Team Doctor's Guide to PSL Match Day Medical Rules Senior 2026/27

Under NSL Handbook Rules 14.11.2 and 14.11.3, the home club must have at least one fully qualified and appropriately insured paramedic who:

• is available from when the gates open until 1 hour after the match
• is qualified to Advanced Life Support (ALS) level or equivalent
• is equipped and qualified to use a fully stocked emergency care response bag, oxygen, a rigid neck brace and an automated external defibrillator (AED)
• is available to help with on-field medical incidents

"Paramedic" means only paramedics and emergency care practitioners registered with the HPCSA, who must carry current registration cards at the match and hold medical indemnity (Rule 14.11.10).

Under NSL Handbook Rule 14.11.7, the home club must provide at least:

• 2 stretchers
• 2 spinal immobilisation boards
• 8 appropriately trained stretcher bearers, each at least a basic life support provider

They are there to remove injured players, club officials or match officials from the field of play. Under IFAB Law 5, once the referee has let doctors or stretcher bearers onto the field, the injured player must leave on a stretcher or on foot.

Yes, both are the home club's responsibility under NSL Handbook Rule 14.11:

• Ambulance (14.11.9): throughout the match, a fully equipped, dedicated and appropriately insured ambulance, suitable for carrying an emergency casualty and staffed by someone qualified to give essential emergency care on the way, must be available at the ground to take anyone needing emergency treatment to hospital.
• Medical room (14.11.8): a medical treatment and examination room close to the teams' dressing rooms, with the mandatory facilities and equipment prescribed by the League.

The home club must also arrange medical personnel, equipment and facilities for the care of everyone at the ground, in line with the relevant legislation (14.11.4).

Yes. NSL Handbook Rule 14.11.6 says a visiting club is not prevented from having its own team doctor, physiotherapist or paramedic at the match. The home club remains responsible for providing all the required medical personnel, equipment and services under Rule 14.11.

Any visiting medical staff who sit on the bench count towards the bench limits: 5 club officials on the bench plus 2 on the extra seats, all holding registration cards and listed on the team sheet (Rules 12 and 16.2). Under Rule 14.11.10, all medical personnel must be registered with the HPCSA (or the Allied Health Professions Council for chiropractors), carry current registration cards at the match, and hold medical indemnity.

Under the NSL Handbook:

• On registration (Rule 31.8.3): every application to register a player with the League must include a completed prescribed medical certificate signed by a medical practitioner.
• Every season (Rule 33.2): for professional players, whose registration lasts for their whole contract, the club must still submit a current medical certificate at the start of each season. Until it is provided, the player is ineligible to play.

Rule 41.9 also says a professional player's employment contract cannot be made conditional on the results of a medical examination.

Fielding an ineligible player, including one on the team sheet or bench, costs the club the match and a fine of at least R100,000 (Rule 58.2).

Only with the referee's permission. Under IFAB Law 1.9, technical area occupants must stay within it except in special circumstances, such as a physiotherapist or doctor entering the field, with the referee's permission, to assess an injured player.

Under Law 5 (2026/27), the referee:

• lets play continue until the ball is out of play if a player is only slightly injured
• stops play if a player is seriously injured and makes sure the player is removed from the field
• once doctors or stretcher bearers have been authorised on, requires the player to leave on a stretcher or on foot; a player who refuses is cautioned
• shows any yellow or red card to an injured player before they leave for treatment

A medical team official who commits a sending-off offence may stay if the team has no other medical person available, and may still act if a player needs medical attention (Law 5).

At PSL matches the home club's team doctor and physiotherapist must sit on the home team bench (NSL Handbook Rule 14.11.1).

Under the 2026/27 Off-field treatment and assessment protocol (Law 5), an outfield player must leave and stay off until one minute after play restarts (running clock) if:

• play is stopped because of their actual or suspected injury
• the referee signals for medical staff to come on, or
• the player asks for on-field medical attention

The medical staff get time for an initial assessment on the field but should not treat the player there unless the injury is serious. The player returns only with the referee's permission, from the touchline if the ball is in play. If the injured player is substituted, the substitution is not delayed.

No one-minute exit is needed when:

• the player says they don't need attention (unless play was stopped for the injury), or leaves voluntarily without delaying the restart
• a goalkeeper is injured, or a goalkeeper and outfield player collide
• team-mates collide and need attention
• there is a severe injury, especially a head injury (e.g. concussion), a cardiac issue or a life-threatening event such as a seizure or choking
• the injury came from a foul punished with a yellow or red card
• the injured player will take an awarded penalty kick

A bleeding player must leave and may return only when the referee is satisfied the bleeding has stopped and there is no blood on their kit.

Additional permanent concussion substitutions are an option in the IFAB Laws (Law 3.2) that a competition may adopt. They apply only where the competition rules allow them; the NSL Handbook does not set them out itself. Where used, the IFAB protocol applies in full:

• Each team may use one concussion substitute per match, regardless of how many substitutes it has already used.
• It can be made immediately, after an on-field or off-field assessment, or later, including after a player has been assessed and returned.
• The referee or fourth official is told, ideally with a substitution card or form of a different colour.
• The player takes no further part, including in a penalty shoot-out, and should where possible be accompanied to the dressing room or a medical facility.
• The opposing team may then use one additional substitute for any reason, with an extra substitution opportunity.
• A concussion substitution does not use a normal substitution opportunity, unless a normal substitution is made at the same time. Once all normal opportunities are used, a concussion substitution cannot be used to make a normal one.

The team does, not the match officials. Under the IFAB Additional permanent concussion substitutions protocol (2026/27), the referee and other match officials, especially the fourth official:

• are not part of the team's decision on whether a player is substituted, or whether by a normal or a concussion substitute
• must not decide whether an injury qualifies for a concussion substitute
• should support an injured player, including by telling the captain, coach or medical staff if they suspect a player needs assessment or treatment
• should support a decision by the captain, coach or medical staff that a player cannot continue, which may mean the referee delays the restart until the player has left the field
• must report to the authorities any concern that a concussion substitution was used inappropriately

Under Law 5, a head injury such as concussion is one of the severe injuries that can be treated on the field, and the player is not then forced to leave for the one-minute period.