What is FIFA FOCUS? The On-Pitch Concussion Assessment for Football
Everything team doctors, physiotherapists and football medical staff need to know about FIFA’s Football-Specific Standardised On-Pitch Concussion Assessment Protocol: when to use it, the 11 domains, what triggers a substitution and what happens next. For concussion assessment across other sports, see our Head Injury Assessment guide.
What is FIFA FOCUS?
FOCUS stands for the Football-Specific Standardised On-Pitch Concussion Assessment Protocol. Published by FIFA in December 2025 and updated in April 2026, it is a structured method for the on-pitch medical assessment of a football (soccer) player after a head impact. Its purpose is not to diagnose concussion, but to identify quickly whether a player shows signs or reports symptoms that mean they must be removed from play for a formal concussion assessment.
How Was FOCUS Developed?
FIFA developed FOCUS from a comprehensive review of the scientific evidence, working with a global group of clinicians and researchers with expertise in identifying and assessing concussion in football players, drawn from across FIFA's six confederations. The development study was published in JAMA Neurology in July 2026.
Why a Football-Specific Protocol?
General tools were not designed around the realities of a football match: a short stoppage, a referee waiting to restart, and players who stay down to win time or a free kick. FOCUS is built for that setting. Lying motionless is not a substitution trigger on its own, and assessments are designed to finish in about 3 minutes.
When Should FIFA FOCUS Be Used, and by Whom?
FIFA says FOCUS should be completed for any head impact event in a match that requires a medical assessment, and should be considered mandatory after a concerning head impact, even if the player says they feel fine.
Which Head Impacts?
Usually the referee indicates the need for a medical assessment. If a medical professional is concerned about a player who has not been assessed, they can raise it with the touchline match officials.
Who Performs It?
Qualified medical or health care professionals only: doctors, physiotherapists, nurses and athletic trainers. The on-pitch assessment always follows the FIFA Emergency Care Manual, and a life- or limb-threatening injury takes precedence.
No Clinician Available?
Where no qualified professional is present, FIFA points to the Concussion Recognition Tool 6 (CRT6), a public tool for coaches, parents and other non-medical people. It helps them recognise a suspected concussion and remove the player.
What Are the 11 Domains of FIFA FOCUS?
FOCUS covers 11 assessment domains. Each item carries one of two recommendations: substitute the player immediately, or lower the threshold for concern and continue.
1. Player Medical History
Has the player been diagnosed with a concussion before, had a concerning head impact or a head injury assessment earlier in this match, or is the player receiving anticoagulation therapy? Any yes lowers the threshold for concern. FIFA advises medical teams to keep this information to hand during every match, because of the risk of second impact syndrome.
2. Mechanism of Injury
Most concussions in football come from direct contact with the head. High-force mechanisms such as head-to-head, elbow-to-head, foot-to-head and head-to-ground contact, especially an unprotected fall, and dual impacts such as elbow-to-head followed by head-to-ground, lower the threshold for concern.
3. Observation
Watching starts on the touchline and continues throughout. Eleven visible signs mean immediate substitution: floppy or no protective action, tonic posturing, impact seizure, motor incoordination, vomiting, an increasing or persisting abnormal emotional or behavioural response, indications of a skull fracture, deformity or abnormal swelling of the head or neck, blood or clear fluid from the ears, periocular or retroauricular haematoma, and pupil abnormalities. A superficial face or head injury, lying motionless with a possible loss of consciousness, and a blank or vacant look lower the threshold instead.
4. Level of Consciousness
Using the ACVPU scale, the assessor first asks whether the player can recall the head impact, and if not, the last thing they remember. Only a player assessed as Alert continues. Alert but confused or disorientated, responsive only to a verbal or physical stimulus, or unresponsive: substitute immediately and manage under the FIFA Emergency Care Manual. Suspected retrograde amnesia is also a substitution trigger.
5. Cervical Spine Assessment
Neck pain at rest lowers the threshold. Midline neck tenderness on palpation, restricted active range of neck motion, an unexplained limb strength or sensation abnormality, or numbness or tingling mean substitution. Brief stingers or burners can explain transient changes, but only without any sign of a more serious neck injury.
6. Symptoms
Headache or pressure in the head, dizziness, not feeling quite right, drowsiness, disorientation, difficulty following instructions, nausea, visual disturbance such as blurred or double vision, feeling slowed down, and acute hearing loss. Any symptom that cannot be explained by another reasonable cause, such as nausea from a blow to the abdomen, means substitution.
7. Orientation
The Maddocks questions, framed for football: What venue are we at today? Which half of the match is it? Who scored last in this match? Which team did you play against last week? Did your team win, lose or draw last week? Any inappropriate answer, judged against what has actually happened, means substitution.
8. Balance
A tandem stand with eyes closed, dominant foot in front and heel to toe, for about 20 seconds. The assessor looks for gross errors, since a minor wobble in boots on grass is common, and the test can be repeated if crowd noise or another player distracts them. Unexplained balance abnormalities or reported dizziness mean substitution.
9. Proprioception
Standing, with eyes closed, the player touches their nose with the left index finger and then the right. The test can be repeated once. Any unexplained abnormality means substitution.
10. Oculomotor Assessment
Smooth pursuit: without moving their head, can the player's eyes follow a target moved side to side and up and down at arm's length? Convergence: can they track it as it moves in towards the nose? The assessor also checks for nystagmus and pupil abnormalities.
11. Activity-Based Assessment
Completed on the touchline, and only if everything else is normal. The player sprints 5m, turns 180 degrees to the left, sprints 5m, turns 180 degrees to the right and sprints 5m again. The distances matter less than how the player moves, turns and feels. Any visible sign or symptom it provokes means substitution.
What Triggers a Substitution in FIFA FOCUS?
FOCUS separates findings that remove a player from the match from findings that should make the assessor more cautious. Only a suspicion of concussion is needed for substitution.
Substitute Immediately
Any of the 11 red-flag visible signs
Anything other than Alert on the ACVPU scale
Suspected retrograde amnesia
Midline neck tenderness, restricted neck movement, limb weakness, sensation change, numbness or tingling
Any symptom not explained by another cause
Any inappropriate answer to a Maddocks question
Abnormal tandem stand, finger to nose or eye tracking
Signs or symptoms provoked by the touchline activity test
A player who cannot change position without help
Lower the Threshold for Concern
A previous concussion
A concerning head impact or head injury assessment earlier in the match
Anticoagulation therapy
A high-force or dual-impact mechanism of injury
A superficial face or head injury, including a nosebleed
Lying motionless with a possible loss of consciousness
A blank or vacant look, which becomes a red flag if abnormal for a player you know
Neck pain at rest
How Is FIFA FOCUS Different From SCAT6?
FIFA's own answer: FOCUS and the SCAT6 have many similarities, but FOCUS was developed by medical researchers and clinicians who work in football specifically for the on-pitch assessment of a suspected concussion during match-play, and it should take less time than a SCAT6 typically does.
FIFA FOCUS
On the Pitch, During the Match
Football-specific. About 3 minutes, inside a stoppage in play. Decides whether a player is substituted. Not a diagnostic tool. For qualified medical and health care professionals.
SCAT6
Off the Pitch, Within 72 Hours
The Concussion in Sport Group's multi-sport tool for athletes aged 13 and over. A fuller assessment, typically 15-20 minutes, with symptom, cognitive, balance and neurological components, used off the field.
SCOAT6
In the Clinic, 72 Hours to 30 Days
The office assessment for the subacute phase, used to guide recovery and return to sport. FIFA names SCAT6 and SCOAT6 as options for the follow-up assessment within 24-48 hours.
What Rules Apply Throughout a FOCUS Assessment?
Alongside the 11 domains, FIFA sets out how the assessment itself should be run.
Do not help the player up
How a player sits or stands unaided can reveal balance or coordination problems. A player who cannot change position without help is substituted.
Head injury before minor injuries
A suspected head injury is assessed before lacerations, even bleeding ones, nasal fractures or dental injuries.
Fixed start, flexible middle
Visible signs, level of consciousness and the cervical spine are assessed as designed. After that, symptoms, orientation, balance, proprioception and eye tests can be reordered, as long as the activity test comes last.
The touchline is an option
Once consciousness and the cervical spine are assessed, the remaining items can be completed at the touchline, knowing the team is a player down while they are.
A visible sign ends the on-pitch assessment
The player is substituted after consciousness and the cervical spine are checked to decide how they leave the pitch. The remaining domains belong to the off-pitch evaluation.
Take the time a serious injury needs
The assessment should be timely, but a player with a potentially catastrophic injury is not moved until it is safe, with clear communication to the referee.
What Happens After FIFA FOCUS?
Once a player is substituted, their care continues under the most appropriate protocol, which may include the FIFA Concussion Protocol for Medical Staff, the FIFA Concussion Protocol for Grassroots Football or the FIFA Emergency Care Manual.
Follow-Up Within 24-48 Hours
FIFA recommends a comprehensive clinical assessment by an appropriately trained medical professional within 24-48 hours of any head impact that needed an on-pitch assessment, regardless of the FOCUS outcome. This applies to players who stayed on, and to concerning impacts that were never assessed, because signs and symptoms can take up to 72 hours to appear.
Watch for Delayed Signs
A player who resumes after a normal FOCUS is monitored for the rest of the match. Delayed signs mean substitution at the next opportunity, and if an item was missed and there is any concern, FOCUS is repeated as soon as possible.
Who Decides?
Medical personnel always have the final say. A player whose judgement may be impaired is substituted whether or not they want to be, and a player asking to come off is taken off. The coach decides whether it is a concussion or a normal substitution.
Where Can You Access FIFA FOCUS?
FIFA publishes FOCUS free at inside.fifa.com, as the full protocol, a pocket leaflet and a lanyard card for use on the pitch, in English, Spanish, French and Arabic. ScreenIT offers a free digital FIFA FOCUS that guides the assessor through every domain and records the result.
Paper FOCUS (FIFA)
The protocol document, pocket leaflet and lanyard card from FIFA Medical. Nothing to sign up for. The assessor works from the card and records findings separately.
Digital FIFA FOCUS (ScreenIT)
Free for unlimited assessments on phone or tablet. Every domain in FIFA's order, a substitution decision that updates as you record, a reason for anything not assessed, a PDF report, and SCAT6 and SCOAT6 follow-up in the same patient record.
Frequently Asked Questions About FIFA FOCUS
What does FOCUS stand for?
FOCUS stands for the Football-Specific Standardised On-Pitch Concussion Assessment Protocol. It was published by FIFA in December 2025 and updated in April 2026, and it is used by medical staff to assess a player on the pitch after a head impact.
When should FIFA FOCUS be used?
For any head impact event in a match that requires a medical assessment. In most cases the referee indicates the need for an assessment, but a medical professional concerned about a player who has not been assessed can raise it with the touchline match officials.
How is FIFA FOCUS different from SCAT6?
FOCUS and the SCAT6 have many similarities, but FOCUS was developed by medical researchers and clinicians who work in football specifically for on-pitch assessment during match-play, and it should take less time than a SCAT6. FOCUS decides whether a player is substituted; SCAT6 and SCOAT6 are used for the fuller assessment that follows.
Can parts of FIFA FOCUS be done at the touchline?
Yes. Once the player’s level of consciousness and cervical spine have been assessed, the remaining items can be completed at the touchline, although the team plays with one player fewer while they are there. The activity-based assessment is always done at the touchline, and always last.
What if a player does not want to be substituted?
Concussion is a brain injury, so a player’s judgement may be impaired after a head impact. If FOCUS shows an indicator for substitution, the player is substituted whether or not they want to be. Medical personnel always have the final say; the coach decides whether to use a concussion or a normal substitution.
What if I am still unsure after completing FIFA FOCUS?
Substitute the player. Only a suspicion of concussion is needed to remove a player from play, and FIFA advises that a player who is later found not to be concussed is a better outcome than a concussed player who stays on.
Evidence & References
Primary Sources
FOCUS Protocol: FIFA, Football-Specific Standardised On-Pitch Concussion Assessment Protocol (April 2026)
FOCUS FAQ: FIFA Medical, FOCUS Frequently Asked Questions (July 2026)
Protocol Development: Peek et al. (2026), JAMA Neurology, doi:10.1001/jamaneurol.2026.2298
FIFA Protocols: FIFA Concussion Protocol for Medical Staff (August 2024); FIFA Emergency Care Manual
SCAT6 and SCOAT6: Echemendia et al. (2023), BJSM 57(11)
CRT6: Echemendia et al. (2023), Concussion Recognition Tool 6, BJSM 57(11)
Last Reviewed
Content last reviewed: September 2026. Based on the April 2026 edition of FOCUS, which updated the December 2025 original.
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FOCUS is developed and published by FIFA. Not a diagnostic tool.