When a Premier League player takes a blow to the head, the team doctor, medical coordinator and medical video operator classify the incident during the match. Where there is evidence of concussion the team doctor must take the player off. Where a concussive injury cannot be entirely and confidently ruled out, he should come off as well.
When a head injury medical assessment is required
A club must carry out a head injury medical assessment whenever it is suspected that a high velocity object or force hit the player's head directly, or hit another part of his body and carried through to his head, or when other visible signs mean a closer check is needed. The trigger is suspicion and visible evidence, not a confirmed diagnosis.
During the match, the team doctor, the medical coordinator and the medical video operator must stay close to the club's medical team and speak to each other so each incident is categorised. Those exchanges, including whether they agreed, must be recorded on the league's electronic system within 24 hours of the final whistle.
Before each season, the team doctor, the medical coordinator and at least two other medical staff at every club must complete the league's video replay training.
What each category means
Here are the three categories and the required response.
| Category | What it means | What happens |
|---|---|---|
| Code Red | Evidence the player has or may have a concussive injury | The team doctor must take him off |
| Code Amber | No conclusive evidence, but a high velocity impact or other visible signs | An immediate assessment, then the doctor's clinical judgement |
| Code Green | No evidence of either | No assessment required on that basis |
The split between Code Red and Code Amber turns on what the video review or direct observation shows at that point. Code Red fixes the outcome straight away. Code Amber leads to an immediate assessment, with the doctor then deciding whether the player should come off.
Code Green means the incident does not meet either of the first two categories and there is no other evidence of a head injury. In that category, the incident does not trigger an assessment on that basis.
Signs looked for on video and signs that force immediate removal
On video, clubs look for possible signs of concussion that include motor incoordination or ataxia, no protective action, evidence of a seizure or convulsion, tonic posturing, lying motionless, and a clearly dazed or blank look. Those signs can come from video review or direct observation.
There is also a listed group of acute signs that means the player must be permanently removed straight away, starting with confirmed or suspected loss of consciousness. The protocol also applies the principle of "if in doubt, sit them out": if a concussive injury cannot be entirely and confidently ruled out, the player should be taken off and should take no further part in that match or training session.
How the assessment is structured before and after match action
The process starts before match day. Every player on the club's squad list must have had a baseline concussion assessment, either when he was recruited or at intervals no greater than two years apart, and the result must be uploaded to the league's system within seven days. If the player's English is not good, the baseline assessment should be carried out in his first language.
The on-field check is only one part of a four-stage process. It is followed by post match assessment and follow-up, then long term follow-up, while the baseline record must already be accessible on match day.
FAQ
What is the Premier League concussion protocol?
It is a matchday and follow-up process for identifying, classifying and assessing possible concussion after a blow to the head. It uses three categories, requires communication between the doctor, medical coordinator and video operator, and applies a remove-the-player rule where concussion is shown or cannot be ruled out.
Who decides if a player comes off after a head injury?
The category is discussed during the match by the team doctor, medical coordinator and medical video operator. For the removal decision itself, Code Red means the team doctor must take the player off, while Code Amber goes to an immediate assessment and then the doctor's clinical judgement.
What is a Code Red head injury in the Premier League?
Code Red means the video review or direct observation shows the player has or may have suffered a concussive injury. Once the incident is placed in that category, the team doctor must remove the player.
Do Premier League players have concussion baseline tests?
Yes. Every player on a club's squad list must have a baseline concussion assessment either on recruitment or at intervals no greater than two years apart, and that record must be uploaded within seven days and be available on match day.