Last year, there were at least three cases of cricketers playing on in Test matches despite having possible signs of concussion. A common factor in all three cases - affecting Pakistan's Ahmed Shehzad, Bangladesh's Mushfiqur Rahim and Sri Lanka's Sadeera Samarawickrama - is that the teams did not have their own doctors.
"The ICC should mandate that, in all international cricket, there is a team doctor," Brukner said. He called it "unacceptable" that only three countries - Australia, England and South Africa (whose manager does the role) - have full-time team doctors, although New Zealand also have emergency paramedics at games. "This shows that other nations are failing to do enough to protect their players."
In a Test in December 2016, Brukner had to conduct concussion tests on Pakistan player Azhar Ali when he was struck on the head. "I was put in a very uncomfortable position," he said. "Clearly, there was a perception of conflict of interest because if I had ruled him out the match that would have benefited Australia." Ali eventually decided he was fit enough to return. In a similar situation, Rahim defied medical advice from South Africa's doctor to bat on in a Test three months ago.
A standard head injury assessment would be "a significant step to keep players safe," Brukner said. He also believes that "concussion substitutes would encourage players to get the support they need during matches, and be honest about what they are experiencing without feeling like they are letting their team-mates down."
In a Test in December 2016, Brukner had to conduct concussion tests on Pakistan player Azhar Ali when he was struck on the head. "I was put in a very uncomfortable position," he said. "Clearly, there was a perception of conflict of interest because if I had ruled him out the match that would have benefited Australia." Ali eventually decided he was fit enough to return. In a similar situation, Rahim defied medical advice from South Africa's doctor to bat on in a Test three months ago.
A standard head injury assessment would be "a significant step to keep players safe," Brukner said. He also believes that "concussion substitutes would encourage players to get the support they need during matches, and be honest about what they are experiencing without feeling like they are letting their team-mates down."
While concussion remains predominantly a concern for batsmen, highlighted by the short bowling from Australia during the Ashes series, there are growing fears that bowlers and umpires are vulnerable because of power hitting in Twenty20 cricket.
In the last fortnight, New Zealand bowler Warren Barnes has started wearing a face mask - which is permitted under ICC rules - while bowling in T20 matches because of fears of being hit by straight drives. Last summer, Nottinghamshire bowler Luke Fletcher suffered a brutal blow to his head from a straight drive in his follow through, which ruled him out of the last two months of the season.
An umpire was killed in a match in Israel in 2014 after being struck on the neck by a straight drive. In T20 non-striking batsmen, who often back-up by several yards, can also be in danger.
Dr Peter Theobald, a specialist in brain injuries in sport from Cardiff University, agreed that cricket was "lagging behind others in terms of concussion management".
As there is no standard head injury assessment, like in rugby, Theobald believes that cricketers are particularly vulnerable to 'second impacts' - a second concussion when a player continued to play on after an initial concussion. "Without there being a formalised protocol to systematically attempt to identify cases of concussion within cricket, then players would seem to be at unnecessary risk."
The ICC formed a medical committee last year, which is monitoring the threat of concussion. From October 2017, the ICC approved a two-year trial of concussion substitutes in first-class cricket - though not the international game - around the world, after Cricket Australia's earlier attempts to get the move approved in 2016 had been rejected.
Concussion substitutes are now allowed in Australia's first-class competition, and will be permitted in all three formats in the domestic game in England from 2018. In Australia, concussed players can only be replaced by a 'like-for-like' replacement, as judged by the match referee, so cannot be used to gain a tactical advantage by improving the balance of the side.
So far only Australia and England have agreed to concussion substitutes in domestic first-class cricket - though Ireland are likely to introduce concussion substitutes from this summer - highlighting the different approaches towards concussion from national boards around the globe. Similarly, there are also concerns about inconsistent standards in player education.
Brukner said that "The laws of the game should be amended immediately to explicitly allow for concussion substitutes." The laws of the game, governed by the MCC, state that "A substitute still cannot bowl, bat or act as captain," though an exemption was agreed for the two-year trial in domestic first-class cricket.
"The principal difficulties with concussion are around the diagnosis, especially below the top level where trained experts are unlikely to be present, and in the mechanics of selecting a suitable replacement," said Fraser Stewart, the MCC laws manager. "Unlike most other sports, the distinct differences between the types of player means that finding a like-for-like replacement is not always straightforward." He believes that replacements waiting in case of a concussion would create logistical difficulties, and "might also favour the home team, for whom it is easier to find someone suitable as a replacement."
The MCC will discuss concussion during the next World Cricket Committee meeting, which takes place in Sydney immediately after the final Ashes Test.
