COACH PROVIDING TACTICAL ADVICE DURING AN INJURY STOPPAGE

Question:
My understanding is during a stoppage for an injury a coach (the team not with the injured player) is not allowed to call his players over to the bench area (technical area) and provide coaching instruction. Likewise, the coach of the injured player who comes on the field with permission cannot gather his field players and provide coaching /tactical advise. I cannot find this in the Laws, Guide to Referees, and Advise to Referees.

Can you direct me where in the USSF I can find this? Also, what is the ruling and where is it for NISOA and NFHS?

USSF answer (May 3, 2010):
We cannot provide official answers for NISOA or NFHS games. However, we can provide official answers regarding the Laws of the Game.

There is no rule against either coach or other team official calling his or her players over to the touch line to discuss tactics during a stoppage for injury. However, if a coach or other team official is permitted on the field to see to the status of a seriously injured player — the only reason for stopping play for an injury is if the referee believes it to be serious — he or she may not share any information with any players of that team who are on the field. That would be regarded as irresponsible behavior, forcing the referee to expel the coach.

However, the intelligent referee will preempt the coach from coaching by stopping him early and letting him know that coaching on the field is not permitted. If the coach persists, then the referee should take more drastic action.…

SHOULD THE REFEREE ADMINISTER FIRST AID?

Question:
During a match a while ago, a very unique situation occurred – one that I have never seen nor heard of before. I was observing a close under 14 girls mid-level match on a wet day while I waited for my ride after my last match of the day and I did talk to the Referee after the match to pin down some of the details.

So, here we go. A defender was dribbling at speed into her own penalty area playing for time to pass the ball to the outside to a team mate who was running into position to accept the pass. The dribbling defender had an attacker just off the back of her left shoulder. The defender touched the ball forward and then ran up on it. As the defender’s right foot moved forward to kick the ball, the attacker lunged forward with her own leg between those of the defender, missing the ball, and causing the defenders kicking leg to impact with the attacker’s ankle, at which point the defender tripped, and fell awkwardly with the attacker falling next to her.

The Referee blew the whistle, and awarded a direct free kick to the defender (for tripping) and pulled the yellow card from his pocket to award a caution for Unsporting Behavior.

Let’s leave questions as to the correctness of the decision up to now, because what occurred next was the strange part. The Referee had the card in his hand held straight down by his side, presumably to show to the attacker once she regained her feet. However, the attacker was more seriously injured than she had upon first glance, and she apparently had dislocated her knee when the defender’s legs scissored her own as the defender fell. Now to add to the strangeness of the situation, I know that the Referee, a friend of mine, is a certified Emergency Medical Technician in the State of Colorado. As such, when he observes a serious injury to someone, he is required by State law to render assistance to the best of his ability. To this end, he quickly stuck the card back into his pocket, called both coaches onto the field (the defender was shaken up on the play as well), yelled for the lead AR to enter the field to keep and eye on the players, identified himself to the running coaches as an EMT and knelt to begin examining the attacker. He quickly determined that an ACL tear was likely and had a parent call for an ambulance.

He remained with the attacker until the ambulance arrived and he could hand off custody of the case to the arriving paramedics. After the ambulance left, but before play was restarted, he informed the attacker’s coach that his player had been cautioned for UB, before restarting play with the direct free kick for the defender’s team.

Under these very narrow facts and circumstances, were the Referee’s actions correct? While his personally tending the player is not in line with USSF policy, State law regarding medical professionals clearly overrides USSF policy. Secondly, when the Referee officially removed his EMT hat and put back on his Referee hat, the girl was in the ambulance already. In both of our opinions, he would have looked foolish showing the yellow card to the back of a moving vehicle. He would have looked equally foolish, not to mention cruel and uncaring, if he had shown the card to the player while she was curled up on the ground in tears. He had already pulled the card out, and the foul, in his opinion, most certainly warranted a caution. Could he simply take no action at all? Or, as he actually did in this case, could he consider pulling the card out to be “showing” it and verbally inform the coach of the caution? We both agreed after the match that things would have been simplified if he had left the card in his pocket and used the “slow” carding method (book then show), in which case he would have seen the extent of the player’s injury before the card was ever out. However, he was still determined to caution the player, as in his (and my) opinion the self-injury did not wipe out the reckless tackle and injury to the defender. Had he gone the slow path, when would the correct time to show the card be? While the player was on the stretcher? Finally, a hypothetical situation – if a referee was not an EMT in this same situation, and therefore left the player to the attention of the local athletic trainers, when (if at all) should he or she show the card? In this case, there is not the eminently justifiable reason of needing to tend to the player’s injury, but there also does not appear to be an opportune moment to show the card. We both agreed that in a higher-level match we would just show the card in the general direction of the player while they were on the stretcher, but at this age, we both felt that such an action would necessarily outrage the protective instincts of the watching parents, and cause the referee an even worse headache in the long-term.

Hope you can help sort this one out with me.

USSF answer (March 31, 2010):
The referee’s grasp of procedure appears to be quite good. As to exercising his skills as an EMT, if it has to be done, it has to be done, particularly if by not doing so he would have placed himself in legal jeopardy. Clearly a quick request for someone in the crowd with similar skills would have been good, but, . . ..

The referee will normally wait until the player has been treated or has risen before showing the card, but each situation is up to the decision of the referee. There is no definite schedule of events here. In a worst case situation, the referee could do as he did, informing the coach of the caution, or less usual but still acceptable, show the card to the captain (but be certain to explain the action).…

REF OR AR AS FIRST AID PROVIDER

Question:
If during a game, a player is injured and no trainers or first-aid providers are available but one of the referees has extensive medical training; is it appropriate for that referee to assess the injury and provide advice to the coach on how to treat the injury or instruct the coach to seek emergency medical care for the player?

USSF answer (February 20 2010):
Only as an absolute last resort. In this litigious society of ours, a referee who is not a licensed medical practitioner would be well advised to stay out of any medical emergency that occurs during the game that referee is working.

The situation is generally controlled by state law (sometimes called a “good Samaritan” law, but also laws that cover specific professions). In some states, you are expected to perform whatever emergency services you are trained/certified to do. An EMT who is also a referee must therefore take off his referee hat and put on his EMT hat if faced with a serious injury on the field. Otherwise, stay out of it and remember that there are other important referee things you could be doing while staying out of it.…

INJURY TO THE GOALKEEPER

Question:
If a goalkeeper gets hurt and is treated on the field, is he or she required to leave the field, as would another field player be required to? Does it depend on the league, eg. FLUGSA or the age of the keeper, or is there one set rule for everyone?

USSF answer (January 11, 2010):
The goalkeeper is not required to leave the field following treatment unless his or her medical condition requires much more extensive treatment. In that case, the team must either temporarily exchange a current field player for the goalkeeper (who is temporarily off the field) or substitute for him or her.

You will find your guidance in the Interpretations of the Laws of the Game and Guidelines for Referees, under Law 5. Note in particular the “Exceptions” at the bottom of the ruling, but let common sense and the Law prevail.

Injured players
The referee must adhere to the following procedure when dealing with injured players:
* Play is allowed to continue until the ball is out of play if a player is, in the opinion of the referee, only slightly injured
* Play is stopped if, in the opinion of the referee, a player is seriously injured
* After questioning the injured player, the referee may authorize one, or at most two doctors, to enter the field of play to assess the injury and arrange the player’s safe and swift removal from the field of play
* The stretcher-bearers should enter the field of play with a stretcher at the same time as the doctors to allow the player to be removed as quickly as possible
* The referee must ensure an injured player is safely removed from the field of play
* A player is not allowed to receive treatment on the field of play
* Any player bleeding from a wound must leave the field of play. He may not return until the referee is satisfied that the bleeding has stopped. A player is not permitted to wear clothing with blood on it
* As soon as the referee has authorized the doctors to enter the field of play, the player must leave the field of play, either on a stretcher or on foot. If a player does not comply, he must be cautioned for unsporting behavior
* An injured player may only return to the field of play after the match has restarted
* When the ball is in play, an injured player must re-enter the field of play from the touch line. When the ball is out of play, the injured player may re-enter from any of the boundary lines
* Irrespective of whether the ball is in play or not, only the referee is authorized to allow an injured player to re-enter the field of play
* The referee may give permission for an injured player to return to the field of play if an assistant referee or the fourth official verifies that the player is ready
* If play has not otherwise been stopped for another reason, or if an injury suffered by a player is not the result of a breach of the Laws of the Game, the referee must restart play with a dropped ball from the position of the ball when play was stopped, unless play was stopped inside the goal area, in which case the referee drops the ball on the goal area line parallel to the goal line at the point nearest to where the ball was when play was stopped.
* The referee must allow for the full amount of time lost through injury to be played at the end of each period of play
* Once the referee has decided to issue a card to a player who is injured and has to leave the field of play for treatment, the referee must issue the card before the player leaves the field of play

Exceptions to this ruling are to be made only when:
* a goalkeeper is injured
* a goalkeeper and an outfield player have collided and need immediate attention
* a severe injury has occurred, e.g. swallowed tongue, concussion, broken leg.

If you need further guidance, here is a USSF memorandum from 2007 that is still valid:

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.

CHICAGO FIRE VS. CHIVAS (OCTOBER 23, 2009)

Question:
Chicago Fire v Chivas 10-23
In the 70th minute Terry Vaughn leaned towards a Fire player and asked him to play the ball out – to attend to a downed Patrick Nyarko. The Fire player had not noticed his teammate was down.
During the stoppage Vaughn issued a yellow card to Braun for unsporting behavior.

Couple questions/comments: the convention of asking player to stop play (by knocking the ball into touch) is a quirk of our game – last night’s example seemed to demonstrate the quirkier side. I cannot find the reference from last year but I thought the FA, prior to the beginning of the 2008-2009 season, had asked referees to try to prevent players from knocking the ball out of play and for referees to control the stoppages themselves. I recall thinking, “We’ll see how this goes.” I really can’t say I’ve seen this tradition go away based on EPL games I’ve watched. And I’m not suggesting the US follow suit but I do feel this tradition is outdated. Law 5 gives latitude to CR to judge whether a player’s injury is such that play should be stopped or not. It’s when a referee actually tells a player to play the ball out (an assumption on my part, only having video evidence to make this assertion) that I wonder whether tradition should be maintained at the expense of the referee making a decision, on their own using their common sense.

The card during the stoppage is what really concerns me. Were the two events connected or just a coincidence? Was Braun’s card a separate matter from Nyarko’s injury? If they were related, why would Vaughn need to ask a player to stop play if he thought a foul occurred that was worthy of a caution? I didn’t see Vaughn consult with his AR so I’m left to guessing what transpired.

I’d like to know that actual sequence of events if that’s possible.


USSF answer (October 27, 2009):

1. KICKING THE BALL OUT OF PLAY
Terry Vaughn saw the incident a bit differently from you. He states:

“In this situation I did not tell the Fire player to kick the ball out. I saw the Chicago player get fouled in a reckless manner, but the ball popped out to one of his teammates who had numbers up going the other way. If he turns with it goes the other way. I had signaled advantage to the player and told him I was coming back to deal with the Chivas player. He decided on his own to play the ball out of play, so his teammate could get treatment and that is when the caution was given for the reckless foul. Part of the decision in allowing play to continue is that the player did not have a serous injury like a broken bone or injury to the head or neck. That is what took place in this situation.”

The information you recall regarding kicking the ball out of play appeared in both the 2008 and 2009 USSF memoranda on the changes in the Laws of the Game:

2008:

Dealing with injured players

In view of the differing practices applied in various competitions around the world by the team in possession when the ball remains in play after a player has been injured and the confusion that this can cause, the IFAB wishes to reiterate that Law 5 states that the referee has the power to stop the match if, in his opinion, a player is seriously injured, but he may allow play to continue if the player is, in his opinion, only slightly injured.

Furthermore, the IFAB calls for the football family to unite in denouncing simulation and working to eradicate this scourge from the game in order to assist the referee’s identification of serious injuries and, more generally, to uphold the fundamental principles of fair play and preserve the integrity of the game.

USSF Advice to Referees: The above guidelines clearly support the view of the International F.A. Board that the referee’s responsibility to distinguish between serious and slight injuries (taking into account the age, skill, and competitive level of the players) is hampered both by players simulating injuries and by the practice of some teams at some times to stop play on their own initiative by kicking the ball off the field. The Board has strongly emphasized the need for all elements of the soccer community to deal firmly with simulation, but the Board is also suggesting (without, it must be noted, changing any requirement of the Law) that the teams should leave the decision to stop play to the referee instead of exercising it themselves. Although referees should not discourage acts of sportsmanship in situations where a team has taken it upon themselves to stop play and the injury was truly serious, the above instructions also suggest that everyone should now see referees moving more quickly to evaluate injuries and to establish clearly whether play should or should not be stopped so that teams will be less likely to feel a need to take this decision upon themselves.

2009:

Reminder to referees

Referees are reminded that Law 5 states that the referee must stop the match if, in his opinion, a player is seriously injured.

USSF Advice to Referees: This statement is intended to reinforce a guideline issued earlier by both the International Board and USSF that the practice of a team kicking the ball off the field to stop play when there is an apparent injury on the field detracts from the responsibility of the referee under Law 5 to assess the injury and to stop play only if, in the opinion of the referee, the injury is serious. Referees are therefore advised to be seen quickly and publicly considering the status of any player seeming to be injured and clearly deciding whether or not the situation merits a stoppage of play. The referee must control this decision as much as possible.

2. THE CARD GIVEN DURING THE STOPPAGE
At exactly 69:00, Braun fouls Nyarko which leads to the injury. The referee clearly uses his arms to signal advantage and then follows it up with a confirmation of the player committing the foul. The “confirmation” ensures the referee does not forget the player who commits the misconduct because, as we know, it could take a long time for the next stoppage in play to occur and this “confirmation” helps cement the player’s number in the referee’s mind.…

WHISTLE FOR RESTART FOLLOWING INJURY?

Question:
Situation:
There is an injury on the field, and the ball is kicked out of bounds, which stops the game.

The injured player’s coach comes on to the field, the other players all take a knee, some go toward the bench area for a drink and coaching instruction.

Play resumes with the team that had the injured player taking a quick throw in while the other team is out of position, resulting in an easy goal.

No whistle is ever blown to stop or re-start the play.

Is it legal to start the play after the injured player is attended to on the field without a whistle from the head referee?

The head referee stated to the coaches that since the play was stopped on a ball played out of bounds, he does not need to blow the whistle to re-start the play.

According to page 76 of the FIFA “Laws of The Game” a whistle is needed to restart play after an injury, but a whistle is NOT needed to restart play from a throw-in.

Which applies in this instance?

Thanks for your time and consideration.

USSF answer (October 8, 2009):
The International Board has commented that the practice of teams kicking the ball out of play because they believe a player has been injured is a challenge to the referee’s authority under Law 5 to make the sole determination as to whether or not an injury during play is “serious” and warrants play being stopped. USSF’s guidance in 2008, however, is that a team which does this has not broken any Law and thus cannot be punished for it. It is the job of the referee to be seen quickly evaluating injuries and clearly establishing whether play should be stopped or not.

Here, a team played the ball out, which of course stopped play. We presume (even though it is not specifically stated) that the coach entered the field with the permission of the referee to tend to his player. USSF has also stated clearly that any player tended to on the field by a team official is required to leave the field regardless of whether play was stopped for this injury or not. The simple act of calling a team official onto the field for this purpose is enough to trigger the requirement that the player leave the field, not to return (if not substituted for) until play has resumed and the referee’s permission to re-enter has been given.

Because of this, the stoppage for the throw-in automatically became a ceremonial restart which requires a whistle signal to restart play. If the referee follows proper mechanics, the teams should be clearly advised by word and gesture that no restart can occur except by the signal of a whistle. If the restart does occur anyway, it must be called back and retaken properly. Even if the referee fails to follow proper procedures by notifying the teams, the whistle is still required.…

“MEDICAL PERSONNEL”

Question:
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.…

RETURN OF PLAYER OFF FIELD FOR BLEEDING

Question:
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.

Thanks.

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

3.13 RETURN OF A PLAYER TEMPORARILY OFF THE FIELD
//snipped//
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.

5.8 RETURN AFTER BLEEDING OR EQUIPMENT REMEDY
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.…

DEALING WITH A PLAYER WHO “MIGHT” BE INJURED

Question:
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.…

DEALING WITH INJURIES

Question:
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.