Leeds United's decision not to substitute defender Robin Koch during yesterday's Premier League fixture with Manchester United has been criticised by the Professional Footballers' Association.
Koch collided with Man United midfielder Scott McTominay midway through the first half at Elland Road and spent an extended period of time on the turf receiving treatment for a wound to his head.
Following the stoppage, Koch was presented with a new shirt and a fresh pair of shorts as the collision had bloodied his kit. Play resumed and Koch returned to the field, with his head tightly bandaged to stem further blood flow.
Minutes later, however, the German international was forced to withdraw and was replaced by Junior Firpo from the bench. Marcelo Bielsa stated after the 4-2 defeat that Koch's substitution was a result of the cut sustained in the initial incident.
"He had a cut on his head and what excludes him or made him come off is the cut. If the cut is the most significant thing than the knock he received, I acted in accordance to that."
The PFA, which acts on behalf of all current and former footballers and scholars in the Premier League, the FA Women’s Super League and the English Football Leagues, disagrees with Leeds' course of action.
"The injury to Leeds United’s Robin Koch demonstrates again that the current concussion protocols within football are failing to prioritise player safety," the union's official account tweeted.
"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.
"As the representative voice of players in England, we have been clear to IFAB [football's lawmakers] that we want to see the introduction of temporary concussion substitutes."
Bielsa was questioned on the reason Leeds did not use a concussion substitute despite the fact it appeared Koch was suffering from the effects of his head injury minutes after the incident.
"No, [I would not have wanted to use a fourth substitution] in the second half our performance was better than the first. I am advising the individuals individualities and I didn't observe a player who would have deserved to come off the pitch. That doesn't mean that having a fourth change isn't something favourable. I understand that the main reason for him coming off was the cut, not the knock he received, because he couldn't contain the blood, that's why he came off," the 66-year-old said.
The PFA have urged for concussion substitutes to become more common-place for cases such as Koch's.
"Temporary concussion substitutes will allow medical teams additional time and an appropriate environment to make an initial assessment," they said.
"Introducing temporary substitutes would allow a match to restart with neither side numerically disadvantaged, reducing pressure on players and medical teams to make quick decisions on whether an injured player continues.
"Put simply, the current rules set by IFAB are not working, and players are being put at risk," the players' union finished.
