Leeds United insist no rules broken in Robin Koch head injury treatment

A clash of heads with Scott McTominay in the 12th minute of the 4-2 defeat left Koch with a deep gash above his left eye.

Leeds’s medical team took four minutes assessing and treating the injury and after a change of shirt and shorts, Koch continued playing. In the 28th minute he sat on the ground and was groggily led from the field, to be replaced by Junior Firpo.

The players union, the Professional Footballers Association (PFA), and concussion campaigners including former Leeds midfielder John Stiles were critical of the decision to allow Koch to continue, with the PFA arguing it showed the need for temporary concussion substitutes.

“Robin Koch passed all of the on-field concussion screening tests that are currently part of the Premier League protocols,” Leeds confirmed in a statement.

“The player was told if he developed any symptoms he should sit down on the field of play and would be substituted immediately, which is what Robin did in the 29th minute (sic) of the game. 

“Robin will follow the concussion protocols before returning to play.”

Most importantly, Koch tweeted on Monday: “I feel much better today and will be back soon.”

Stiles, whose father Nobby died after suffering dementia, tweeted: “How on earth could they leave the Leeds player on after that head injury – does a player have to die before they act?”

Second impact syndrome, when the brain swells rapidly shortly after a second concussion before symptoms from an earlier concussion have subsided, is rare but usually fatal.

The Football Association’s concussion guidelines state: “Anyone with a suspected concussion must be IMMEDIATELY REMOVED FROM PLAY. Once safely removed they must not be returned to activity that day.”

Leeds’s medical staff apparently did not suspect concussion.

It is the second incident involving a Leeds player this year. Firpo played on despite looking dizzy after colliding with Illan Meslier in the first half of an FA Cup tie against West Ham United. He was substituted in the second period signalling his vision was blurred.

He was found not to be concussed and played against the same opponent seven days later in the Premier League. Players with concussion are not allowed to train or play for a minimum of 14 days under the graduated return to play protocols.

The PFA again called for football to follow other sports in allowing temporary concussion substitutes for a proper assessment away from the field, something Leeds’s medical staff support. Expert opinion is that such assessments cannot properly be made within a few minutes.

Since last February, an extra substitute has been allowed if a player comes off with concussion during a Premier League or FA Cup game but once substituted he cannot return if found not to be concussed.

A PFA statement said: “The injury to Leeds United’s Robin Koch demonstrates again that the current concussion protocols within football are failing to prioritise player safety.

“The ‘if in doubt, sit them out’ protocol is not being applied consistently within the pressurised environment of elite competitive football. We see frequent incidents of players returning to play with a potential brain injury, only to be removed shortly afterwards once symptoms visibly worsen. We have been clear to IFAB (International Football Association Board, which writes football’s laws) that we want to see the introduction of temporary concussion substitutes.”

After the match, Leeds coach Marcelo Bielsa said Koch had been removed because the cut opened up. Firpo was not a concussion substitute although Sky’s touchline reporter said it was because the Whites had not requested one in time.

The deputy chief executive of brain injury charity Headway, Luke Griggs, put the emphasis on the league to act, saying: “We need urgent answers from the Premier League as their reputation is on the line here.

“Concussion protocols in all sports clearly state ‘if in doubt, sit it out’. The Premier League needs to come out and explain to everyone – particularly impressionable youngsters and grassroots players – what the word ‘doubt’ actually means because I think we have a different definition.”

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