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Players past and present together with a host of medical experts are queuing up to support FIFPro's calls for the implementation of a well-defined concussion protocol in football that puts health and safety first.

Former Manchester United and Real Madrid striker Ruud van Nistelrooy said "action is needed" after the incident which saw Uruguayan Alvaro Pereira suffer a potentially concussive blow to the head in the recent World Cup clash against England.

"I think the reason why you want a protocol is to protect the players against themselves," Van Nistelrooy told US sports channel ESPN.

"You can see this very emotional player (Pereira) who does not want to come off. He can't make a rational decision on his health at that moment and time."

"I think it's very clear now that concussions and head injuries are a concern in football and they need to be dealt with because it can be dangerous for players."

In an interview with Associated Press, Belgium's World Cup captain Vincent Kompany recalls the time he played out a World Cup qualifying match against Serbia last year with a broken nose, a fractured eye socket and light concussion, "No one in my family was very happy with the fact that I kept on playing."Kompany-concussion

"I would always listen to what the medical staff has to say but, then again, I would do the opposite of what the medical staff would say."

"You have to take emotions and adrenaline into account," Kompany said. "Unless someone puts on the emergency brake, you are not going to do it yourself."

Pereira has since apologised for overruling Uruguay's team doctor who called for a substitution, "I said 'sorry' a thousand times to the doctor because I was dizzy. It was that moment your adrenaline flowing in your body, maybe without thinking ... what I really wanted to do was to help get the result."

Kompany and Pereira raise a contentious point. To remove the emotion and any vested interests in such a situation, FIFPro insists independent medical professionals are required to conduct a sideline concussion assessment, whereas FIFA maintains the ultimate responsibility lies with the team physician.

Former US national team captain Alexi Lalas agrees with FIFPro and said an independent approach is the only way forward, "You have to have someone who's unbiased in that situation making those medical decisions, who doesn't care about the score or if you're going to win the game."

"It's a disgrace that we don't have something in place right now. I think things will get done, but more importantly they have to get done for the future of this game."

Lalas adds, "Whatever game you're playing in, it will end and the rest of your life will happen. Most of it will happen without soccer in it and you want it to be good and you want to be healthy and if you have a family you want to experience things with your family.

"But if it's all because you got hit in the head and we didn't have a protocol in place, with what we know now, then that's ridiculous."

dempsey-noseReaction to the Pereira incident has sparked a global debate pushing the health and safety of the players to the top of the agenda. Italy's national team physician Enrico Castellaci said, "There should be standardized protocols – at the national, European and international levels and that still isn't the case."

Even FIFA's medical chief Michel D'Hooghe conceded on the need to legislate procedures for managing suspected concussions, "I think we can make that step forward, from guideline to rule, and we will do that."

One of the world's most outspoken players on this issue is Taylor Twellman, a former US international striker whose career ended after suffering seven concussions,  which still affect him to this day.

"It's disappointing," Twellman said. "Watching this (Pereira incident) shows you one thing. This is barbaric treatment of players."

"Even Clint Dempsey's broken nose (in the match between USA and Ghana), he came over to the sideline. Who's to say that's not a concussion."

"FIFA has to address this. It's 2014. It's not 1950. And the most important thing to remember is this: It's not the concussion. If Pereira gets another one there's something called second impact syndrome. That's fatal."

"You're now playing with people's lives. I couldn't care less about knees, arms, ankles you get one brain. And right now, FIFA should address it. Otherwise, it's going to take someone losing their life."


Photo (top left): Immediate reaction after Alvaro Pereira takes a blow to the head in Uruguay's World Cup clash with England

Photo (top right): Vincent Kompany in visible discomfort after sustaining a head injury during a Belgium World Cup qualifier

Photo (bottom right): US star Clint Dempsey breaks his nose in the World Cup match with Ghana