A good scorekeeper will keep track on a piece of paper. Write the five starters in a column. Cross them off when they leave and enter in the same row the new player. The last five listed are in the game. If there are multiple subs, it doesn't matter specifically who is in for whom. Just cross off the ones leaving and enter the ones entering.
I did that when I kept score and I know some who still do it. I know some don't. At higher level games you might have a stats person who is tracking this.
Other than at the end of the game when I know who leaves to be sure they sit and don't reenter before they can, I don't really care.
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