For the first time in a Test match in India, the Ranchi game witnessed a concussion substitute. In the ongoing game between India and South Africa on day 3, Dean Elgar was facing Umesh Yadav in the last over before the tea break. On the third ball, Umesh bowled a sharp bouncer at close to 140 kmph and Elgar took his eyes off the ball. The delivery hit Elgar flush in the middle of the helmet and he was down immediately for the count. Elgar looked dazed and he was given the mandatory concussion testing by the South Africa physio. The Indian players crowded around and expressed genuine concern at Elgar's health.
After the tea break, it was announced that Elgar would not be able to bat. George Linde and Dane Piedt came out to bat as South Africa had not yet named a concussion substitute. As Linde and Piedt stitched a partnership, it was announced that Theunis de Bruyn would be the concussion substitute. de Bruyn came out to bat after George Linde was run-out for 27.
Previously, a substitute would only have been permitted to field. But this series is the first in the ICC's inaugural World Test Championship featuring new rules that allow replacement players to bat or bowl if they are covering for concussed team-mates. Marnus Labuschagne of Australia became the first concussion substitute in history after he subbed for Steve Smith in the Lord's Ashes Test after Smith was hit on the side of a neck by a 92 mph bouncer from Jofra Archer.
West Indies had 12 batsmen on the scorecard for West Indies in their second innings of the Jamaica Test after Jermaine Blackwood was named as a concussion substitute for Darren Bravo. Bravo retired hurt with a blow to the head from a Jasprit Bumrah bouncer and the substitution was made under the new rule where teams can use a new batsmen if someone suffers a concussion. This was the second time the rule was applied in international cricket.