State Referee Emeritus (and NJSDI) Derek Von Langen delivered a USSF presentation on managing injuries at the May meeting of the SRANJ. He discussed the Laws of the Game that reference injury management, and then presented the USSF position on injury management in youth and amateur soccer. He stated that the Laws of the Game state that a referee shall stop play only for serious or severe injury. What constitutes serious or severe is up to the referee’s judgment on that day in that match. It will depend on the age and expectations of the players.
With youth players, and even with most amateur players, safety is the overriding concern. For U-10 any time a player is on the ground from a possible injury, we shall treat it as serious and STOP THE MATCH. As the players get older, we might wait a moment to see if they get up, but if there is any doubt, we STOP THE MATCH. For any obvious severe or serious injury, we MUST STOP THE MATCH.
Derek provided the following guidance:
- Run to the injury (even if we are not sure we will be stopping the match, we go to the injury).
- We do not touch players.
- If a coach or medical assistance is beckoned onto the field, we move away from the player and do not get involved in discussion. If the coach is beckoned and a parent comes out also, it is okay!
- If play is stopped and an adult runs onto the field to a youth player on the ground, we will use common sense and consider that we have beckoned the adult after the fact. This is not a time to scold coaches or parents about the proper protocol.
- We do not provide diagnosis – we simply state the facts observed.
The Laws require that an injured player leave the field under certain circumstances.
- If the referee stops play solely for an injury, the injured player MUST leave the field (see exceptions below).
- If a referee checks on an injury while play is stopped for some other reason, and no one comes onto the field, the player being checked does not have to leave the field.
- If an adult comes onto the field to examine the player even if not initially beckoned, the player MUST leave the field.
- If the referee stops the match solely to deal with the injury to a single field player, the player MUST leave the field.
- If two opponents are injured and you stop for that or call for treatment for both, they both MUST leave the field.
- If a goal keeper only is injured, the GK does not have to leave even if treatment is provided.
- If an opponent and a GK are both injured and play is stopped for the injury and the GK receives treatment or neither receives treatment, neither has to leave.
- If two teammates are injured and play is stopped for the injury or both receive treatment, NEITHER has to leave the field (team does not have to play two down).
If a player must leave the field due to the above requirements, and the player’s team will not have the minimum number of required players as a result, the match shall be temporarily stopped for a reasonable amount of time to see if the player is able to return. If the player cannot return, the match is abandoned and the details are included in the match report.
Note that if we are able to check an injury while the ball is out of play, we and the teams have more options. Yet, we are not to wait for a ball out of play if there is a severe or serious injury! (as defined above). Perhaps the most common mistake we make is stopping solely to check on an injured player, and then not requiring the player to leave the field even though no one was beckoned for treatment. A second common mistake is to allow a player to remain once a coach or parent is on the field with the player. If the coach complains, simply remind them of the requirements.
In matches with limited substitutions, where a coach does not want to use a substitute, the player off the field can be waved back onto the field by the referee as soon as play is restarted. It must be with permission of the referee, and the reentry must be over a touchline if the ball is in play. If the ball is out of play when the player wants to return, the player may enter over the goal line also.
If a player has suffered an injury to the head and leaves the field, we cannot prevent the player from re-entering the match (unlike NFHS). What we can do, however, if a player who appears to be suffering the effects of the injury to the head re-enters the field, is to immediately advise the coach that the player appears injured and must leave the field. The coach should get the message.
Finally, we must note the player and some details in the match report for all serious or severe injuries. Regardless of what criteria we use for stopping play, this means that we MUST record the details for any player that had to leave the field because we stopped for the injury or because treatment was beckoned – regardless of how minor the actual injury turned out to be. If a player must leave the field, it is always considered a serious or severe injury.
More information is presented in the USSF video on managing injuries.
From USSF Advice to Referees:
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). Goalkeepers are exempt from this requirement, along with any field player who may also have been injured as a result of a collision with the goalkeeper, as well as teammates who collide. The failure of a player to leave the field when required to do so may be considered cautionable behavior.
Although the treatment of injuries is not normally permitted on the field, the referee is authorized to allow this in the case of severe injuries where further movement of the injured player would be dangerous. Goalkeepers (and field players injured as a result of a collision with the goalkeeper) may be treated on the field at any time. The determination of what constitutes a “serious injury” should take into account the age of the player. Only the referee may permit the return to the field of play of a player who was permitted to leave the field for treatment of an injury. This is not a substitution. The player who left the field for treatment of an injury may return during play with the permission of the referee, but only from the touch line. If the ball is out of play, the player may return with the permission of the referee across any boundary line.
Referees should avoid remaining in the area of the injured player once they have made their determination to stop play or to prevent play from immediately restarting while the injured player is being attended to on the field.
Prior to the restart, the referee must blow the whistle.
From the FIFA Guidelines to Referees:
Injured Players – Instructions
- 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 shall 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 shall 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
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 shall restart play with a dropped ball.
the referee shall 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 shall issue the card before the player leaves the field of play.
- 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