Additional permanent concussion substitutions protocol

Updated as from 1st July 2024


Following approval at the 138th Annual General Meeting (AGM) of The IFAB held in Scotland on 2nd March 2024, the Laws of the Game now allow competitions to permit the use of additional permanent concussion substitutions.

An additional permanent concussion substitution occurs when a player who has an actual or suspected concussion is substituted and takes no further part in the match. This substitution does not count as one of the ‘normal’ permitted substitutions (or substitution opportunities, where applicable).

Reference to additional permanent concussion substitutions is found in:

Law 3. The Players

3.2 Number of substitutions - Additional permanent concussion substitutions

Competitions may use additional permanent concussion substitutions in accordance with the protocol listed under ‘Notes and modifications’.

NB: Although two different protocols were used during the trials, a single protocol was approved at The IFAB AGM and must be used in its entirety.


  • Each team is permitted to use a maximum of one ‘concussion substitute’ in a match.
  • A ‘concussion substitution’ may be made regardless of the number of substitutes already used.
  • In competitions in which the number of named substitutes is the same as the maximum number of ‘normal substitutes’ that can be used, the ‘concussion substitute’ can be a player who has previously been substituted and may be used at any time, regardless of the number of substitutes already used.
  • When a ‘concussion substitute’ is used, the opposing team then has the option to use an ‘additional substitute’ for any reason.


  • The substitution procedure operates in accordance with Law 3 – The Players (except as outlined otherwise below).
  • A ‘concussion substitution’ may be made:
    • immediately after a concussion occurs or is suspected;
    • after an on-field assessment and/or an off-field assessment;
    • or at any other time when a concussion occurs or is suspected, including when a player has previously been assessed and has returned to the field of play.
  • If a team decides to make a ‘concussion substitution’, the referee/fourth official is informed, ideally by using a substitution card/form of a different colour.
  • The player with concussion or suspected concussion is not permitted to take any further part in the match, including penalties (penalty shoot-out), and should, where possible, be accompanied to the dressing room and/or a medical facility.
  • The opposing team is informed by the referee/fourth official that it has the option of using an ‘additional substitute’ and an ‘additional substitution’ opportunity, which may be used concurrently with the ‘concussion substitution’ made by the other team or at any time thereafter (except as outlined otherwise in the Laws of the Game).

Substitution opportunities

  • Making a ‘concussion substitution’ is separate from any limit on the number of ‘normal substitution’ opportunities.
  • However, if a team makes a ‘normal substitution’ at the same time as a ‘concussion substitution’, this will count as one of its ‘normal substitution’ opportunities.
  • Once a team has used all its ‘normal substitution’ opportunities, it cannot use a ‘concussion substitution’ to make a ‘normal substitution’.
  • Where a team makes a ‘concussion substitution’, the opposing team can use an ‘additional substitute’ and receives an ‘additional substitution’ opportunity. This additional opportunity can be used only for the ‘additional substitute’ and not for a ‘normal substitute’.

Match officials

The referee and other match officials, especially the fourth official:

  • are not part of a team’s decision-making process as to whether a player should be substituted or not, nor whether a player should be replaced by a ‘normal substitute’ or a ‘concussion substitute’;
  • must not decide whether an actual or suspected injury qualifies for a ‘concussion substitute’ to be used;
  • should give appropriate support where a player has an actual or suspected injury, including by informing the team captain, coach and/or medical staff if they suspect that a player needs to be assessed and/or treated;
  • should support a decision by the team captain, coach and/or medical staff that an injured player cannot continue playing, which may require the referee to delay the restart until after the player has left the field of play; and
  • must inform the appropriate authorities if there are concerns that a ‘concussion substitution’ has been made inappropriately.