend to an injury (regardless of whether that person enters to assist or not and regardless of why play was stopped).”

The USSF position paper on “Handling Injuries,” dated October 12, 2007, states: “‘Medical personnel’ for purposes of these guidelines includes any team official who has responsibility for the player in the absence of available trained medical staff.”

Basic answer: If there no “medical personnel” available at the game and someone, anyone, is called into the field to attend to an injury, the player must leave the field. It makes no difference if it is the coach, Mom or Dad, or a passing stranger: The player MUST leave the field.

And when play is restarted, after the player has left the field, the referee must blow the whistle.


What is the proper procedure for a player who is bleeding or is seen with blood on his/her uniform? I know the player has to leave the field of play and can not return until the Referee or A.R. has inspected the player ensuring that the bleeding has stopped or blood removed but what about the stoppage of play and substitution? I’ve seen referees stop play, send the player off, allow substitutions then restart with a drop ball. I’ve seen other referees send the player off, allow play to continue and no substitution.


USSF answer (March 24, 2009):
See the Advice to Referees, Advice 3.13 and 5.8

If a player has been instructed to leave the field to correct bleeding, blood on the uniform, or illegal equipment, the procedure for permitting that player to return to the field is described in Advice 5.8.

If a player is bleeding or the uniform is blood-soaked, the player must leave the field immediately to have the bleeding stopped and his or her skin and uniform cleaned as thoroughly as possible (replacing the uniform may be necessary to meet this requirement). Before the player can return to the field, the correction of the situation must be confirmed by an official-the referee or, if delegated by the referee in the pregame conference, the fourth official or, if there is no fourth official, an assistant referee. Once the correction has been confirmed, the player can be permitted to return to the field if beckoned by the referee, even if play is continuing. The objective is to bring the team back to its authorized strength as soon as possible.

To the extent that your question deals with substitutions, the only answer we can offer is that you review the rules of the competitions in which you are working.  For example, if the match is using the so-called “youth substitution rules,” then certainly the team will want to put a substitute in for one of its players who is off the field dealing with a bleeding/blood on the uniform problem.  If the match uses full Law 3 substitution rules, then more likely than not the team will NOT want to substitute (thus using one of its limited substitutions) for a player who might otherwise be ready to play in a few minutes.

It also depends on whether the player in question was ordered off at a stoppage (which might then also be a substitution opportunity under the rules of competition) or whether the player was ordered off during play with no stoppage.


The various scenarios about the Holland-Italy goal put forth on “Referee Week in Review” are very thorough and I hope every referee is aware of each of them. However I do have some questions on Scenario 5. It addresses the hypothetical that “the Italian defender is clearly injured and off the field of play,” and states:

“The referee makes a decision that the defender is seriously injured and cannot return to play by himself. Once the referee has acknowledged the seriousness of the injury, the player may not participate in the play and must not be considered to be in active play (at this point, he would not be considered in determining offside position and should not be considered in the equation as either the first or second last opponent). For purposes of Law 11, the defender is considered to be on the goal line for calculating offside position.

This player, however, may not return to play without the referee’s permission. Remember, the referee is instructed in Law 5 to stop the game only for serious injury.”

Under this scenario, the referee must “acknowledge the seriousness of the injury” and, once this is done, the player cannot participate in the play nor return to play without the referee’s permission. My question is how, in a situation as we had in Holland-Italy, the referee could inform the downed player or anyone else that this player no longer counted for any offside determination and also could not re-enter the field. If play continued upfield, the referee could not possibly get near enough to the downed player to issue any instructions and, even if he could, most players on the field likely would be unaware of the exact situation. How would the attackers know where to line up to stay onside? How would the downed defender, if he got up and was able to continue play, know that he was not allowed to re-enter the field?

Any clarification of what to do in this situation – both for the U15-18 level and for higher level games – would be much appreciated.

My instinct would be to either count the downed player or else decide his injury is severe enough to stop play.

USSF answer (June 23 2008):
In the case under discussion, the goal was scored within three seconds of Panucci leaving the field after being pushed by his teammate, Buffon. That was not enough time for the referee to make any determination as to whether or not an injury existed, much less to judge its seriousness.

Soccer is a contact sport. The referee is required to stop play if, in his or her opinion, a player is seriously injured. He or she does not stop play for a slight injury. Remember that referees will rarely stop play within three seconds. If it’s clearly a severe injury, such as to the head, then yes, there should be an immediate stoppage. However, referees will usually take more than three seconds to make a judgment on the extent of a player’s injury. Panucci was at most slightly injured, if at all. He got up after the goal and did not need any treatment. In addition, it makes little difference whether he fell on or off the field of play. He could have fallen in the goal area. He had been part of the defense and still was part of play, part of the move, part of the game, when the goal was scored.


In one of your answers you mentioned an Oct 12, 07 position paper on Handling Injuries. I cannot find it on the ussf web site.

USSF answer (March 13, 2008):
From the U.S. Soccer Communications Center:

To: National Referees
National Instructors
National Assessors
State Referee Administrators
State Directors of Instruction
State Directors of Assessment
State Directors of Coaching
From: Alfred Kleinaitis
Manager of Referee Development and Education
Subject:  Handling Injuries  
Date:  October 12, 2007

An incident at the first U.S. Soccer Development Academy Fall Showcase tournament led to extensive discussions regarding the correct referee actions to be taken when a goalkeeper and opponent are injured. The lack of a single clear answer among the many experienced observers gathered there is the reason for this position paper.

Injuries pose numerous difficult decisions for the referee. On the one hand, soccer is a game of continuous action in which stoppages are and should be infrequent. On the other hand, player safety is an obvious matter of concern. Since stopping play may be beneficial for one team, an added issue is the possibility of a player simulating an injury or its degree of severity in an effort to gain that benefit.  

Law 5 establishes several basic principles regarding player injuries:

If, in the opinion of the referee, the injury is serious, play must be stopped.
If, in the opinion of the referee, the injury is not serious, treatment of the injury is delayed until play is stopped for some other reason.
If the referee stops play for an injury, the injured player must leave the field and cannot return until play is restarted and the referee gives permission.
The International Football Association Board (IFAB), in its Additional Instructions and Guidelines (AIG) which accompany the Laws of the Game, has clarified certain issues:

An injured player may not receive treatment on the field unless the injury is “severe” (immediate medical attention is needed).
An injured goalkeeper is not required to leave the field and may receive treatment while on the field.
The refusal of an injured player to leave the field despite being required to do so is a cautionable offense (unsporting behavior).
The removal of an injured player must be swift but safe.
The referee may signal permission for medical personnel (including stretcher-bearers) to enter the field to assist in the player’s removal from the field (or to provide emergency first aid).
Referees should keep in mind the following additional guidelines regarding the handling of player injuries:

A player may seek assistance and treatment off the field during play if given permission by the referee to do so (permission is also needed to return to the field, which may occur during play).
A player who is injured may leave the field for treatment and return to the field before play resumes if the stoppage was not solely for that player’s injury and if medical personnel were not called onto the field by the referee to aid the player’s removal.
“Medical personnel” for purposes of these guidelines includes any team official who has responsibility for the player in the absence of available trained medical staff.
If a goalkeeper is seriously injured as a result of a collision with a teammate or opponent and the teammate or opponent is also injured, all players injured in the collision may be treated on the field and are not required to leave the field.
A player for whom the referee has requested medical personnel to enter the field at a stoppage is required to leave the field and may return with the referee’s permission only after play has resumed even if the stoppage was not expressly for the injury.
Evaluating and balancing these factors must be done quickly and fairly, with appropriate regard for the age and skill of the players. In all cases of doubt, the safety of the player must be the referee’s primary concern.


[An instructor asks:] Can the referee prevent a youth player from continuing to participate in play, or return to play, after he has suffered an apparent concussion? I am looking for a general guideline from a referee’s position.

The California Youth Soccer Association-South “Rules and Regulations” state:
2.5. Player Safety
2.5.1. No player should be allowed to play in any regularly scheduled league or tournament game with an injury which can be aggravated by playing or which constitutes a danger to others. Can the referee prevent a youth player to continue to participate in play, or return to play, after he has suffered an apparent concussion? I am looking for a general guideline from a refereeÕs position.

I will follow up with Cal-South for an elaboration, e.g., does the referee have authority to enforce this rule, and why is the word “should” used instead of “shall”. And how does the referee judge if the injury can be aggravated, etc.

p.s. – it would be fantastic if one could do a search on ALL of the “Ask A Referee” articles, without opening each archive and repeating the search. That way I would know if you had touched on this before.

USSF answer (December 19, 2007):
1. The first portion of this answer repeats an answer of September 27, 2006:

In reading this answer, please remember that the U. S. Soccer Federation has no authority over games not played under its aegis, nor over the referees who officiate them.Under the Laws of the Game, the referee has no direct authority to prevent a player from participating for unspecified reasons. While the spirit of the game requires the referee to ensure the safety of the players, it does not give the referee the right to prevent the further participation of a player who has been treated for injury and cleared to play by a trainer or medical doctor. The only possible reason would be that player was still bleeding or had blood on his or her uniform.

If there is a trainer and/or medically trained person officially affiliated with the team or the competition authority (including, where relevant, the tournament), the referee should defer to that person’s decision as to whether a player’s return to the field following a serious injury would be safe. In the absence of such a person, the referee retains the authority under the Law to determine if a player is still seriously injured and, if necessary, to stop play and to require that player to again leave the field. The Law does not allow the referee to prevent the return of the player to the field, but once play resumes with that player on the field, the referee reverts to his or her original duty to stop play if, in the referee’s opinion, the player is seriously injured. As always, the referee must use common sense in making such a potentially controversial decision and must include full details in the match report.

Once the player has been required to leave the field, the referee remains in complete control of the situation by virtue of the fact that the player cannot return until and unless he or she receives the permission of the referee — simply withhold it if you are convinced the player remains seriously injured. It takes courage to do this but, if the referee is certain of the state of the player, so be it.

For additional information on this matter, see the USSF position paper “Handling Injuries,” dated October 12, 2007.

2. As to searching for old answers, many have tried and none has succeeded in finding a way to search the archives.


On two occurrences I have stopped play because of an injury to the head of a player, both times players and coaches were yelling to “kick the ball out” however no one did. With play stopped and the ball still in play and in the possession of one team, is the correct restart a drop ball with both teams participating or only the team that was in possession? Where does possession come into play when the match has been stopped for injuries? I have had a coach complain that the drop ball should be one sided in the “spirit of the game” and another coach argue that his team had possession and that his team should have the ball.

Answer (October 29, 2007):
Many major competitions throughout the world have instructed their players not to follow the traditional “kick the ball out of play” procedure when a player appears to be seriously injured. And the Law instructs the referee to stop play only when he or she believes the player is indeed seriously injured.

The only possible way to restart play after stopping for an injury is a dropped ball. There is no alternative under the Laws of the Game.

With regard to your question of possession, there is no such thing in the Laws of the Game once the referee has stopped play. Possession by one team or the other does not enter into the picture at all. (Maybe you are thinking of high school soccer?) The referee must make his or her own decision as to how to manage the dropped ball after having stopped play for the injury. The intelligent referee will remember that there is no requirement that players from both teams – or that any player at all – must take part at a dropped ball.


I was looking to get some information on the rules that are enacted when a player is down on the field. Specifically, if team A is in clear possession of the ball (for example, if team A’s goalie has the ball safely in his arms) and the referee stops the game because a player is down on the field, what is supposed to occur when the player finally gets up or is helped off the field? I saw a game where this occurred and the referee called for a drop ball at the location where the player went down (even though it was at mid field and Team A’s goalie had the ball in his box). Despite playing for over 25 years, I did not know what the rules governing this situation were and wanted to know.

Answer (June 6, 2007):
First things first: The referee should NEVER stop the game solely because “a player is down on the field.” Law 5 (The Referee) clearly states that the referee stops the game only for serious injury, not simply because a player is down. We might point out here that the definition of “serious” can vary with the age and skill levels of the players concerned.

When the referee does stop play for serious injury — and did not determine that this serious injury was caused by a foul or serious misconduct by another player — play is restarted with a dropped ball from the point where the ball was at the moment play was stopped. This applies even if the ball was in the possession of the goalkeeper. You will find this restart under Law 8 (The Start and Restart of Play):
Dropped Ball
A dropped ball is a way of restarting the match after a temporary stoppage that becomes necessary, while the ball is in play, for any reason not mentioned elsewhere in the Laws of the Game.


During course of play, a player from Team A slides into player from Team B and is hurt. Referee allows play to continue for 5 seconds until he determines that the player is not getting up. Team A has ball in their possession when Referee stops play and stops the clock. He calls out that Team A will re-start play with indirect kick from where they had the ball in their possession.The teams clear the field while the injured player is attended to. During break, Referee confers with Assistant Referee and determines that the injured player deserved a Yellow Card for sliding into the play with spikes up from behind. So, after the injured player is carried off the field, Referee goes to Team A’s bench and gives the player a Yellow Card.

Team A re-starts play with indirect free kick which is played behind Team B’s defense and Team A scores immediately.

Coach from Team B is upset. After the goal is scored but before the kick-off, he asks two questions of the Referee:
1) If you stop play for injury, shouldn’t the game have been re-started with drop ball? 2) If referee gave a yellow card to Team A, how could Team A restart play with indirect free kick? Shouldn’t Team B have received possession of ball at the point of the foul?

If Coach from Team B is correct on either of these points, is there anything that can be done or is it too late?

Referee determined that he may or may not have made an error but it didn’t matter because it was too late.

What is your opinion?

USSF answer (April 10, 2007):
If the referee was aware of the misconduct, applied advantage, and waited for the next stoppage (which happened to be the injury), the restart should have been a DB.

If the referee decides that the reason (determined after the fact) for the stoppage was NOT the injury but previously missed misconduct by Player A that had happened before the injury but which was brought to his attention ex post facto by the AR, then the proper restart should have been an IFK for team B.

If, as really should have been the case, the referee recognized that the misconduct was serious, then the card should have been red and the restart would still have been an IFK for team B.

If the referee had been totally on top of things and recognized that the red card misconduct was the result of a foul which endangered the safety of an opponent, then the restart should have been a DFK for team B.

There is no scenario here under The Laws of the Game which could result in an IFK for team A.


With the allowance of players drinking water at the touchline is it permissible for a player to take a breath of oxygen in the same manner under the same stipulations?USSF answer (January 29, 2007):
Oxygen for breathing is available in the air, but water for drinking is not; therefore they are not the same thing. If players cannot breathe properly on the field, then they should not be playing. Oxygen on the sideline would be for emergency use only in the hands of an athletic trainer or medical person. Anyone needing to avail themselves of oxygen in an emergency capacity would be out of that game and need a medical release from a doctor, after a check-up, to be permitted to play. Making the decision to keep the player out of the game is within the authority of the referee.


now i am grade 9 ref im going to get upgraded but my question is when i ref games and there is a player down cause this happens a lot on minor injuries instead of blowing my whistle all the time i try to get players to play the ball out you know fifa fair play and then get the other team to throw the ball back to them is this bad?USSF answer (December 12, 2006):
No, this is not bad, but neither is it sanctioned under the Laws of the Game. The referee has no authority to direct the players to put the ball out of play or to tell them to play it back in to the other team to restart.

It is the job of the referee to stop play for injury, regardless of what players may or may not do, only if a player is, in the referee’s opinion, seriously injured–keeping in mind the age of the players. There are considerable practical differences between the referee stopping play for a serious injury and players stopping play for what they believe is an injury. If the players do it on their own, there is little the referee can do to control it, at least as the Laws read now.