LONDON (AP) — A day after goalkeeper Hugo Lloris was briefly knocked unconscious but continued to play, Tottenham defended its decision despite criticism from FIFA and the football players' union.
Lloris was knocked out Sunday when his head smashed into Everton striker Romelu Lukaku's knee during a Premier League match. The goalkeeper was treated on the field but, despite medical advice and not remembering the incident, he was allowed to continue playing.
"The player should have been substituted," FIFA chief medical officer Professor Jiri Dvorak said. "The fact the other player needed ice on his knee means it's obvious the blow was extensive.
"It's a 99 percent probability that losing consciousness in such an event will result in concussion."
On Monday, Tottenham said that brain scans gave Lloris the all-clear. But the extent of the injury would not have been known during the match.
"When he has been knocked unconscious, the player himself may not see the reality," Dvorak said.
By allowing Lloris to finish the match, the FIFPro players' union said Tottenham manager Andre Villas-Boas and his staff "failed to protect the goalkeeper."
"FIFPro condemns that the health and safety of players are left to coaches/trainers or even to players themselves," FIFPro medical advisor Vincent Gouttebarge said.
"Medical professionals should be aware of any relevant medical guidelines and apply them in order to empower the health and safety on the field. The health and safety of the players should be the No. 1 priority and should prevail against any other matters."
English Football Association regulations say that a player who is treated after being "immobile and unresponsive to verbal commands following a head injury" should not return to action that day. But if the player experiences "a transient alteration of conscious level," he can resume playing.
"If there is any doubt, keep the player out," Dvorak said.
The Professional Footballers' Association in England said that players who suffer severe head injuries or loss of consciousness should automatically be taken off.
"When treating a player on the pitch, it can be very difficult to determine the severity of a head injury," PFA deputy chief executive John Bramhall said. "It is important to take the pressure off the players, club medical staff, and the manager — removing the need for them to make a very difficult decision."
Tottenham, however, saw nothing wrong with its decision to allow Lloris to continue.
"Once the relevant tests and assessments were carried out we were totally satisfied that he was fit to continue playing," said Wayne Diesel, Tottenham's head of medical services.
Football has been subjected to less focus on how it handles concussions than other sports, which experience more impact injuries.
In August, the NFL agreed to pay $765 million to settle lawsuits from thousands of former players who developed dementia or other concussion-related health problems.
More than 4,500 former players, some of them suffering from Alzheimer's disease or depression, accused the NFL of concealing the long-term dangers of concussions and rushing injured players back onto the field.
Rob Harris can be followed at www.twitter.com/RobHarris