Argentina defensive midfielder Javier Mascherano suffered a significant concussion in Wednesday night’s World Cup semi-final against Netherlands after clashing heads with Georginio Wijnaldum. Seconds after the collision, Mascherano stumbled in a daze, and looked like he was going to fall head first on to the grass, before he turned and fell down. It appeared for a second that Mascherano was going to be completely unconscious, but thanks to the help of the players around him and the medical staff, he slowly but surely regained his composure before being walked off the field.

Just minutes later, he was back on the field.

A similar incident happened earlier in the World Cup when Maxi Pereira suffered a knock to the head against England. This time, the Uruguay doctor on the sideline was adamant that Pereira wasn’t fit to continue playing. But the Uruguay defender remonstrated, and got his wish. He ended up playing the entire 90 minutes of the game.

In both instances, the players should have been substituted. Instead, the crowd applauded their “heart” for fighting to stay on the field.

We’ve seen in this World Cup the continuation of a pattern with international and European club soccer where concussions due to head injuries are not taken seriously enough by the authorities who run the game. This is in sharp contrast to the attitude exhibited on these matters in the United States both in soccer and in other competitive sports.

Last year we had an incident involving Hugo Lloris of Tottenham Hotspur during a Premier League match in England where he was severely hit, but refused to be substituted. The reaction by much of the English press and many Spurs fans to the incident was disturbing. Many media members lauded Lloris for playing on despite his injury, while the supporters of his club gave him a standing ovation after the match. But in fact, Lloris did have a serious head injury and he missed the following two matches. Following the Lloris incident, the idea of temporary substitutes playing was raised though no English governing body or league has taken action to make this possible.

As explained by ESPN World Cup soccer analyst Taylor Twellman, the concern is regarding the possibility of a second hit to a player who is concussed in the game. It’s the second hit that can cause extreme damage.

Unfortunately, the powers that be within FIFA and much of the media seem to ignore the issue. FIFA has failed to take a proactive approach to this issue. At this rate, it’s unfortunate but it may take a serious injury to a player before FIFA or top leagues around the world enact rules to deal with head injuries.

Previously as a league official with the North American Soccer League (NASL), the league took any indication of a head injury very seriously. At the NASL, we adopted a strict concussion policy, which was modeled after what Major League Soccer had already developed in the wake of several injuries. I have no hesitation in saying if Mascherano’s injury had occurred in the top two divisions of North American soccer, he would have been subbed out and whisked away to some place for observation and tests. Sure this is was a World Cup semifinal with hundreds of millions of television viewers around the world watching, but at some point common sense and player safety/health must be made a priority.

It shouldn’t be the player or the head coach that makes the decision whether or not the player should return to the field. As Twellman suggested, there should be an independent doctor who can make the determination, especially if it’s in a high-profile game.

Twellman’s career in Major League Soccer was cut short due to head injuries.

This evening, Twellman tweeted the following:

The recognition of the difficulties around head injuries is something that seems to offend the sensibilities of people who want to see top athletes “tough it out” during the course of soccer games. FIFA has made absolutely no effort to change this thinking partly because of the complicity of many of the top writers who cover the sport. Wednesday’s match should have sent off alarm bells about this issue. Every news outlet should be discussing how Mascherano stayed on the pitch and played 85 more minutes of football after sustaining a blow to the head. Educational pieces should be written about how simply completing a match means nothing, because the real damage from a concussion comes afterwards. Instead, the articles about Mascherano focus on his game saving tackle on Arjen Robben in second half stoppage time. That act alone seems to justify the decision of so many to ignore the head injury that took place earlier in the match.

In so many ways, international soccer is still behind the times. This is yet another example of where FIFA, and many of the leading writers about the sport, are living in a different era. Once again it will take journalists with a megaphone and experts on this topic like Taylor Twellman to raise awareness to a point where FIFA is forced to make a change. That process should start now.