New Protocols & Modified Substitution Rules Regarding Suspected Head Injuries

New Protocols & Modified Substitution Rules Regarding Suspected Head Injuries

New protocols & modified substitution rules regarding suspected head injuries

Summary fact sheets (.pdf)


CHARLESTON, S.C. (Dec. 18, 2015) - New protocols have been introduced and substitution rules modified regarding head injuries, per U.S. Soccer's new concussion initiatives.

These initiatives will take effect on Jan. 1, 2016, in addition to the requirement of healthcare professionals at all tournaments with 64 or more teams at U-11 and older age groups. Healthcare professionals are considered licensed professionals, such as an athletic trainer certified (ATC) or physician (MD/DO), with skills in emergency care, sports medicine injuries and experience related to concussion evaluation and management.

The initiatives are included within Recognize to Recover, which U.S. Soccer recently announced as its branded, comprehensive player safety campaign. Currently, the program includes information and guidelines about concussions and heat-related illnesses. More topics will be introduced next month.

Protocols following suspected head injuries - as of Jan. 1, 2016

U.S. Soccer recommends and US Club Soccer requires the immediate removal of any player who sustains a significant blow to the head or body, who complains about or who is showing symptoms consistent with having suffered a concussion.

For events with an on-site healthcare professional, this professional will perform applicable testing - SCAT3 or Child SCAT3 and modified BESS - to evaluate players on the field/sideline. Any player suspected of suffering a concussion will not be allowed to return to play until he/she is cleared by the healthcare professional. No coach, parent/guardian or player may overrule the healthcare professional.

If a coach attempts to allow a player who had been removed from a game for concussion assessment and who has not been cleared to return to play by the on-site healthcare professional, the referee should immediately stop play, direct the player to leave the field, instruct the coach to select a substitute and issue a warning to the coach. If a coach persists, the referee is entitled to take necessary disciplinary measures against the coach.

For events without an on-site healthcare professional, no coach can permit a player who has been removed from a game for concussion suspicion/assessment to return to play until he/she is cleared by a healthcare professional. Referee responses and actions outlined in the previous paragraph should be taken against any coach who persists in trying to re-insert the player into the game without proper clearance by a healthcare professional.

Modified substitution rules (for competitions without unlimited substitutions) - as of Jan. 1, 2016

Any player suspected of suffering a head injury may be substituted for evaluation without the substitution counting against the team’s total number of allowed substitutions during the game.

If the player is evaluated by a healthcare professional or certified athletic trainer and determined to not have suffered a concussion, the player may re-enter the game at any stoppage of play. This player must replace the original substitute, and this medical substitution will not count as an official substitution. Additionally, the temporary substituted player may re-enter the game as a regular substitute.

IMPORTANT: Please distribute these fact sheets to your coaches. Leagues and sanctioned tournament hosts should send these materials to member clubs and teams, as well as your referee assignors. US Club Soccer also recommends having these fact sheets readily available at competitions and to discuss with referees before games.

Questions may be directed to your respective US Club Soccer membership services representative.





A National Association member of the U.S. Soccer Federation, US Club Soccer is an organization committed to the development and support of soccer clubs in the United States.


US Club Soccer offers youth and adult registration, league- and cup-based competition platforms at the recreational and competitive levels, as well as a variety of other programming, including the Olympic Development Program-sanctioned id2 Program and Player Development Programs.


Through US Club Soccer, all of a club's programs - recreational, competitive and adult - are able to be united under one organizational umbrella, creating a "members for life" culture within each club. US Club Soccer is sponsored by Nike.



USSF has a FAQ web page:  

And here is the complete PDF of U.S. Soccer’s concussion initiatives: