The announcement yesterday by the ECB's chief medical officer, Dr Nick Peirce, for concussion substitutes to be allowed in county cricket matches highlights again the safeguards needed in professional sport as more and more information is made available about the long term implications of concussion injury.

On the same day the former professional footballer and manager Ian Dowie, writing in a national paper, commented that he suffered concussion "maybe 50 times...but played on". Much has changed since Dowie terrorised defences in the 80s and 90s. Now all professional sports, not just heavy contact ones like rugby, are addressing this issue.

I wrote a short piece on this topic for a leading sports physician insurer two years ago and the points made then still apply today.

Leading medical experts will argue that you should never tell a professional athlete that they have fully recovered from a concussion injury and the decision is instead around what is an acceptable level of risk after such injury. Governing bodies in sport and clubs themselves need to keep up to date on research and literature and ensure:

• appropriate guidelines and protocols are in place
• athletes are fully informed of the material risks relevant to them in having a concussion injury
• athletes give their informed consent before returning to play
• all discussions are clearly documented in the medical records.

Athletes will often want to carry on after injury but it is the duty of treating doctors to remove players from the field of play where appropriate and ensure they are fully informed of any risks before returning to play.

County cricket will use concussion substitutes this summer as the sport continues to strengthen its safeguarding against head injuries.

A like for like replacement will be allowed when a player suffers a serious head injury forcing him to retire.

https://www.telegraph.co.uk/cricket/2018/03/21/county-cricket-use-concussion-substitutes-summer/