ORLANDO, Fla. – Sports have come a long way in concussion awareness, but some moments in the inaugural game of Major League Soccer expansion teams Orlando City SC and New York City FC made it seem like the dark ages all over again.

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NYCFC goalkeeper Josh Saunders leapt high in the air to make a save in the first half of Sunday's 1-1 draw and was unintentionally slammed into the goal on the way down. His head hit the post hard, causing a sickening ping that national television cameras picked up. Saunders developed a large welt and some blood emerged on his scalp. As Citrus Bowl stadium screens showed the replay again and again, the Orlando crowd gasped multiple times.

Saunders played on.

In the second half, he made a diving save and the wound opened again, with rivulets of blood coming down onto his face. Trainers came onto the field and dabbed Saunders' wound, and again he stayed in.

After the match, Saunders insisted he was "fine" and would have taken himself out if he felt his health was at stake.

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"This is a big thing," he said. "I don't take this lightly. Your health is more important than anything."

Saunders said the team went over concussion protocol this past week and it was followed on the field. He said trainers asked him to recall three words – "ball," "truck," "Fifth Avenue" – and repeat them back. He did so.

Despite Saunders' admirable stressing of the right procedure, other reactions were more upsetting. Said New York City coach Jason Kreis: "You're not going to take a goalkeeper out of a match like that unless he's begging to come out."

Most followers of sports know an athlete will almost never ask to come out of a game, no matter what his pain or discomfort. It's never the responsibility of the player to signal his inability to play, let alone his desire to be removed from a game. Brain injuries often don't allow for clarity of thought.

And although Saunders was put through a protocol, it's still a question whether the protocol was thorough enough. According to sports neurologist Jeffrey Kutcher at the University of Michigan, a doctor needs at least seven minutes to properly assess a player who has suffered a head injury. The time taken on Saunders once he rose to his feet seemed fairly short, and only three minutes of injury time was added to the end of the first half.

Asked at halftime about the decision not to pull Saunders, MLS commissioner Don Garber said, "The system worked" and "Josh looked pretty good out there." That too is inconclusive evidence that the right decision was made. As Kutcher says, signs of a concussion can show up anywhere from within five seconds to within 48 hours of an injury.

"We've been leaders in this area," Garber said, while acknowledging that he is open to discussing a substitution rule tweak in the future.

"The MLS should lead," he said.

Sadly, there have been few leaders in this area. Awareness of the nuances of brain injury is still lagging in soccer and all sports.

Saunders had the most evolved response to a scary situation on Sunday, and that alone is worrisome. Just because the goalkeeper was "fine" doesn't mean the process is.