A year ago today, tragedy was averted at a small field in Austria. Dutch giants Ajax were playing a warm-up match against Werder Bremen and trailing 2-1 after 70 minutes. All of the sudden, Abdelhak Nouri, the gem of the famed Ajax Toekomst (their youth academy), fell to the pitch. At first it looked like he was merely exhausted, or perhaps he had the wind knocked out of him. Play stopped immediately, and Nouri was quickly visited by a qualified medic and received the care he needed. He was rushed to the hospital and ended up making a full recovery from what was a rare occurrence of his cardiac arrhythmia, which was well known to the Ajax medical staff.
That is what should have happened. What actually happened is far worse. Appie, as he is known, fell to the ground in the 71st minute. His heart rate decreased so rapidly, causing his brain to be critically deprived of oxygen. It took almost 40 seconds for play to be stopped so that the one medic could come to him on the field, while many players crowded around. It took 9 minutes for the ambulance to arrive, and it took 13 for the ambulance to depart. The medical staff did not perform CPR or use the defibrillator that would have mitigated the damage. At that point, Appie had taken his last step on a football field, and possibly his last step ever. By the time he was lifted into the ambulance, he had suffered irreversable brain damage due to the lack of oxygen. Somehow, despite multiple medical reports of a possible heart issue in his medicals with Ajax and the Dutch FA, his cardiac issues were unknown by the medical staff. Nouri has been in a coma for the past year, and his prognosis is not good. Doctors believe it is unlikely that he will ever come out of his permanent vegetative state.
Ajax recently came out and took full responsibility for the inadequacy of their response when Nouri collapsed. “We recognize our responsibility and liability for the consequences of this…for a long time we were convinced that Abdelhak had received the best possible care on the field,” said general manager Edwin Van der Sar, while breaking down in tears at a news conference.
Perhaps the most astounding aspect of Appie’s tragedy was that the Dutch Football Association (KNVB) had found his minor heart condition during “a routine screening in 2014,” yet Ajax chose to ignore that medical report, despite the KNVB “[informing] Ajax in writing” of this discovery. Nouri never got the follow-ups and closer attention that he merited. That clear incompetency, combined with the shocking on-field lethargy, ended up robbing the world of a bright talent.
With Ajax’s admission of liability, the question is posed: how many other footballing nightmares could be averted? Even in instances when death is not the worst case scenario, the general lack of medical competency has been clearly on display. When Moroccan winger Nordin Amrabat was knocked unconscious against Iran in their opening match of the World Cup, his medical staff poured water on his head and slapped him on the head, before ushering him back onto the field. Amrabat was clearly woozy and unable to walk unassisted in the first minute after his collision, yet he was somehow permitted to play on.
In a similar incident, Romelu Lukaku’s knee collided with Tottenham keeper Hugo Lloris, knocking the latter unconscious. A stretcher was brought onto the pitch, but Lloris was somehow able to convince his medical staff that he should continue to play. It was later revealed that he had no memory of the incident. His manager, Andre Villas-Boas, lauded Lloris’ “great character and personality” that he displayed by requesting to stay in the game. This was a terrifying injury. Watching the video, it is clear that Lloris’ head snaps back at a fast pace before colliding with the turf, and the fact that it took him minutes to get back to his feet should have been enough to merit his withdrawal.
All of the above incidents are unacceptable in the modern day. While professional sports have been notoriously slow at recognizing the severity of injuries, cerebral or otherwise, there is no excuse for clubs to not conduct thorough medical examinations of their own players. Similarly, there is no reason for a club to let a player who is clearly concussed continue to play. Morocco’s Amrabat even broke FIFA protocol by playing in a match less than the mandated 6 days after suffering a concussion. (And even this is obscene–the American Journal of Public Health states that most concussion-like symptoms don’t fade for over two weeks, rendering FIFA’s 6-day policy inadequate.) Part of this has to do with the rules of the game: it is a tough task to ask a club to make one of their three permitted substitutions when a player insists he can keep playing, especially when footballing culture rewards playing through pain. Many football associations are adopting different rules about substitutions, with the most prevalent one being the allowance of a fourth substitute in extra time. Perhaps teams could be allowed a substitution without penalty in the instance of a clear head injury to eliminate any potential tragedies.
Football clubs have many responsibilities. They have a duty to their owners to create profit, and they have a duty to their supporters to win. However, what has been overlooked is their duty to their players. Clubs should prioritize the health of their players over anything else, whether that means doing an extra heart examination on a player or substituting a concussed player without a second thought. Clubs should ensure that their medical staff are competent, and can recognize when injuries are more serious than perhaps they might seem. Nothing can bring Appie back, although his former teammates Mauro Savastano, Justin Kluivert, and Danilho Doekhi have all taken Appie’s number 34 in tribute. However, every club should keep this tragedy in mind when providing any type of routine medical care to their players.