Chelsea's handling of the head injury suffered by goalkeeper Thibaut Courtois on Sunday has come under fire by a British brain injury association that questioned whether the Blues followed all of the Premier League's regulations.
Courtois was knocked to the ground in a collision with Arsenal's Alexis Sanchez but remained in the match for an additional 14 minutes before being replaced.
Chelsea followed new Premier League rules by immediately assessing Courtois, though the team's medical staff made the decision to let Courtois play on. It wasn't until later, when bleeding from Courtois' ear was discovered, that the Belgian was removed and taken to hospital.
In addition to team doctors assessing players on the pitch, the Premier League's guidelines also call for an independent "tunnel doctor" to "support" the team doctor's in assessing head injuries. However, Headway, a British organisation and charity, expressed concern that Chelsea failed to follow all of the instructions.
"This incident calls into question whether these rules are working effectively. For example, was the third 'tunnel doctor' consulted on the decision to allow Courtois to continue? If so, did he or she agree that there was no suspicion of concussion?" Headway asked in a statement.
Courtois has said he's "feeling better" after leaving hospital, and Chelsea has not said he was diagnosed with a concussion.
Headway added that "the fact that the bleeding only became apparent 15 minutes after the injury also demonstrates the evolving nature of concussion and highlights why a safety-first approach must be taken with all head injuries."
Criticism of how the Premier League handles head injuries has increased over the past year following several incidents. In September 2013, Everton's Romelu Lukaku said he couldn't remember scoring a goal after he was knocked unconscious against West Ham. Then in November, Lukaku's knee collided with Tottenham goalkeeper Hugo Lloris, who was briefly knocked unconscious but stayed in the match.
Head injuries in the sport gained even more attention in this summer's World Cup final as Germany's Christoph Kramer played for 15 minutes after suffering a head injury before having to be helped off the pitch. He later said he could not remember playing in the match.
Taylor Twellman, an ESPN analyst and a former United States international who retired in 2010 because of complications from multiple concussions, also said the guidelines do not go far enough to protect players.
"I think what's important to realize is that after the [Hugo] Lloris incident last year, I think [Romelu] Lukaku was another incident last year and obviously what happened at the World Cup, there's a need for a world governing body like FIFA to address it and everyone else will follow," Twellman said.
"The problem is this: the EPL yesterday -- how is Courtois' incident any different than Lloris? It's not. Both happened on the field, both were blatantly obvious yet this year, with 'new' concussion protocol, the same mistakes were made. Less than a minute of assessment and Courtois was back on the field.
"And there's a neutral doctor on the touchline. How is a neutral doctor on the touchline any different from a doctor for the team? They have the same vantage point, they have no different view as opposed to the rest of us watching the game with six, seven or eight different cameras. If that neutral doctor is watching via a camera, Courtois is immediately off the field. So there's real inconsistencies with the protocols in the EPL."
Twellman started the ThinkTaylor Foundation to increase awareness that head injuries have on footballers. He said he was "not shocked" that the Chelsea doctors allowed the goalkeeper to play on.
"They came out to say they addressed it and they were really going after it, when in reality they were just trying to cover it up with some bogus 'protocol' that has no real base to it at all," Twellman said.
Twellman said a star player would have to be suffer a massive injury for more action to be taken.
"We shouldn't need Wayne Rooney to be fatally injured in order for us to wake up," the former New England Revolution star said. "We already know what the answers are, and [soccer] really needs to be ahead of the game. It just goes to show you how far behind everyone is when Chelsea comes out and says, 'Oh, he went to the hospital and he had a CT scan and an MRI and an X-ray and he's fine,' when science tells us that none of those tests shows a concussion.
"It's mind-boggling to me that we're in 2014 and we're getting 1950s, 1960s answers with regard to traumatic brain injuries. It makes no sense."