Robin Koch suffered a head injury while playing for Leeds in February

An open letter calling for temporary concussion substitutions has been written to the International Football Association Board (Ifab).

Key figures insist the current protocols, which allow permanent substitutions, are not working and want football’s lawmakers to go further.

Ifab will meet in Doha on Monday with concussion substitutes on the agenda.

Campaigner Dawn Astle said: “The current rules by Ifab are not working and players are being put at risk.”

Astle is the daughter of former England and West Brom striker Jeff Astle, who died in 2002, and co-founder of the Jeff Astle Foundation.

A neuropathologist said he died of a brain condition normally linked to boxers and caused by heading footballs.

Figures from the Professional Footballers’ Association, the Concussion Legacy Foundation and brain injury association Headway have also signed the open letter.

In December 2020 Ifab invited competitions to take part in a trial of permanent concussion substitutions, which the Premier League agreed to months later.

The rule allows for a permanent substitution to be made if a player suffers a head injury – regardless of the number of replacements a team has already used.

While it was viewed as a step forward in the sport’s battle against neurogenerative disease, the option to temporarily replace players while they undergo a head injury assessment is still unavailable.

Astle continued: “This is completely unacceptable. Too often we are seeing players assessed for a complex brain injury on the field of play, with the noise and intensity of a football stadium, and continuing the game only for them to be replaced later on.

“This demonstrates that the current guidelines are failing to prioritise player safety. Change is long overdue.”

PFA chief executive Maheta Molango said: “When determining the laws of the game, player safety and welfare have to be the top priorities. Medical teams are being given an impossible task.

“As the representative voice of professional players in England, we have been clear that we want to see the immediate introduction of temporary concussion substitutes.”

Former Norwich and Blackburn forward Chris Sutton, whose dad Mike suffered with dementia before his death in 2020, was one of several former professionals to sign the open letter.

The family members of Nobby Stiles, Dave Watson, Peter Bonetti, Frank Worthington and Rod Taylor have also given their support.

Concussion Legacy Foundation UK executive director Dr Adam White said: “We need to do everything we can to support medical professionals to make the best decisions for player safety. That means allowing them the time and space to conduct robust clinical assessments away from the field of play.

“Temporary concussion substitutions are the only way that can happen.”

Headway chief executive Peter McCabe added: “It is vital that we better protect footballers from the dangers of continuing to play after sustaining a concussion – particularly those playing at grass-roots level.”

A number of medical professionals, including Dr Willie Stewart, have also signed the letter.

It was Dr Stewart’s FIELD study, published in 2019, which found footballers were three and a half times more likely to die from a neurodegenerative brain disease than than the general population.

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