Germany’s Christoph Kramer lies on the pitch after getting hit in the face by Argentina’s Ezequiel Garay’s shoulder during the World Cup final soccer match between Germany and Argentina at the Maracana Stadium in Rio de Janeiro, Brazil, Sunday, July 13, 2014. (AP Photo/Natacha Pisarenko) ORG XMIT: WCDP124 (Natacha Pisarenko)

Saying that FIFA is acting as a proverbial ostrich by putting its head in the sand is a kind way to put it, for FIFA. Not so kind a comparison for ostriches.

By the way, I worked with ostriches at the Hai Bar Nature Preserve outside of Eilat, Israel for 3 months and never saw any of them put their head into the sand. Just saying. They did get their head very low to the ground – but still above the surface – when looking after chicks.

Many of you may be aware that in the final World Cup game, a German player, Christoph Kramer, received a brutal blow to the head. He continued playing for about a quarter of an hour before “slumping to the ground”. It was at this point that the geniuses on the sideline came to the brilliant conclusion that Mr Kramer may have suffered from a concussion. A colleague alerted me to this story just a couple of days after it happened when I published my latest post on concussions which concerned yet another World Cup head injury.

There is not anything new to say from a neurobiology point of view. As I have said before, we should use head trauma, not immediate symptoms of a concussion, as a trigger for removing a player. There may not be any objective sign of a concussion present after a blow to the head which nonetheless triggers a dangerous cascade of intracranial events that ultimately damage brain health. The decision whether to take someone out of a game should rest entirely on the head trauma. If this results in a few extra minutes lost for head traumas that do not damage the brain, that is a consequence that is easier to live with than the converse – not taking out a player who does suffer intracranial damage. In making the assessment of a head trauma, use video re-play. Moreover, put the decision in independent hands. The player’s, coach’s, and team’s opinions should not count, at all. Obvious.

An independent viewer who does not answer to either team or to league offices should make the determination of whether to take a player out or not. For a couple of reasons, I do not believe that it is important that the person making the determination has medical training. First, the trained individuals have been doing an outstandingly bad job of showing the value of their trained judgment. See for example Dr Pan’s handling of Mr Perreira. Second, we don’t know which head traumas lead to long-term consequences and which do not. I am not sure how the MD degree resolves that essential hole in our knowledge.

The prompt for this post, several weeks after the incident involving Mr Kramer, is the news that seven former NFL players “have asked an appeals court to intervene in the proposed settlement” between former NFL players and the league. Let’s do a brief recap at this point:

• NFL players filed a class-action suit against the NFL.
• NFL players won a settlement for $675 million.
• The judge in the case, worrying that $675 million was not enough, did not accept the settlement.
• The NFL agreed to a settlement without a monetary cap.

The NFL players who have asked the court to intervene are concerned regarding some of the payout details such as compensation for CTE diagnosed before but not after the date of the agreement. The details are less important than is the obvious: Does FIFA follow the news? Are they blind to the writing on the wall?