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Set-Pieces - S.E.R.I.O.U.S. Method of Dealing with Injuries    By Julian Carosi.
(A series of articles on how to officiate in a proactive way by improving how you deal with specific incidents and how to become a better Referee).                       

The advice given here, is not just about how you can recognise injuries or how you should take a more considered approach when players are young children etc, it's also about encouraging you to have a set process that enables you to manage all injuries properly; whilst at the same time, keeping a watchful eye on the rest of the players. The latter is something that many Referees often forget to do when an injury occurs. 

Invariably, the Referee (in good faith) deals with each situation with the health and safety of the injured player paramount. But very often, there is little (or no) thought given, to proactively preventing eager trainers from rushing onto the field of play when there is no need to. Sensible close positioning by the Referee (whilst monitoring the injury situation) is also another consideration. The Referee has a duty to monitor all of the players, and not just the one who is injured. Another worrying aspect is the habit that some Referees adopt, of wandering away from the injury location, to have friendly conversations with the other players whilst the injury is being dealt with. Without a set injury process to use, it is also not surprising, that on other occasions, the Referee also forgets to ask the treated player to leave the field of play, and to await a signal to re-enter at a suitable time after play has been restarted. 

Having a process for managing injuries properly is not something that Referees are often taught or even consider. If you can do this right, then you have fulfilled your part, both as a caring human being who has a duty of care towards others, and as a Referee who has the added responsibility of trying to keep the game flowing whenever it is safe to do so.

The advice shown here encourages Referees to use a set process for managing injuries, it is a basis for improving the process that YOU use when dealing with injury situations. Also included below, is a selection of relevant useful injury information included in official publications. It is not surprising to see, that the Law book contains many references to injuries. But what is surprising is that many Referees have forgotten its importance. 

CONTENTS:

Part A: The S.ER.I.O.U.S. (Standard process for dealing with injuries in the field of play.)
Part B: Details contained within the Laws and other official publications concerning the safety of players and how to deal with injuries.

Part C: Questions and Answers:

1. SERIOUS? (The first consideration is to decide if an injury is serious or not.)

• The following are your most important duties: To preserve life, to prevent an injury worsening and to promote recovery. And finally, to prevent/minimise injuries occurring by proactively managing the players.

• In the event of an injury requiring specialist treatment, the emergency services should be called.

• When an injury situation occurs, the first consideration - is to decide if the injury is serious or not.

• Do not move someone who has a major injury. Wait for the emergency services.

• As soon as you have authorised the trainer/medical staff to enter the field, the injured player must leave the field, whether he receives treatment or not. If the player does not comply, he should be cautioned.

Exceptions to this ruling are made only for: 

• a goalkeeper is injured

• a goalkeeper and an outfield player have collided and need immediate attention

• players from the same team have collided and need immediate attention

• a severe injury has occurred, e.g. swallowed tongue, concussion, broken leg
  Note: It is considered unfair that players of the same team who collided are required to leave the field of play to receive
  treatment, leaving that team at a numerical disadvantage.

• You should note the position of the ball if the game has to be stopped, so that the correct restart can be applied once the injury has been dealt with. It is very easy to forget the type of restart, or the location of the restart when focusing on the injury. In the pre-match brief to your Assistant Referees, you should instruct the Assistants to make a note of the required restart. This will aid you if you forget the restart!

• If there is any discipline action to be taken as a result of the injury, you should firstly organise any treatment for the injured player, before taking any discipline action. 

• There may be occasions when you will need to fend off angry players crowding around the injury scene. This must be done assertively and in conjunction with help from the Assistant Referees if required. You must brief the Assistant Referees as to their role in such circumstances.

• If the delay for dealing with the injury is likely to be long, you can stop your watch.

• Add the full amount of time lost for injury delays at the end of each period of play.

If the injury is serious:

• For example, if the injury is to the head or neck or is a serious bleeding injury, broken bones, concussion, torn ligaments, or involves breathing difficulties, you should stop play and summon the trainer/medical staff immediately.

• You should always stop play immediately and summon medical aid if a serious head injury is suspected or there is difficulty in breathing.

• You should try and recognise serious injuries by looking out for body signs such as an inert unconscious body, or obvious pain, or genuine concern expressed by other players near the scene. If there is any doubt as to the seriousness of an injury, (especially if a young child is involved), you must always err on the side of caution by summoning medical aid immediately.

• A player's health is far more important than a game of football/soccer. 

• Summoning the trainer/medical staff, can be done immediately by using a loud whistle, vocal instructions and by waving a beckoning arm/palm towards the Technical Area, or towards the vicinity of where the team's trainer/medical staff are located.

• If there are players injured from both teams, then waving two beckoning arms will clearly show that both of the competing team's trainers are urgently required. 

• Assistant Referees should also play their part in summoning on trainers/medical staff in cases of urgency.

• In local Park level football, when there are no medically qualified personnel in attendance, professional assistance should be quickly obtained for serious injuries, and the advice offered, acted upon.

• Extra care is required when dealing with breathing, head, neck and back injuries or bleeding wounds.

What is serious injury? 

In an emergency do not get distracted from the essential matters. On arriving at the scene, assess the situation, take in quickly what has happened, look for dangers to yourself and to the injured player, make the area safe, an unconscious player always takes priority and needs immediate help to make sure they can breathe, only then should any other injuries be assessed.

The A.B.C. priorities of First Aid when a player gets an injury are as follows 

A AIRWAY 
B BREATHING 
C CIRCULATION (and bleeding) 
Followed by burns and broken bones. 

• AIRWAY: The airway of an unconscious player may get blocked if the tongue drops back and blocks the throat. You can lift the tongue away from the entrance to the air passage by lifting the chin and tilting the head back. If you think the neck may be injured, tilt the head back very very carefully, just enough to open the airway.

• BREATHING: You can check that a player is breathing by placing your head near the person's nose and mouth. Feel for breath on your cheek or moisture on the back of your hand. If a player has just stopped breathing then make sure the airway is open and head tilted back and begin mouth-to-mouth ventilation. Pinch the nostrils together, take a deep breath and blow into the mouth, firmly sealing your lips around the mouth so air is not lost. You should see the chest rise. Remove your lips and let the chest fall. Continue this, giving about ten breaths every minute until help arrives or breathing begins.

• CIRCULATION (and bleeding): If a player has a serious wound that is bleeding, stop the bleeding by applying firm pressure to the wound for about 15 minutes. Never use a tourniquet. If there is any suspicion of heart failure, check for circulation by sliding two fingers to the side of the windpipe (by the Adam's apple - lump on the windpipe) and feel for a pulse. If there is no pulse, use chest compressions to try to restart the heart.
  Place your hand flat just above the point where the ribs meet the breastbone. Bring the other hand on top of it and lock your fingers together. With your arms straight, press down firmly on the breastbone, pushing it down by 4-5 cm. Release the pressure and repeat the compressions at a rate of about 80 per minute. If the player is also not breathing, alternate 15 compressions with two breaths until help arrives.

•  A Referee is not expected to administer First Aid; this is the prerogative of the team's medical personnel. But if you are the only person who can help save a life - save it.

• A serious injury cannot be easily defined in just a few words; but should be fairly obvious to identify.

• Serious injury is when there is harm done to the body that causes severe, permanent or protracted loss of or impairment to the health or to the function of any part of the body.

• A serious injury can have a major impact upon the life of the player and warrant possible compensation if caused by wilful misconduct or negligent treatment or movement of the player. Note down the specific details of what happened in your notebook if required.

• A serious injury can have a major impact on the victim's earnings and lifestyle. An injury that causes a substantial loss of earnings or earning capacity would be termed "serious". 

• An injury that requires a player to make major accommodations to their lifestyle is also serious.

• You must be particularly vigilant when young players are concerned - a serious injury can have a significant impact on the development of a child.

• Serious injury can have devastating consequences for the player and their family.

• Serious injury affects the whole person, from physical abilities to changes in the quality of life.

• You should never sanction the movement of a player who has possible internal injuries without seeking the authority of the trainer/medical staff.

• If you are some distance away from the scene, you should look out for the body language of any players near the scene. Any signs of distress from them should be used as a trigger to seeking help immediately.

Some examples of serious injury that can occur to a player in a game of football/soccer are:

• becomes unconscious.

• has trouble breathing or is breathing in a strange way.

• has swallowed his tongue.

• has chest pain or pressure.

• is bleeding severely.

• has pressure or pain in the abdomen that does not go away.

• is vomiting or passing blood.

• has seizures, a severe headache, or slurred speech or blurred vision.

• has injuries to the head, neck, or back.

• has possible broken bones.

• dislocations and ligament damage.

• disfigurement (significant scarring or burns).

• spinal cord injuries.

• heart attack.

Why is a head injury so serious?

• A head injury may cause serious injury to the brain, even when there is no visible bleeding or injury visible on the outside of the skull.

• The impact of a hard blow to the head may jar or shake the brain within the skull (closed head injury).

• The rapid movement of the brain within the skull can cause bruising, swelling, or tearing of the brain tissue. It can also stretch, pull apart, or tear nerves or blood vessels within or around the brain.

• Head injuries can sometimes be more complex when players have been taking alcohol or drugs, which can make injury evaluation and recognition difficult. Do not assume any altered behaviour is only from alcohol or drug use.

• Where serious head, neck or back injuries are suspected, any movement by untrained hands has the greatest consequences. The player should be immobilized pending arrival of medical personnel.

A serious head injury may include some of the following symptoms: 

• A severe headache or a headache that continues to get worse.

• Confusion or abnormal behaviour. 

• A young player with a head injury may be extremely irritable or fretful or may cry constantly.

• Difficulty with staying awake.

• Slurred speech.

• Numbness, weakness, or loss of movement in the arms or legs.

• Vision changes and changes in the pupils' size, shape, and reaction to light.

• Dizziness, nausea, vertigo, or unsteadiness that prevents standing or walking.

• Bleeding from the ears or elsewhere on the head.

• May have unequal pupils.

• Altered level of consciousness 

Immediately after a head injury occurs, it can be difficult to tell the difference between a mild concussion and a more serious injury. A brain bruise (contusion) or bleeding within the skull at first may cause only mild symptoms. 

Players who have experienced a head injury should be watched carefully for 24 hours. 

If serious head injury is suspected, an immediate visit to the hospital or to a Doctor is essential. Players who have suffered from concussion should be advised not to play any further part in the game.

When a non-serious injury occurs very near to a boundary line, and the injured player is capable of leaving the field, you should encourage him to do so. This will: (a) minimised the time lost (i.e. delayed restarts), and (b) prevent the trainer from crossing over the field to reach the scene. If you can remove the player safely, and then signal for the trainer to skirt the boundaries, to apply treatment off the field, it will enable you to restart the game much quicker.

What is concussion?

CONCUSSION is an internal head injury. Of all the head injuries, this is the most insidious, and many casualties have succumbed several hours after the incident. 

You should be especially observant when contact involves children - the myth that you can 'run off' concussion by 'playing on', is a dangerous attitude, and has caused grief and embarrassment to many players, parents and coaches when the player eventually collapses. 

Whether or not a player who has suffered possible concussion is fit to return after receiving treatment, should be deferred to the Club's medical staff. In the absence of such a person, the Referee has the authority under Law 5 to determine if a player is still seriously injured and, if necessary, to stop play and to require that the player is once again removed from the field of play. Concussion is a serious injury that must be taken SERIOUSLY. 

Concussion is potentially very serious, and an indifferent attitude is to be discouraged.

What are the signs and symptoms of fractured bones?

Some, or all, of the following:

• pale, cool, clammy skin

• rapid, weak pulse

• pain at the site

• tenderness

• loss of power to limb

• associated wound and blood loss

• associated organ damage

• nausea

• deformity

• crepitus

Are damaged ligaments more serious than a broken bone? 

Bones are connected to each other in joints by ligaments. When excessive force is applied to joint, ligaments may be torn or damaged. This type of injury is a sprain. 

The seriousness of a sprain depends on how badly ligaments are damaged. Sprains can occur in any joint, but they occur most commonly in the ankle, knee, and finger.

• Damaged ligaments can be more serious than a broken bone.

• Great care must be taken to isolate the injury.

• Moving unsupported and properly bandaged injuries can have a devastating effect in causing further injury and pain to the injured player.

• Where serious neck or back injuries are suspected, any movement by untrained hands has the greatest consequences. The player should be immobilized pending arrival of medical personnel. 

Should the Referee allow a dirty sponge or dirty bucket of water to be used?

• Precautions for reducing the potential for transmission of infectious diseases must be considered.

• Whilst a Referee is not responsible for administering treatment, he should advise against dirty (or previously used) water from a bucket being used to treat an injury - particularly if the injury is an open wound. Thankfully, this practise had almost disappeared.

• Dirty water is a carrier of disease, and players can become contaminated as a result of negligent treatment.

• The soccer community is like all other segments of society. Some participants may have infectious diseases including HIV/AIDS and Hepatitis B (blood borne pathogens). Treat every person on the field, as in any area of society, with the assumption they could be HIV positive.

• Contaminated towels, dressings, and other articles containing body fluids should be properly disposed of or disinfected.

2. EVALUATE? (Evaluate each injury situation as it arises. Does play need to be stopped?)

You will need to quickly evaluate each injury situation as it arises. Initial evaluation can sometimes be done from a distance, but on other occasions, you will need to evaluate the seriousness of an injury from close quarters. Whether to stop play or not, depends on a number of factors which will need to be taken into consideration. Some of these are listed below:

• The first consideration for you to evaluate, is whether the injury is serious or not, and to subsequently decide if play should be stopped or not.

• Stay calm but act swiftly and observe the situation. 

• Is the injured player in the way of ensuing play, which constitutes a further danger to himself or to other players; or is he in a safe location that does not involve the development of the current phase of play?

• Is the injury to a goalkeeper?

• Is blood leakage involved?

• Does it look like one of the teams are about to kick the ball out of play to allow the injury to be dealt with?

• In general terms for non-serious injuries, you should encourage play to continue. The decision for stopping play or not, is for you to make in accordance with Law 5.

• If a team purposefully kicks the ball out to allow treatment, then you should be sympathetic to the gesture. Nevertheless, problems have occurred, when following the restart, the ball is not returned to the team who kicked it out of play. You must therefore be vigilant and deal with the restart carefully, so that players hopefully do not abuse 'The Spirit of this Gesture'. But the you have no say (in Law) in where the returned ball should go once play restarts.

• Does the injury involve a young child? Greater emphasis to stopping play should be given when young players are concerned.

• Is the injury being simulated? If so, then a caution should be issued.

• Is the injury likely to result in retaliation?

• Does it look like the player may make a quick recovery?

• Has the player lain himself down on the ground, thereby indicating that he requires treatment?

• Has the manager instructed the player to drop to the ground?

• Is there an element of time wasting involved? There are occasions when an injured player will not be as seriously injured as you first thought. In fact, at the first squirt of magic water, the player is ready to play on. If players are wasting time, you will need to deal with this in accordance with the Laws.

• Is the tempo of the game such, that a forced stoppage by you will provide an opportunity that allows tempers to cool?

• Does the injury occur whilst a goal scoring opportunity is developing?

• Does the injury involve the need for disciplinary action to be taken? 

• Can the injured player make his own way off the field to receive treatment? (Including being near enough to the touchline/goal line to roll himself off).

• Will the weather have an adverse effect, if treatment is delayed?

• Is there danger of further injuries?

• Does the injury involve a vulnerable player? For example, someone who suffers from asthma or is recovering from a previous injury.

If the player is only slightly injured.

• If the player is only slightly injured (for example, a thigh strain or cramp), you will need to decide if play can be allowed to continue until a natural stoppage.

• You should allow play to continue until the ball naturally goes out of play if a player is, in his opinion, only slightly injured.

• On some occasions, the ball may be purposefully kicked out of play by a sympathetic player, thus allowing you to temporarily suspend the game to allow the injury situation to be dealt with.

• If an injured player is able to safely leave the field of play without help, then he should be encouraged by you to do so.

• If the player is bleeding slightly, you can instruct the player to leave the field of play immediately. The player may only return when authorised by you, after checking that the bleeding has stopped and/or is suitably covered. The Fourth Official or an Assistant Referee may assist you in checking the player, before they return to the field of play.

• A player cannot wear clothing with blood on it, or clothing that has been contaminated with blood.

• Players uniforms contaminated with blood should be changed. They should NOT be rinsed out with water and re-worn. You should never allow a player back onto the field without properly clean equipment. As yourself; " Would you wear a bloodied shirt against your skin that has been rinsed with a water bottle?" No.

3. RACE. (Sprinting to the scene of the injury).

• When a natural stoppage in play occurs (or if play has been subsequently stopped for a serious injury) you should RACE sprint towards the injured player.

• A Referee who ambles towards an injury location, emits a signal that says, "I don't care for the well-being" of the players under my charge today", whereas a Referee who RACES towards the scene, shows that he is genuinely concerned, and eager to seek medical help if it is required.

• Prior to summoning on the trainers/medical staff, you need to make an initial assessment before you can get to the scene. Does the injured player immediately require the trainer/medical staff assistance?

• Listen to what the injured player is saying. Ask him if he wants medical assistance.

• As mentioned above, if you are some distance away from the scene, you should look out for the body language of any players near the scene. Any signs of distress from them should be used as a trigger to seeking help immediately.

• For non-serious injuries, whilst RACING towards the injured player, you should use an outstretched palm to delay the entry of any over-eager trainers/medical staff. This is important, for as soon as you have authorised the trainers/medical staff to enter the field, the player must leave the field whether he has received treatment on the field or not. In other words, the player should at least be evaluated by you, and given the option to request help from the trainer/medical staff if required.

• When young children are involved, parents very often rush onto the field of play when their child gets injured. You must be sympathetic to the parent's concerns, and manage each circumstance carefully (without antagonising the situation). In these situations, it's more a case of educating and sympathising with the parents, rather than strictly adhering to the duties and responsibilities as laid out in the Laws.

4. INSPECT. (Taking up a position that allows inspection of the injury and monitoring the remaining players).

Inspecting and assessing the injury:

• On arrival at the injury scene, and after correctly positioning himself, you should ask the injured player whether he requires a trainer/medical staff; using simple words to the effect of, "Do you want your trainer?" 

• You should not say, "Do you require treatment?" Otherwise the player will assume that the you will allow treatment on the field of play.

• If on arrival at the scene, it is apparent that the player is in obvious need of prompt medical assistance, you should summon aid immediately (there is no need to ask a severely distressed player if he needs treatment).

• After questioning the injured player, you can authorise one, or at most two trainers/medical staff, to enter the field to ascertain the type of injury and to arrange the player's safe and swift removal from the field by the shortest route or by stretcher or by walking.

• Important Note: It is imperative, that you do not make the decision to remove a player with a serious injury from the field of play, or to make a decision to call for a stretcher to be provided. You must first seek this advice and authority for removal from the trainer/medical staff. You can do this by engaging with the trainer/medical staff by asking them if it is possible to remove the player without incurring further injury or distress. Once this has been achieved, you can summon a stretcher. If you call for the stretcher, or insists that a player be removed without recourse to the trainer/medical staff, it could have dire consequences for you, if the injury involves damage to the spine, head or is a serious fracture (and the hasty removal on your sole authority causes further trauma to the injured player).

• The bottom line is, that when a serious injury is suspected, you MUST seek advice from the trainer/medical staff before sanctioning the removal of an injured player.

• Deal with the rest of the players to ensure that they are adequately supervised (see below).

5. ORGANISE. (Taking charge, positioning and seeking medical assistance if it is required).

• When you arrive at the scene, you should position yourself so that you can still keep an eye on the rest of the players. In other words, you should not place your back to the rest of the players when you are dealing with the injury. This is the most common fault of Referees when dealing with an injury situation. 

• When managing injuries, it is not only the injured player that you should be monitoring; it is also the other 21 players. You should therefore position yourself near to the injury location, so that you have the majority of the rest of the players, in front of you. This usually means placing your back to one of the boundary lines so that you have the injury situation in front of you, and between yourself and your active Assistant Referee.

• In moments of tension, you should also position yourself so that you can monitor the technical area occupants. This is doubly important if the injury location is very near to the technical areas, as heated tempers are prone to rise.

• When it is safe to do so, the emphasis should always be on the injured players receiving treatment after they have left the field of play, rather than whilst they are on it.

• When an injured player is being assessed, or receiving any immediately required emergency treatment, you should stand a couple of paces back from the scene, in a position so that you can communicate clearly with the participants, and in such a way that you can also keep an eye on the rest of the players whilst overseeing the assessment of the injury.

• You should allow the trainer/medical staff a reasonable amount of time to make a diagnosis/verification of the injury, but they must be reminded that no (non-emergency) treatment is allowed on the field of play.

• When an injury occurs, tempers can be at a heightened state. You should allow a reasonable space between yourself and the medical staff. Close attendance by you may on some occasions, inflame tempers. Keep calm.

• Whilst monitoring the injury assessment, you may also have to simultaneously deal with indiscipline. The priority must always be in seeking help for the injured player. Once this has been achieved, you can deal with any misconduct. 

• Some trainers/medical staff when dealing with an injured player cannot refrain from berating the Referee. You must allow the injured player to be sorted out, before taking any discipline action against misbehaving trainers/medical staff.

6. USHER. (Overseeing the safe removal of injured players). 

• If the player does not require treatment, and is able to walk to the touchline unaided, you should encourage the player do so by the shortest route. In such cases, you should provide a signal towards the trainer/medical staff, to indicate that their medical assistance on the field of play is not required on this occasion.

• When or if it is safe to do so, ask the player to leave the field of play, and to await a signal from you to re-enter at a suitable time after play has been restarted.

• If an injured player is able to remove himself from the field of play, you should prevent any trainers/medical staff from rushing across the field of play, rather than making their way around the boundaries to reach the injured player as play resumes.

• If the player is unable to make his way to the touchline unaided, or if he requires a trainer's presence, you should signal for help with a clear one arm-beckoning wave, vocal instructions and if necessary, use of the whistle to attract attention.

• Once the (one or two permitted) medical staff have arrived, you should allow a reasonable amount of time for them to assess the extent of the injury.

• If the injured player does not require a trainer/medical staff, and intends to remain on the field of play to recover, you should allow a reasonable amount of time for recovery, prior to recommencing the game.

• If you are advised by a Doctor or other medically qualified person that a player's injury is so bad, that it would be harmful for that player to continue playing, you should ask the Doctor (or other medically qualified person) to decide whether the player can be moved or not, or whether the player is able to leave the field of play.

• If the trainer/medical staff considers that the player cannot walk off, they will advise you, you can then use the two-handed hand-pumping signal for a stretcher. A seriously injured player should only be moved from the field of play on the trainer/medical staff's authority. A Referee is not medically qualified to make this decision.

• You MUST stay with the injured player to ensure whatever action is required is completed as quickly possible and that the trainers/medical staff leave the field as quickly as possible, taking the shortest practical direction from the field even if this is in the opposite direction to the technical area.

• An injured goalkeeper is not required to leave the field of play and may receive treatment while on the field of play.

7. START. (Starting the game again after the injury has been seen to).

• Play can be restarted once the injured player and any trainer/medical staff have completely left the field of play.

• You can use a combination of arm and vocal communications, to signal to the injured player that he can re-enter the field of play.

• An injured player may only return to the field of play after the match has started. 

• An injured player may only re-enter the field from the touchline when the ball is in play.

• 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, you can restart play with a dropped ball

• The Referee alone (or if nominated, the Assistant Referee or Fourth Official) is authorised to allow an injured player to re-enter the field whether the ball is in play or not.

• When play has been restarted, you must be very careful when you allow the injured player to return onto the field of play. You should wait until the play action is away from the vicinity of the returning player before signalling him to enter. The oncoming player should not become immediately involved in active play, as this may generate problems.

• The Referee (or if nominated, the Assistant Referee or Fourth Official) must check that any bleeding players have been treated properly before they are allowed to enter the field of play. 

• A player cannot wear clothing with blood on it, and players uniforms contaminated with blood should be changed. The player's equipment should NOT be rinsed out and re-worn.

• You should always read the Competition Rules. In some competitions, the Rules forbid Referees from adding on time at the end of either half of the game for injuries or any other cause because of the tight schedule of games being played, for example, in a tournament.

Summary:
There is a lot of information to consider in this S.E.R.I.O.U.S injury advice, but the words immediately below, summarise what you need to do to manage an injury situation properly. It is a very easy process to adopt. Try it. 

• Your first consideration is to decide if an injury is serious or not.

• If it is serious, then you need to act immediately, stop play and summon help.

• A Referee is not expected to administer First Aid as this is the prerogative of the team's medical personnel. But if you are the only person who can help save a life - save it.

• If the injury is not serious, then you should allow play to continue if it is safe to do so.

• React to any injury, by running to the scene, rather than walking. 

• Fend hasty entry by eager trainers/medic (with an open outstretched palm) until you have assessed the situation, and then summon the trainer/medic if required. 

• Do not wander off, but place yourself in a position very near to the scene, where you can still monitor the other players. 

• Restart the game when it is safe and proper to do so. 

• You have no say in how many players attend a dropped ball, or where a ball that has been kicked out of play is subsequently returned, when play restarts.

• And finally, don't forget to add any time lost onto the end of the half.

To emphasise how important the proper management of injuries is, see Part B, for several useful excerpts from official publications regarding injuries. Read them, as it will remind you of your main duty - the safety of the players. 

Part B: Details contained within the Laws and other official publications concerning the safety of players and how to deal with injuries.

(Sources: (1) Laws of Association Football including the chapter entitled 'Interpretation of the Laws of the Game and Guidelines for Referees'; and (2) FA Advice on the Application of the Laws of the Game booklet.)

1. What the Law book tells us about injuries. 

Guidelines for Referees.
Dealing With Injuries:

The referee must adhere to the following procedure when dealing with injured players

• play is allowed to continue until the ball is out of play if a player is, in the opinion of the referee, only slightly injured

• play is stopped if, in the opinion of the referee, a player is seriously injured

• after questioning the injured player, the referee may authorise 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 following a signal from the Referee
  · the referee must 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 authorised 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 must be cautioned for unsporting behaviour

• 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

• irrespective of whether the ball is in play or not, only the referee is authorised to allow an injured player to re-enter the field of play

• the referee may give permission for an injured player to return to the field of play if an assistant referee or the fourth official verifies that the player is ready

• 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 must restart play with a dropped ball from the position of the ball when play was stopped, unless play was stopped inside the goal area, in which case the referee drops the ball on the goal area line parallel to the goal line at the point nearest to where the ball was located when play was stopped

• the referee must 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 must issue the card before the player leaves the field of play

Exceptions to this ruling are to be made only when:

• 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

More than one offence occurring at the same time

• Offences committed by two players from the same team:

  • the referee must punish the most serious offence when players commit more than one offence at the same time

  • play must be restarted according to the most serious offence committed

• Offences committed by players from different teams:

  • the referee must stop play and restart it with a dropped ball from the position of the ball at the time of the stoppage, unless play was stopped inside the goal area, in which case the referee drops the ball on the goal area line parallel to the goal line at the point nearest to where the ball was located when play was stopped.

Law 1 - The Field of Play:

Flagposts - A flagpost, must not be less than 1.5 m (5 ft) high, with a non-pointed top.

Safety - Goals must be anchored securely to the ground. Portable goals may only be used if they satisfy this requirement.

Goalposts and crossbars must be made of wood, metal or other approved material. Their shape may be square, rectangular, round or elliptical and they must not be dangerous to players.

Guidelines for Referees:
If the crossbar becomes displaced or broken, play is stopped until it has been repaired or replaced in position. If a repair is not possible, the match is abandoned. The use of a rope to replace the crossbar is not permitted.

Law 4 - The Players Equipment: 

Safety: A player must not use equipment or wear anything which is dangerous to himself or another player (including any kind of jewellery). 

Law 5 - The Referee: 

Powers and Duties.

• stops the match if, in his opinion, a player is seriously injured and ensures that he is removed from the field of play. An injured player may only return to the field of play after the match has restarted. 

• allows play to continue until the ball is out of play if a player is, in his opinion, only slightly injured

• ensures that any player bleeding from a wound leaves the field of play. The player may only return on receiving a signal from the Referee, who must be satisfied that the bleeding has stopped

Decisions of the International F.A. Board

Decision 1

A Referee (or where applicable, an Assistant Referee or fourth official) is not held liable for:

• any kind of injury suffered by a player, official or spectator

• a decision to stop or not to stop play to allow an injured player to be removed from the field of play for treatment.

Law 12 - Fouls and Misconduct:
Decisions of the International F.A. Board
Cautionable Offences

A direct free kick is awarded to the opposing team if a player is careless, reckless, or uses excessive force if he kicks (or attempts to kick), trips (or attempts to trip), jumps at, charges, strikes, pushes or tackles an opponent. 

Guidelines for Referees
When a player must be cautioned: Attempts to deceive the Referee by feigning injury or pretending to have been fouled (simulation).

Sending-Off Offences:

A player, substitute or substituted player is sent off and shown the red card if he is guilty of violent conduct, serious foul play or spitting.

Guidelines for Referees
Law 12: Careless, reckless, using excessive force:

"Careless" means that the player has shown a lack of attention or consideration when making a challenge or that he acted without precaution.

• No further disciplinary sanction is needed if a foul is judged to be careless

"Reckless" means that the player has acted with complete disregard to the danger to, or consequences for, his opponent

• A player who plays in a reckless manner must be cautioned.

"Using excessive force" means that the player has far exceeded the necessary use of force and is in danger of injuring his opponent.

• A player who uses excessive force must be sent off.

Playing in a dangerous manner:

Playing in a dangerous manner is defined as any action that, while trying to play the ball, threatens injury to someone (including the player himself). It is committed with an opponent nearby and prevents the opponent from playing the ball for fear of injury.

A scissors or bicycle kick is permissible provided that, in the opinion of the referee, it is not dangerous to an opponent.

Playing in a dangerous manner involves no physical contact between the players. If there is physical contact, the action becomes an offence punishable with a direct free kick or penalty kick. In the case of physical contact, the referee should carefully consider the high probability that misconduct has also been committed.

Disciplinary sanctions:

• If a player plays in a dangerous manner in a "normal" challenge, the referee should not take any disciplinary action. If the action is made with obvious risk of injury, the referee should caution the player

• If a player denies an obvious goal-scoring opportunity by playing in a dangerous manner, the referee should send off the player

Restart of play:

• Indirect free kick from the position where the offence occurred (see Law 13 - Position of Free Kick)

• If there is contact, a different offence has been committed punishable by a direct free kick or penalty kick.

Serious foul play
A player is guilty of serious foul play if he uses excessive force or brutality against an opponent when challenging for the ball when it is in play.

A tackle that endangers the safety of an opponent must be sanctioned as serious foul play.

Any player who lunges at an opponent in challenging for the ball from the front, from the side or from behind using one or both legs, with excessive force and endangering the safety of an opponent is guilty of serious foul play.

Advantage should not be applied in situations involving serious foul play unless there is a clear subsequent opportunity to score a goal. The referee shall send off the player guilty of serious foul play when the ball is next out of play.

A player who is guilty of serious foul play should be sent off and play is restarted with a direct free kick from the position where the offence occurred (see Law 13 - Position of Free Kick) or a penalty kick (if the offence occurred inside the offender's penalty area).

Violent conduct
A player is guilty of violent conduct if he uses excessive force or brutality against an opponent when not challenging for the ball.

He is also guilty of violent conduct if he uses excessive force or brutality against a team-mate, spectator, match official or any other person.

Violent conduct may occur either on the field of play or outside its boundaries, whether the ball is in play or not.

Advantage should not be applied in situations involving violent conduct unless there is a clear subsequent opportunity to score a goal. The referee must send off the player guilty of violent conduct when the ball is next out of play.

Referees are reminded that violent conduct often leads to mass confrontation; therefore they must try to avert this with active intervention.

A player, substitute or substituted player who is guilty of violent conduct must be sent off.

Offences where an object (or the ball) is thrown
If while the ball is in play, a player, substitute or substituted player throws an object at an opponent or other person in a reckless manner, the referee shall stop play and caution the player, substitute or substituted player.

If while the ball is in play, a player, substitute or substituted player throws an object at an opponent or other person using excessive force, the referee shall stop play and send off the player, substitute or substituted player for violent conduct.

If a player, while correctly taking a throw-in, intentionally throws the ball at an opponent in order to play the ball again but neither in a careless nor a reckless manner nor using excessive force, the referee must allow play to continue.

Kicks from the Penalty Mark:
A goalkeeper who is injured while kicks are being taken from the penalty mark and is unable to continue as goalkeeper may be replaced by a named substitute provided his team has not used the maximum number of substitutes permitted under the competition rules.

Guidelines for Referees
A player other than the goalkeeper who is injured may not be substituted during the taking of kicks from the penalty mark.

The Technical Area:

The coach and other officials must remain within the confines of the technical area except in special circumstances, for example, a physiotherapist or doctor entering the field of play, with the Referee's permission, to assess an injured player.


(2) What the FA Advice on the Application of the Laws of the Game booklet tells us.

Goalpost Safety
It is the responsibility of the match referee to point out to the participating clubs or pitch users before a game that any metal cup hooks on either the goalposts or crossbar could constitute a danger. This could constitute finger entrapment due to the wearing of a ring or create severe neck injuries due to other jewellery being worn such as earrings or necklaces. Whilst the Laws of the Game clearly state that jewellery should not be worn during any part of a match, such dangers could also exist prior to, or immediately after matches, where nets need to be fitted or removed by any user or club personnel.

If both teams are prepared to play, having had this fact pointed out to them, then it is The FA's view that the referee can be considered to have done as much as might be reasonable in the circumstances to the relevant League and County FA.

LAW 4--The Player's Equipment
Safety
Referees should ensure that players do not wear articles that may constitute a danger to other players or to themselves. Referees should set a good example by removing or taping their own rings and jewellery. Referees, however, should make allowances for religious symbols (e.g. a player of the Sikh religion wearing a Kara in a match), provided that they are not dangerous and that adequate covering be applied as protection.

Goalkeepers
Goalkeepers may choose to wear tracksuit trousers, if the state of the field of play or weather conditions render it necessary, provided that Competition Rules permit.

Footwear
Competition Rules may require referees to examine footwear and/or players' equipment. Referees may do so additionally either during a match or at half time if they have any reason to doubt their safety.

Injury to players or the Referee
A player who has left the field of play for treatment for an injury when he/she is bleeding from a wound may only return to the field of play after inspection by the referee, neutral assistant referee or the 4th Official, which, through necessity, will normally be during a stoppage of the play and at the touchline. The player is only allowed to return to the field of play on receiving a signal from the referee.

Care needs to be exercised before a seriously injured player is removed from the field of play and referees must continue to be vigilant and err on the side of safety, accepting the advice of those who are medically qualified or claim to have similar skills. There is a particular need for a rapid assessment and action in cases of head injuries. However, in local football, when there are no medically qualified personnel in attendance, professional assistance should be quickly obtained and the advice offered acted upon. Referees are reminded to add the full amount of time lost to the end of each period of play.

Particular attention is drawn to Decision 1 of the International FA Board in relation to the liability of referees, assistant referees and fourth officials.

If a referee becomes incapacitated and an assistant referee replaces him, the "new" referee has the authority to reverse a decision made by his colleague, provided the game has not been restarted.

A club trainer or physiotherapist who has been guilty of misconduct should still be granted permission to enter the field of play to treat an injured player. However, a player sent from the field of play, by a referee, for misconduct, cannot return to the field in any official capacity. Suitable reports must be sent to the appropriate authority.

Players felt to be under the influence of alcohol or drugs:
Referees should always exercise extreme care in their choice of words to describe players who may be under the influence of alcohol or drugs, especially in connection with drug influence. In such circumstances, the matter should be considered as a team responsibility and suitable attention be drawn to a club official, perhaps suggesting that a player was too ill to continue/participate or seemed to have a problem.

Restarting by a dropped ball
Occasions do occur in a game when a player having fallen to the ground, has the ball locked between his feet and legs. To dispossess him of the ball may not only be difficult, but fraught with danger of injury. The referee may, therefore, feel justified in halting play and restarting by dropping the ball appropriately, in accordance with the relevant Law. Similarly, there will be occasions when the goalkeeper, in taking possession of the ball, is injured and no offence has occurred. In this situation, the welfare and safety of the goalkeeper is paramount and the game should be stopped immediately. Once the goalkeeper, or his replacement, is ready to take part in the game, the ball must be dropped by the referee in accordance with Law. In keeping with the spirit of the game, referees should ensure that no unfair advantage accrues in favour of either team. Referees are reminded that it is not essential to have a player from either side present at the dropping of the ball.

As a means of restarting the game after a temporary suspension, referees should not bounce the ball or throw it in the air. The ball should simply be released from no higher than waist level and allowed to fall to the ground.

Players who clearly simulate injury in order to deceive the referee must also be dealt with under Law 12, International Board Decision No. 5.

A substitute who has not taken part in the match, including extra time where it is played, may not take part in kicks from the penalty mark, except to replace an injured goalkeeper.

Attitude towards Referees
A player who assaults a Referee or who is guilty of using offensive, insulting or abusive language or gestures must be sent off.

Jewellery
All items of jewellery are potentially dangerous. The term "dangerous" can sometimes be ambiguous and controversial; therefore in order to be uniform and consistent any kind of jewellery has to be forbidden.

Players are not allowed to use tape to cover jewellery. Taping jewellery is not adequate protection.

Rings, earrings, leather or rubber bands are not necessary to play and the only thing they can bring about is injury.

In order to avoid "last minute" problems, teams should inform their players in advance.

Please avoid injuries! Necklaces, rings, bracelets, earrings, leather or rubber bands etc. are not allowed.

Advice from The FA.
Jewellery
The FA has re-iterated the situation regarding players and jewellery. Match Officials are reminded that Law 4 states: "A player must not use equipment or wear anything which is dangerous to himself or another player, including any kind of jewellery."
All jewellery, including plain wedding rings, must be removed. The Referee's decision is final and players in contravention of this Law must not be allowed to enter the field of play. 

Match Officials are also to incorporate a footwear inspection into the pre-match safety check of players' equipment. This will take place before entry to the field of play immediately prior to the game.

Further notes of interest: 

Non-Basic Equipment

• A player must not use equipment or wear anything that is dangerous to himself/herself or another player

• Modern protective equipment such as headgear, facemasks, knee and arm protectors made of soft, lightweight, padded material are not considered to be dangerous and are therefore permitted

• New technology has made sports spectacles much safer, both for the players themselves and for other players

Safety
A player must not use equipment or wear anything that is dangerous to himself/herself or another player (including any kind of jewellery).

Liquid Refreshments
Players are entitled to take liquid refreshments during a stoppage in the match but only on the touchline. It is not permitted to throw plastic water bags or any water containers onto the field.

Playing dangerously
Football is a game where body contact occurs and the Laws are framed so that the players can play without danger to themselves, if their opponents respect both the letter and spirit of the Laws. Each incident must be judged by the Referee as it happens and the question of danger rests entirely on his opinion.

Playing dangerously close to goalkeepers
Kicking or attempting to kick the ball whilst it is in the goalkeeper's possession is universally considered to be dangerous; raising the foot to block the ball as he kicks it from his hands is equally dangerous. Attempts to kick the ball powerfully as it is about to come into the goalkeeper's possession are also a common source of danger to goalkeepers. Depending on the degree or intensity of the offender's action, the Referee may have to caution or send off the player committing such an offence.

Goalkeepers
Goalkeepers, when advancing to catch the ball, sometimes raise one leg in an outward direction to keep opposing players at a distance. If an opponent is in close proximity to the goalkeeper, the Referee may well consider such action constitutes careless or even reckless play, but if the opponent is further away then it would be deemed dangerous play and be punished accordingly.

Tackling with the foot lifted from the ground
This may be dangerous, but is not necessarily so. Using the sole of the foot is an effective method of controlling the ball, but a player who lifts his foot should be penalised if the Referee considers he is endangering an opponent by doing so. If the player deliberately plays over the ball and makes contact with his opponent's leg, this is a serious foul.

Tackling with two feet together
If it is an uncontrolled jump at the ball from a distance, the tackle certainly entails a large element of danger to the opponent. A player who jumps into a challenge two footed and airborne is not in control of himself or his challenge. This is also the case where, during the act of launching himself with two feet, he retracts one foot at the last moment.

• If he makes contact with the ball and the player he should be dismissed.

• If he makes contact with the player and misses the ball he should be dismissed.

Use of elbows
A referee also has to be alert to the illegal use of arm and elbow, and detect accurately those challenges where the player raises his arm and executes a deliberate forearm smash into his opponent.

• A Referee must in these incidents also issue the appropriate sanction of a red card.

Use of hands
Equally, be alert and aware of the player involved in a clash with an opponent who uses his hand and makes contact with his opponent's neck, or slaps/pushes his face, or punches.

• Here again the appropriate sanction must be a red card.

Tackling by sliding
This tackle is carried out with one or both legs outstretched, and the same considerations as for the two-footed tackle apply. 

Tackling which endangers the safety of an opponent
A tackle which is violent with little or no attempt to play the ball and which endangers the safety of an opponent is prohibited and must be sanctioned as serious foul play.

Referees should watch for players who tackle the ball with one foot but trip the opponent with the other foot. In these circumstances, a penal offence has been committed. 

Serious foul play and violent conduct
Football is a bodily contact sport. However, the contest to gain possession of the ball should nonetheless be fair. Where play is vigorous, but fair, the Referee must recognise this and allow play to proceed.

Serious foul play and violent conduct are, however, strictly forbidden and the Referee must react to them by stringently applying the Laws of the Game.

Players who, in the Referee's opinion, are guilty of serious foul play or violent conduct shall be sent off the field of play, even if they have not already been cautioned.

The difference between serious foul play and violent conduct can be defined as follows:

(a) Serious foul play can only occur when the ball is in play and when a player unfairly challenges for the ball against an opponent using excessive force.

(b) Violent conduct occurs when a player is guilty of aggression towards an opponent even if he is not challenging for the ball. The ball can be in or out of play. If the ball is in play he shall be sanctioned with a direct free kick in favour of the team of the player who was attacked, from the place where the offence was committed, or with a penalty kick if it took place within the penalty area. If the ball is out of play, the game shall be resumed at the stage where it was interrupted prior to the offence (throw-in, free kick, etc.).

Moreover, if a player, substitute player or substituted player attacks one of his teammates, the Referee, an Assistant Referee, a spectator, etc., this shall also be considered violent conduct. As mentioned above, this offence can arise when the ball is in or out of play. If the ball is in play, the player shall be penalised by the award of an indirect free kick against his team from the spot where the violent conduct occurred or with a dropped ball taken at the place where the ball was situated at the time of the offence, if this occurred beyond the boundaries of the field of play. If the ball is out of play the game shall be resumed at the stage where it was interrupted prior to the offence (throw-in, free kick, etc.).

Any player, substitute player or substituted player, whether he is within or outside the field of play, whose conduct is unsporting or violent, whether or not it is directed toward an opponent, the Referee, an Assistant Referee, colleague or other person, or who uses offensive or insulting or abusive language and/or gestures is guilty of an offence and shall be dealt with according to the nature of the offence. 

Making contact with the trainers/medical staff before the game starts
Prior to kick-off, the Referee (and Assistant Referees) should try and make contact with the team trainers (or medical staff) and remind them to await the Referee's signal before entering the field of play when an injury occurs. The Referee should demonstrate the outstretched beckoning arm/palm signal that he will be using to summon the trainers/medical staff onto the field of play to assess an injury. The trainers/medical staff should be reminded that if it is possible to safely remove an injured player, treatment should not be applied on the field of play. But that the players' health and safety must always be paramount.

Part C: Questions and Answers: 

Question 1a: What is a goalkeeper supposed to do if while catching the ball, he gets an injury? Is he supposed to try and throw the ball out for a corner or keep hold of it and give the opposing team an indirect free kick for holding onto the the ball too long? Or is there something in the small print of the rules which allows the Referee to deal with this scenario?

Answer 1a: A game should not proceed without a goalkeeper. If a goalkeeper gets injured and a goal is immediately following the injury, most Referees will allow the goal to count (as long as no foul had been committed on the goalkeeper). But if a goalkeeper gets injured and play carries on for a moment or two, then most Referees will stop play to allow the goalkeeper to be treated. Referees will need to use their judgement in deciding whether to stop play or not, and it is generally accepted by the players, that goalkeepers should be treated as soon as possible.

Although there is nothing in the Laws to cover this specific scenario, Referees will always accord goalkeepers with special protection.

The reason for this, is that Law 3 'Number of Players' states that:

"On field of play: Before kick-off, check that there are 11 players per side including a goalkeeper".

In other words, a game should not proceed without a goalkeeper.

The situation where the goalkeeper goes down injured whilst still possessing the ball, is no different to when an outfield player goes down injured with the ball trapped beneath him. And in these cases, the Referee should stop play immediately, before any opponents decide that the ball is still in play, and start kicking at the prostrate player.

Law 5 also states that the Referee can stop play if he suspects that a player is seriously injured.

The Referee usually allows the goalkeeper a moment or two to see whether he is able to throw the ball out of play himself. If this is not he case, then the Referee will (or should) always stop the game to allow treatment to be administered. Referees must err on the side of caution when judging whether an injury is serious or not. The game should not be allowed to continue without the goalkeeper.

If the Referee needs to stop the game, then the correct restart is a dropped ball. A dropped ball does not have to have two players, it can have none!. So in theses cases, all the Referee needs to do to restart play, is to drop the ball back to the goalkeeper (when no other players are nearby). If the injured goalkeeper managed to throw the ball out of play before the game was stopped - the correct restart is the natural restart, i.e. corner or throw-in. In these cases, opposing players usually follow 'the spirit of the game' and return the ball directly back to the goalkeeper's team.

An indirect free kick cannot be awarded in these situations, because they do not directly involve a foul committed by an opponent. The restart is either a dropped ball, or the neutral restart i.e. corner or throw-in.

Law 8: "A dropped ball is a way of restarting the match after a temporary stoppage that becomes necessary, while the ball is in play - for any reason not mentioned elsewhere in the Laws of the Game."

Thanks to Glynn for this interesting question.

Question 1b: A player kicks the ball towards the opposition's goal. The goalkeeper plunges, hurts his head on a goal post and remains on the ground; the ball returns from the post to the attacker. He kicks the ball into the free goal. How shall the referee decide?

Answer 1b:  A game should not proceed without a goalkeeper. If a goalkeeper gets injured and a goal is immediately scored following the injury, most Referees will allow the goal to count (as long as no foul had been committed on the goalkeeper). But if a goalkeeper gets injured and play carries on for a moment or two, then most Referees will stop play to allow the goalkeeper to be treated. Referees will need to use their judgement in deciding whether to stop play or not, and it is generally accepted by the players, that goalkeepers should be treated as soon as possible.
Although there is nothing in the Laws to cover this specific scenario, Referees will always accord goalkeepers with special protection. The reason for this, is that Law 3 'Number of Players' states that:
"On field of play: Before kick-off, check that there are 11 players per side including a goalkeeper".
In other words, a game should not proceed without a goalkeeper. There are no answers in Law to this questions. The Referee will need to use his initiative to make a decision based on how long there is between the injury occurring to the goalkeeper, and the ball entering the goal. 
As a rule of thumb, I would personally use the following criteria if the period between the injury occurring and a potential attempt to score a goal was 2 or 3 seconds only:

I would imagine in my mind that the goalkeeper was (hypothetically) NOT injured:

(a) If it were physically possible for an uninjured goalkeeper to stop the goal being scored; then I would stop play.

(b) If it was physically impossible for an uninjured goalkeeper to stop the goal being scored; then the goal should be allowed. (WebMaster)

Question 2: Are players allowed to wear spectacles?

Answer 2: Sympathy has been expressed for players, especially young players, who need to wear spectacles. It is accepted that new technology had made sports spectacles much safer, both for the player himself and for other players.

While the Referee has the final decision on the safety of players’ equipment, the FA Board expects that Referees will take full account of modern technology and the improved safety features of spectacle design when making their decision.

Question 3: Does a Referee have any jurisdiction in deciding whether an ill or injured player can carry on playing on the field of play or not? For example, how does he deal with a player under the influence of drugs or drink?

Answer 3: With issues of safety, Referees shouldn't assume players to be "innocent until proven guilty", but rather be erring on the side of caution. It's up to the Referee to ensure that the situation is safe by being proactive, rather than being reactive and waiting until there are conclusive reasons to believe otherwise. Of course, Referees should not be breath-testing players before the game. But if something comes up to raise a doubt in the Referee's mind, then it's up to the Referee to eliminate that doubt before proceeding as a matter of basic caution. The fact that someone has been drinking, raises the very real possibility that their ability to play the game safely is impaired. Just because they don't seem drunk, doesn't mean that everything's okay.

Although in general, Referees are not medically qualified to make a judgement on why a player is behaving as if he were drunk (or to assess the extent of an injury), there will be times when common sense dictates that the Referee will have to make a sensible decision to protect the player from himself, and from causing potential injury (or contamination) to other players. There are many symptoms that could lead to a player behaving strangely. He may be on medication, or he may be genuinely ill or not be ill at all. He may have behavioural difficulties. He may have taken drugs or yes! - he may be under the influence of alcohol - but by how much? Smelling alcohol on someone's breath is an invitation for a reasonable suspicion that they've probably consumed it. Certainly there are other possible explanations, but consumption is the most likely.

Another consideration to think about, is if a seriously injured (or drunk) player is asked to leave the field of play by the Referee, and that player further damages himself whilst making his way of the field of play, this could lead to serious accusations being made against the Referee for ordering the player to leave the field before being medically assessed by a qualified person.

But we live in a world frightened of litigation. My advice is as follows:

Referees should always exercise extreme care in their choice of words to describe players who may be under the influence of alcohol or drugs, especially in connection with drug influence. In such circumstances, the matter should in the first instance be considered as a team responsibility and suitable attention be drawn to a club official, perhaps suggesting that a player looks too ill to continue/participate or seems to have a problem. Give the captain, coach/manger or a responsible medical person the chance to make this decision, and consult them by suggesting that the player seems to have a problem, and ask THEM to take some appropriate action. It should be pointed out to the team officials that the behaviour of the player might be dangerous to other players or to himself. 

A Referee is given licence to use his common sense, and if a Referee believes that a player may be under the influence of alcohol, there is a huge chance that the Referee will be correct in his assessment of that player. Of course, there is a remote chance that the Referee may be wrong, but that is very doubtful, as a drunk person is usually easy to spot.

It's like giving permission for a player to wear a plaster cast or glasses; it is not a black and white decision. Therefore, if a Referee smells alcohol on a player breath and the player is behaving as if he were drunk, and the team officials take no action, then the Referee should simply not allow him to play. 

Other Referees may wish to allow this player to participate in the game, but that's their prerogative. But my advice (failing sensible action being taken by the player's team) is for Referees to do what they think needs doing, and not worry about getting one decision wrong in maybe 100. 

Alcohol is a suppressant and also a drink which dehydrates people...particularly players of football matches. If a Referee decides that safety is compromised, the Referee should make sure to put this in a report and outline it specifically to the appropriate authority.

Question 4: Are some of the substances used for marking out the lines more dangerous than others?

Answer 4: Yes. Some substances are more dangerous than others. Various practices have been used in the past for the application of white lines to football pitches. The objectives of such practices has been to both reduce labour and materials costs whilst endeavouring to keep the lines visible for a greater length of time. Some of these practices have led to injury and subsequent court action being taken against managers and clubs. Slaked Lime and creosote must not be used.

Question 5: When can players and Referees drink fluids during a game?

Answer 5: Because the balance of water in the body is essential for the health, drinking liquids during a game is not only permitted by FIFA but actively encouraged. The following rules must however be observed so as to avoid disorderliness on the field and prevent injury from missiles being thrown through the air.

(a) Liquids may only be drunk during stoppages in play.
(b) Drinks must be contained in plastic bottles and handed to the players on the sidelines.
(c) It is forbidden to throw bottles or other receptacles onto the field of play.
(d) The goalkeeper may keep a plastic bottle in the corner of his goal.
(e) Plastic bottles may be placed around the field of play approximately 1 metre away from the sidelines and goal-lines but only as long as they do not obstruct the Assistant Referees in the course of their duty.

Thank you for taking note of the above
Source:
J S Blatter
FIFA General Secretary
Taken from FIFA Circular 619 (1997)

If an infraction occurs that involves a player who is drinking whilst on the field of play, the Referee should punish the infraction in accordance with the type of offence that occurred. If the infraction involves the drink or its container, the Referee should view the drink or its container as being illegal use of an object on the field of play.

• Example 1: If a defending player uses the drink container (either by holding it or throwing it) to deflect the ball away from the goal, the object is considered to be an extension of the player's arm. Play should be stopped, a penalty kick should be awarded, and the offending player should be sent off for preventing a goal by deliberately handling the ball.

• Example 2: If the goalkeeper is the perpetrator in example 1 above; play should be stopped, and the match restarted with an indirect free kick to be taken from the place where the ball was when it was struck by the object. The goalkeeper should be cautioned. If the offence occurred inside the goalkeeper's goal area, the indirect free kick is taken from the goal area line parallel to the goal line at the point nearest to where the infringement occurred.

 If no infraction occurs, the Referee should use common sense and inform the player that to avoid disorderliness, liquids should only be drunk during stoppages in play. A caution would be extreme in such cases.

Question 6: Why is it that some Referees insist that a player who has been treated on the field of play leave the field of play after being treated, whilst other Referees are content for the player to remain on the field as play restarts?

Answer 6: Referees deal with injuries by using by common sense within the ‘spirit of the game’ – each incident is different.

1998/1999 Law 5 Amendment: An injured player returning into the field of play can enter from any boundary if the ball is out of play. And on the Referee’s signal. If the ball is still in play, the returning player can only enter from a touchline, and on the Referee’s signal.

2002/2003 Law 5 Amendment: The Referee stops the match if, in his opinion, a player Is seriously injured and ensures that he is removed from the field of play. An injured player may only return to the field of play after the match has restarted.
Reason: - This clarifies the procedure to be followed when a player returns to the field of play following injury.

The goalkeeper is different, because the Law requires a goalkeeper to be present on the field of play for each team, and that is why the goalkeeper is usually treated on the field of play. If the Referee stops play, he can restart it by just dropping the ball to the goalkeeper (a dropped-ball can take place with only one player in situ). But normally, a member of the opposition will offer (in the spirit of the game) to touch the dropped ball back to the goalkeeper. Treating the goalkeeper on the field of play also saves time, because if the goalkeeper had to be treated off the field of play, a colleague would have to take his place in goal. They would then have to swap again when the goalkeeper had received his treatment and was ready to return. It is therefore usually quicker to treat the goalkeeper on the field of play. It is also permissible for any other player, injured at the same time as the goalkeeper, to be treated on the field of play and neither player needs to leave after treatment unless required to do so by the Rules of some Competitions.

If a player is bleeding, he must leave the field immediately to have the bleeding stopped and his skin and uniform cleaned as thoroughly as possible. An injured player may only return to the field of play after the match has restarted.

FIFA instruction 549 dated 2nd December 1994 was the initial instruction advising that players must leave the field of play for treatment. An abridged version reads:

"When play is stopped the referee will enquire of a player if he needs treatment.

If the player does require treatment - can he walk to the touchline unaided? If yes, the player leaves the field of play and then play in restarted. If no, the Referee signals for physiotherapist, with a one arm wave.

The physiotherapist will be given time for his diagnosis/verification of the injury but must be reminded that no treatment is allowed on the field of play.

After diagnosis/verification, the player and the physiotherapist will walk off the field of play for treatment to be administered. The player will only return after a signal from the Referee, and after the match has restarted.

If the physiotherapist considers that the player cannot walk off the pitch, he will advise the Referee who will use the two-handed signal for a stretcher.

Players who refuse to leave the field of play must be cautioned for unsporting behaviour.

Two exceptions to the procedure will apply: (a) a head injury sustained by any player and (b) an injury sustained by a goalkeeper.

With the permission of the referee, a physiotherapist is allowed to attend an injured player on the field of play, during the time that the referee is administering disciplinary action against an offending player".

Question 7:  Prior to the game while checking the teams uniforms and shoes,
can you provide advice or any instructions of how to address the team/coach during youth games.

Answer 7: The Competition Rules should dictate whether or not the players equipment needs checking prior to the start of a game. As a general rule for Youth team games and lower-level games, players’ equipment is not necessarily inspected by the Referee prior to commencement of the game. A visual check as the Referee enters the field of play usually suffices. Nevertheless, if the Referee is suspicious about the safety of a player’s equipment, he can inspect at anytime (including before the game starts). If the Referee needs to advise the youth team coach before the game, something along the lines of the following would suffice:

"Please can you ensure that no jewellery of any sort is worn, unless suitably bandaged. All players must wear shin-pads, and I would be grateful if you could take a quick look at your players’ studs".

The Referee is within his rights to inspect all of the players’ equipment prior to a game, but this is not always done, and neither is it necessary (or expected) at the lower levels. The Referee is ultimately responsible for the safety of the players. Therefore it is his individual choice on how far he needs to go when inspecting equipment.

Question 8: Can you explain why players must have their shin-pads covered completely by their socks? In my daughter's team, they all prefer (for some unexplained reason) to wear the socks half-down, or they don't have tie-ups to keep them up. When I asked for the players of both teams to cover shin-pads up, I was accused (by my daughter after the game) of being pedantic! Is it a hang-on from when shin-pads were loose and liable to fall out if the socks were not fully covering them?  Maybe that's why she accused me of being pedantic!

Answer 8: (From the webmaster)  I've got a lump on my shin the size of an egg - a legacy of a hard challenge between me and a goalkeeper nearly 30 years ago! And I was wearing shin-pads. The socks help to keep the shin-pads in place during a hefty challenge, and they also serve to cushion against those little knobs that are on some shin-pads (there to grip the sock better). The socks also form a pad against the shin-pad material of which some plastic versions are rather hard. Although some players seem to think that ‘half-mast’ socks may look ‘trendy’ or ‘macho’, they do nothing to provide maximum protection to their shins (and other players). And as such, the Referee also has a duty in protecting the players from themselves!

I have 3 girls myself, and I know that such advice will probably "go in one ear and out the next" – but in my case I just flash my ‘lump’ and they run away in disgust! Yuck!!!!!!!!

Better to be pedantic than to regret any damage because you wanted to be ‘in with the girls!’.

If a player received a nasty injury because of the exposure of an opponent’s shin pad, you could be on ‘dodgy’ ground.

Question 9: Are goalkeepers allowed to dive at the feet of oncoming attacking players?. Surely, if there is a collision it is up to the goalkeeper as to what he does.  I wouldn't penalise an attacking player if he attempted a diving header.

Answer 9: Although goalkeepers must be especially protected by Referees, an attacking player is allowed to challenge for the ball and may attempt to play the ball as long as it is not in possession of the goalkeeper - providing that (in the opinion of the Referee) the challenge on the goalkeeper (or by the goalkeeper on the oncoming attacker) is not dangerous (reckless, careless or using excessive force) - then it should be OK.

If a goalkeeper wants to dive recklessly at the feet of an attacking player, then he should take the consequences if he gets injured. He should also be penalised if the dive ‘fouls’ the oncoming-attacking player.

It is virtually impossible for a Referee to protect a goalkeeper against acts that the goalkeeper does himself. It would be impossible to do so. Nevertheless, after the first occasion that a ‘mad’ goalkeeper dives at the feet on an attacking player, an astute Referee should have a ‘quiet word’ with the goalkeeper, and offer him some advice.

One last thought - always err on the side of safety - football comes second when it comes to the well-being of players (including mad goalkeepers).

Question 10: A long ball is kicked over the defence. An attacking player runs after the ball. The defending team’s goalkeeper reaches the ball first, and gives it a big kick. The attacker, who by this time is in close proximity, is hit full in the face by the ball and falls bleeding to the ground in some discomfort.   Meanwhile, the ball ricochets off the attacker, over the goalkeeper, and drops into the net. GOAL!
It is apparent that the unfortunate attacker has broken his nose as blood is leaking onto the grass.
Should the Referee allow the goal?
Or should he have stopped play immediately for the head injury?

Answer 10: Following a head injury, the Referee will normally very quickly anticipate where the ball is travelling and make a judgement as to whether he should stop play immediately or allow the ball to naturally make its own way out of play if the distance-delay is not great. It is difficult to give an answer to this question without actually being there. But it sounds as though there was only a very small time delay before the ball entered the goal, and therefore out of play.  In such cases the Referee may allow play to continue, but only if the delay is very short (and the head injury is not immediately life threatening).

Of course, if you take the question to its extreme, and the incident happened near the half-way line, then because of the greater distance that he ball has to travel, the chances are that an astute Referee would stop play immediately.

After all, it is only game, and it only takes a few seconds to die!

Question 11: I recently watched a youth game that was decided by a controversial goal.
The events leading to the goal were as follows: the left ‘winger’ ran down his wing in possession on the ball, cut into the box was confronted by the goalkeeper who saved the shot. The left ‘winger’ fell over the goalkeeper and claimed a penalty. The Referee waved play-on. The left ‘winger’ then feigned injury by rolling around the floor just inside the 18 yard box (penalty area). The goalkeeper cleared the ball up field into the opposition half. The ball was then cleared on the volley (back into the half from which it came) by a defender to his colleague on the right wing. The right winger (from an onside position) raced onto the ball. The left winger was still prostrate on the floor inside the penalty area. The right winger raced into the penalty area and was ‘closed down’ by the goalkeeper. He then passed the ball across the penalty area to the left winger who miraculously recovered from injury to tap the ball into an empty net.
I know that to the letter of the law the goal was legal, but the actions of the left winger left a "bad taste in the mouth". Should any action have been taken against the left winger?

Answer 11: Thank you for your question Dave.

Like you, I dislike the playacting antics of the modern player. In my time, if a team-mate made a fool of himself by such acts, we would have castigated him for not committing himself to the cause of the ‘team’ by not ‘getting on with it’ and getting back to defend.

As far as Law interpretation is concerned, I believe that this is looked as at being a ‘second phase’ in the play action – and as such, there is nothing in the Laws to say that this player is breaching the offside criteria (so long as the left winger was not nearer to both the ball and the second last defender when the ball was passed to him by his colleague the right winger.). The goal cannot therefore be disallowed.

Nevertheless, advice being received over the past few years encourages Referees to discipline players who feign injury. It is very difficult for a Referee to be certain that an injury is being feigned, and Referees tend to give players the benefit of the doubt. But there is nothing to stop the Referee in this scenario from awarding a yellow card to the left winger for his ‘cheating’ actions. (WebMaster)

Question 12: Can a Referee by held responsible for an injury occurring to a player?

Answer 12: There was a case in 2002 concerning a rugby front-row player Richard Vowles, 29, from Llanharan, south Wales, who broke his back in a match playing for the village side in January 1998. In the High Court in London, the Wales Rugby Union (WRU) admitted responsibility for the match Referee's failure to opt for uncontested scrums, which caused the collapse while Mr Vowles was playing hooker in the scrum.

See: http://news.bbc.co.uk/sport1/hi/rugby_union/2573291.stm

It is only a matter of time before a similar case hits the streets in the World of Football.

Thousands of players are badly injured every year by dangerous foul play or unsafe playing conditions. Careers are ruined and thousands of pounds lost in wages, yet very few football players claim compensation.  When players play football, they accept the risks of things like an accidental clash of heads. But they don't accept the risks that someone might throw a punch or kick them when the ball isn't there or that a tackle on them is made with the sole intention of committing bodily harm or that the facilities being used are unsafe.

As far as the Laws of Associated Football are concerned.

Decision 1 of (Laws of Associated Football Law 5 states that:

"A referee (or where applicable, an assistant referee or fourth official) is not held liable for:

• any kind of injury suffered by a player, official or spectator
• any damage to property of any kind
• any other loss suffered by any individual, club, company, association or other body, which is due or which may be due to any decision which he may take under the terms of the Laws of the Game or in respect of the normal procedures required to hold, play and control a match."

Whether this holds any sway in Court, is for the Court to decide.

The advice from the FA, is that there is no specific advice for Referees where a player seeks to take legal action against another player. The Referee will not be involved unless the law requires him to attend any Court Proceedings. If this is the case The County Football Association, The Football Association or the Referees Association may offer advice. This is always done on a case by case basis.

Your question: "Would the Referee be liable for legal action?"

Is one that only a Court of Law can provide. Most Referees put players’ safety at the top of their agenda in every game. In fact they sometimes go too far the other way to prevent injuries.

Question 13: During a league match, immediately after the kick off a team captain complains to the referee that an opponent is drunk. What action should the referee take?

Answer 13:  Referees should always exercise extreme care in their choice of words to describe players who may be under the influence of alcohol or drugs, especially in connection with drug influence. In such circumstances, the matter should be considered as a team responsibility and suitable attention be drawn to a club official, perhaps suggesting that a player was too ill to continue/participate or seemed to have a problem.
(Source Referees Association)

Question 15: The Referee stops play for a foul. On closer inspection, the Referee notices that that the player who committed the foul is not wearing any shin guards. The Referee asks this player to leave the field of play to put on some shin pads. The victim of the foul is injured, and has to be treated outside of the field of play. Before play is restarted, the Referee is asked to ensure that the defensive wall is the correct distance away. Whilst the Referee is managing this, the two players who have left the field of play, ask to re-enter. What should the Referee do?

Law 5 states; " An injured player may only return to the field of play after the match has restarted."

Answer 16: The Referee should remind the Blue Team manager that revealing such confidential information in a non- professional setting may qualify as a breach of privacy and opens up the possibility of a civil suit.
Individuals with infectious diseases have the same right to confidentiality as any other person. It is the player's responsibility to maintain strict personal hygiene, as this is the best method of controlling the spread of infectious diseases.

FIFA are proactive in promoting HIV/AIDS information and prevention campaigns. Referees should treat every person on the field, as they would do in any area of society, with the assumption there is a possibility that any player may be HIV positive. The referee should prevent a player who is bleeding profusely from taking any further part in a match until he has been adequately treated and the bleeding has stopped. This is a straightforward duty for the Referee perform.

A Referees should serve to be a sports ambassadors for HIV prevention, the same as he is for all the other duties and responsibilities he is expected to uphold. If the Blue Team manager persists in his attentions to you, he should be told that you will be reporting his comments to the FA. The diagnosis or confirmation of such afflictions is far beyond the capabilities and responsibilities of a Referee.

Question 17. A player breaks his nose in a collision and becomes irritated by comments from the opposition bench as he leaves the field of play. With his nose bleeding like a waterfall he tries to confront the bench and throws a handful of his blood at the principle person making the remarks, who in turn becomes unhappy by this. What action should the Referee take ?

Answer 17 (From The Referees' Association England April 04). This should be considered the same as a striking offence, and the player banned from any further participation in the game. Also, the main culprit on the bench should be dealt with in accordance with law, depending on his actions and words.

Question 18: Should a trainer be allowed to put muddy water (from the 'bucket') onto a bleeding wound?

Answer 18: Although the Referee has no authority to stop such an action, he can certainly strongly advise for the muddy water NOT to put on the bleeding wound - and I have done so many times.

Question 19: Is there any advice about lightening?

Answer 19: Using the ‘30-30 ’ rule, the distance of the storm should be estimated before allowing play to continue. This rule is one of the most practical techniques for estimating the distance to lightning activity and is based on the fact that light travels faster than sound.

When lightning is sighted, count the time until thunder is heard. If that time is 30 seconds or less, the thunderstorm is within 10km and is dangerous. As most experts believe that the ‘safe ’ distance is no less than 10km,,all people at risk should be seeking, or already inside safe shelters. This is the time at which matches should be suspended.

Click here for a the comprehensive lightning policy advice from the NSW Soccer Federation:

Or here for the USSF advice.

Question 20: Who should be allowed on to the field of play to administer treatment for an injury (and how many of them)?

Answer 20: Of course, this very much depends at what level you are Refereeing at, and the type of injury sustained. But as a general rule, there is some guidance in the section of the Laws of Association Football (LOAF) chapter entitled "Additional Instructions for Referees, Assistant Referees and Fourth Officials", which stipulates the following:

after questioning the injured player, the referee authorises one, or at most two doctors, to enter the field to ascertain the type of injury and to arrange the player's safe and swift removal from the field.

Add to this the stretcher-bearers, and the number grows.
Of course, if it takes 10 doctors (or medics) to save a life, then all the rulings above go out of the window.
At the top games in England, each Home Club must have a Team Doctor, a Crowd Doctor and a physiotherapist available throughout the game, and for a reasonable time before, and after the game. No person other than the participating Club's Team Doctor and physiotherapist are permitted to treat players on the field of play.
As you get lower down the footballing levels, teams should have in attendance, the holder of an Emergency Aid Certificate approved by the FA.
Oh -and if the ambulance arrives, then of course, the paramedics and duty doctor may also make up the numbers.
If you are interested in reading more on this subject, then you an do so by visiting the FA web site here, and downloading  'The FA Handbook', where detailed medical information can be found in the Appendix to the handbook. 

Question 21: Should I allow players to play when wearing glasses? Is this a dangerous item that can crack and cause cuts or would I be "discriminating" by not allowing them to do so!


Answer 21: It is down to the Referee's discretion if a player can wear glasses as he or she has to decide if they pose a danger to the player or the other players. There are a number of special sport glasses that are available through all leading opticians, which are suitable for playing football in. 

Alternatively players should wear contact lenses. Wearing glasses does not come under Law 4 in FIFA Laws of the Game 'Players Equipment', this is why the decision comes down to the referees discretion.

The advice we are given from our FA (FAMOA Journal June 2004) here in England is as follows:

Football is a contact sport and as such is a moderate risk for eye injuries. Players in preference to contact lenses sometimes wear spectacles or goggles.

Polycarbonate lenses are the most important property of all protective spectacles or goggles. Polycarbonate is virtually unbreakable, and will sustain the impact of a ball or finger. An elasticised band and not just temple pieces should secure the frame. Players must have a means of securing the spectacles or goggles tightly to the head so that they will stay in place during play. A frame with temple support only will not hold tight enough, and a jab from a finger could lift the frame off, and make its way to the eye.

Although sports eyewear is intended to offer the best protection available, there is always the possibility that the wearer may sustain an eye or facial injury due to severe impact or because of the nature of the athletic activity,

Referees should ensure that if a request has been made to wear glasses or goggles, that they must not constitute a danger to himself or to any other player. We are anxious not to put obstacles in the way of players who wish to participate in the game but neither must we compromise safety.

Stay safe.

Julian Carosi www.CorshamRef.org.uk

Happy reffing.