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From: Alfred Kleinaitis
Manager of Referee Development and Education

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.