Morgan Brian's collision raises scrutiny of FIFA's concussion rules

VANCOUVER – So much about FIFA, soccer's world governing body, flies directly in the face of basic logic.

A sport watched and enjoyed by billions of people is controlled politically by a tiny, cliquish collective of bureaucrats. The World Cup, the tournament that claims to unite humanity across the globe, will go in 2022 to a nation that seems to treat human rights as a quaint yet unnecessary notion.

And, in the case of protecting players from the dangers of head injury, FIFA's protocols and measures for handling such matters are made worthless by the organization's own rules and practices.

When United States midfielder Morgan Brian was involved in a sickening head collision with Germany's Alexandra Popp during Tuesday night's Women's World Cup semifinal, it was the latest example of how players are left exposed by soccer's regulatory paradox.

Brian and Popp both rose to attempt to head a ball in the U.S. penalty area during the first half of the Americans' 2-0 win. Popp, her eyes firmly on the ball and with the intent of sending it to the goal, launched herself toward the ball. In midair, her head smashed into Brian's, leaving both athletes poleaxed on the ground. Brian lay writhing on the artificial turf in agony, while blood streamed from a gash in Popp's scalp.

"In those moments of course you are worried about your teammate, and for both players," said U.S. captain Carli Lloyd.

A few minutes later, both were back on the field, in the thick of the action, and carried on until the end of the game.

What happened in those brief intervening minutes constitutes FIFA's attempt to address the issue of soccer concussions. Following an incident involving Germany's Christoph Kramer during the men's World Cup final last summer, special measures were brought in specifically to address head injuries and suspected concussions.

A three-minute window is now allowed whereby a player can be evaluated by a team doctor. The doctor performs a series of tests; Brian was asked to touch her finger to her nose, answer specific questions and repeat certain words to examine her cognitive function.

At the end of the evaluation period, the doctor decides whether the player is fit to continue. In theory, it is not a bad plan. In reality, it falls well short of a medically sound policy.

"Three minutes is something, it is better than nothing," said Dr. Christopher Giza, a pediatric neurologist and sports concussion expert who directs UCLA's Steve Tisch BrainSPORT Program. "But for a proper standardized test, that is something that can't be accurately done in a stadium full of screaming people, in such a short time window."

Giza highlighted the SCAT3 test, a widely-used concussion evaluation tool that takes around 10 minutes, should be done in a quiet location and includes memory and balance examinations.

In practical terms, stopping a soccer game at any competitive level for 10 minutes, let alone a World Cup semifinal, is not an ideal solution.

Briana Scurry and Brandi Chastain, both star members of the USA's victorious 1999 World Cup winning team, are strong believers that FIFA should allow for a "fourth substitute" rule, whereby players involved in blows to the head can be temporarily replaced for long enough for an extensive evaluation to be performed. The substitution would not count against the currently allotted maximum of three. Under such a plan, the game could carry on, the player could receive proper attention, and the team would not be unfairly penalized.

Another problem with the current system is that it makes no allowance for the very thing that makes soccer and its global events so entertaining – competitiveness.

"No player is going to want to leave the field in what might be the biggest game of their life," Scurry told USA TODAY Sports recently. "They might tell you they are OK, but in actual fact it might be quite the opposite. You can't be basing something so important to a person's health on such limited information."

Indeed, medical research has found that one of the key symptoms of a concussion is "poor judgment" and the information a player imparts to a doctor on the field about how she is feeling may not be reliable.

Furthermore, Giza said, the adrenaline an athlete experiences in competition can sometimes temporarily mask symptoms of a brain injury.

"They might seem alright but it is possible for symptoms to evolve," Giza said. "The downsides I see in the three-minute rule is that it's not quiet and that you can't observe for a prolonged period. Someone can look good at the time or even look good at the end of the game, but suffer symptoms that emerge later on."

The situation whereby a team employee is the one making the final call raises obvious concerns about a potential conflict of interest. FIFA has so far resisted calls for an independent specialist to be on hand during competitions.

U.S. head coach Jill Ellis said she had "absolute faith and trust" in the team's medical staff and Dr. Bojan Zoric, who evaluated Brian.

Zoric was not available to speak to the media on Tuesday but based on information provided by a US Soccer spokesman, remained highly vigilant in relation to Brian.

The 22-year-old, who is the youngest member of the U.S. squad, was tested by Zoric at halftime against Germany, following the match, back at the team hotel and again at regular intervals on Wednesday, as the group traveled from Montreal to Vancouver in advance of Sunday's final. It does not appear that she suffered a concussion.

Popp said Tuesday that it took a while for her "head to clear". Hopefully FIFA's wielders of power find some mental clarity of their own in relation to one of soccer's most pressing problems.

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