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.

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