Three years after joining FIFA as Director of Medical from Liverpool FC, Dr Andrew Massey looks back on an eventful time while identifying the current medical challenges and objectives as part of FIFA’s commitment to regard the health of all individuals involved in football as the key priority.

Dr Massey’s initial challenge emerged just a week into his new job when the World Health Organization declared the COVID-19 outbreak a global pandemic, which had an immediate impact on football all across the world.

“I was at FIFA for a week before the pandemic hit. The first week was all about developing a strategy for the medical department going over the next three years, and then that was all just turned on its head with COVID. I think, at the time, our President said, “Health comes first,” and that really was probably the most pertinent health message that FIFA had ever had in 118 years.”

“The safety of the individuals and the safety of the communities were so important that we had to put in so many strategies to try and prevent the spread of COVID, prevent the unfortunate deaths, prevent people getting sick, to such an extent that 207 of our 211 member associations had to stop playing football for different periods of time.”

In relation to FIFA’s work vis-à-vis its member associations, Dr Massey commented: “We’ve developed emergency medicine courses and what we want to do with these emergency medicine courses is for each of the 211 member associations to have a national disseminator who can teach these courses to everybody else within the football environment, so that you have almost like a pyramid effect.”

Brain health strategy

Key to Dr Massey’s work has been the implementation of a brain health strategy, as confirmed by the unprecedented concussion management programme implemented for the FIFA World Cup 2022™ in Qatar.

“The gravity of brain injury needs to be highlighted. Everybody also agrees that a brain injury or a concussion can take 72 hours to manifest itself - three days before you could potentially get symptoms. What we want to do is to avoid returning an injured brain to play before they are ready. If we did that, that’s what we would call a false negative, where we assess somebody, we think they’re negative to the injury, and we let them play on. That’s the most dangerous.”

“Brains suffer whenever they get injured, but they suffer exponentially more whenever they get another injury on top of that initial one. We want to decrease the likelihood of these false negatives. Having temporary subs, we’ve seen in the literature, will have the chance of a false negative of anything in the region of 16-25%. So, we’d be returning one in four people who do have a concussion, but it just hasn’t manifested itself yet.”

“So, we want to get a safer threshold. We want to change the narrative with respect to what everyone agrees with, not: “Is this person concussed?” Rather: “Can we rule a concussion out?” That’s why the permanent subs are so much safer: zero chance of a false negative and zero chance of taking a risk with anybody that you suspect has a concussion, either from whatever symptoms they’re displaying at the time, or the mechanism of their injury.”

The full video interview with Dr Massey is available on FIFA.com.