The pitch-side assessments of professional footballers who have suffered a head injury are too 'quick' and 'cursory' to determine if a player is really hurt, a leading brain surgeon has told Sportsmail.
Professor Anthonio Belli, who is advising the Premier League and FA on managing head injuries, spoke out after the sickening collision between Raul Jimenez and David Luiz when Wolves beat Arsenal at the Emirates on Sunday.
Jimenez has undergone surgery for a fractured skull after the collision at a corner, but Luiz was allowed to continue in the game following an assessment, with a thick bandage around his head, which soon started seeping blood.
The Gunners' manager, Mikel Arteta said after the game the club doctors completed the necessary concussion protocol before allowing Luiz to continue.
The Brazilian defender was eventually withdrawn at half-time, due to the laceration.
Belli, who treated Welsh international rugby player George North after he suffered a string of concussions in matches, has no criticism of the Arsenal medical staff, who are well respected for their approach to concussion.
He said they are known for taking concussion 'most seriously'.
But Belli's concern is the protocol itself, which he believes is simply not good enough.
'There is a protocol, but it is not robust enough. It is very quick. It is cursory,' the Professor of Trauma Neurosurgery at the University of Birmingham, told Sportsmail.
'You will have a lot of people who incorrectly pass the test. Unless you give doctors the opportunity to do [the tests] properly they may be left exposed.'
He is pushing for a tough new framework, which will ensure rigorous assessment of a player, like in rugby.
In rugby, a Head Injury Assessment involves taking a player to the medical room, where they receive a 'battery of assessments', which include tests for memory, balance and neurological function. It takes 10 minutes.
The memory recall test involves remembering a list of words and requires a gap between the impact and the test, or else it may not pick up a problem.
Prof Belli said the assessment in rugby is a formal process, which is documented and then independently checked. It is repeated after the match and then at 36 and 48 hours.
He argues the pitch-side assessments in football are simply not sufficient.
'It cannot be a full assessment of consciousness,’ he said. 'That is why [concussion] substitutions have become necessary.
'Unless you allow the team to substitute a player there would be so much pressure on returning a player.'
Change is coming, with Fifa and the Football Association planning to begin trials for an additional, permanent concussion substitutes next year. The Premier League are also supportive of the idea and the two organisations will discuss their plans this week.
Prof Belli welcomes any improvement to the current situation as a step in the right direction, but there is significant concern that the introduction of a permanent substitute will not allow the off-field assessment seen in rugby.
Critics argue that to improve assessments, temporary substitutes are needed because this would take the pressure off medical and coaching staff to make quick, irreversible decisions. However, that is not currently proposed by the sport's rule-making body, the International Football Association Board (IFAB).
Luke Griggs, deputy chief executive at the brain injury charity, Headway, said: 'Too often in football, we see players returning to the pitch having undergone a concussion assessment - only to be withdrawn a few minutes later when it is clear that they are not fit to continue.
'That is the very reason why we urgently need temporary concussion substitutes in football. You simply cannot take a risk with head injuries.
Dr Willie Stewart, the neuropathologist whose research has revealed former professionals are 3.5 times more likely to die of dementia, is also a powerful advocate of temporary substitutes.
He has accused the football authorities of missing an “open goal” by introducing trials for a new concussion protocol that include permanent subs.
“Only football, faced with an open goal to make a statement of intent around improving management of head injuries in their sport and, with that, perhaps addressing the dementia issue in their game could send a proposal so high over the bar,” he told The Telegraph last week.
The FA has said it will support the proposal for concussion substitutes at a meeting of IFAB on December 16, with a view to trialling the change in the FA Cup and Women's FA Cup from January.
A FA spokesman said: 'Player welfare is paramount and we believe that this is an important step to help support players, clubs and medical teams when identifying and managing head injuries and incidents of concussion during a game.'