In 1823, William Webb Ellis first picked up the ball in his arms and ran with it. And for the next 156 years forwards have been trying to work out why. - Tasker Watkins VC, LJ.

Sunday, July 15, 2012

Concussion and the GAA - Updated.

A former Munster fullback* was supposed to have said that the true Irish sports were rugby and hurling. And, with my beloved Cork now in the All-Ireland quarter-finals, I'm delighted to see at least one of them is dealing properly with the issue of concussion.

I wrote before about Fermanagh player Mark McGovern, who suffered a serious concussion injury from an on-pitch incident in San Francisco last May while playing Gaelic Football, and how his case highlighted the failures of the Gaelic Athletic Association (GAA) to address the subject of concussion management and the effect this could have on liability for such injuries.. He spoke at the recent launch of the GAA's concussion management program, in association with the excellent Acquired Brain Injury Ireland (ABII) and the Gaelic Players' Association (GPA).

The management program is excellent, and there is no question that the GAA are now taking the steps needed to deal with concussion on-pitch in as required by the Zurich Consensus, to which the GAA has signed up since 2008. However, as with rugby, the problem is historical. It has taken five years to actually bring in an active pitch-side concussion management program when the data showed that such a program is the best way to deal with the duty of care to player safety. In that time, there has been, as there has been and regrettably continues to be in rugby in Ireland, a failure properly to deal with concussion as required by the Association's own rules.

The statistics gathered by the GPA and ABII that over half of all players at elite levels have sustained a concussion, and 44% have sustained repeat concussions gives an indication that the number of players affected by this is not small. In fact, it's probably a majority of those who play at the elite levels of GAA, which are effectively professional in all aspects but for being paid. Mercifully, the numbers who will be symptomatic as a result are much smaller. But it is far, far too much of a leap to assume that there will be no-one who will not be symptomatic as a result of this sustained failure to address this issue since 2007.

However, at least the GAA is now addressing this issue and taking it seriously. To my astonishment, the IRFU site still states, in defiance of the comments of international referees on the IRB site to which it links to the effect that referees should bring the Pocket SCAT2 onto the pitch and use it, that

While referees will see a reference to Pocket Scat2 in the iRB Guidelines, it is important to clarify that it is not necessary to attempt to use this to assist in the identification of suspected concussion.
Begging the question, of course, of just what on earth they think the Pocket SCAT2 is for if not for its designed function of managing concussion on-pitch accurately and safely for the benefit of all.

By this stage, one has to ask: is it really too much to ask that the IRFU give those who could end up being sued as a result of its failures the proper information to help prevent that happening, and, more importantly, protect the players on the pitch?

*The quotation is attributed to Eamon de Valera, who played full-back for Munster in the 1900s.

Sunday, July 1, 2012

Concussion update - Warburton, Lipman and Concussion Bins

"Everyone's getting bigger, stronger and faster, [but] the brain's the brain, if you drop a computer that many times eventually it's not going to turn back on."

I wish, fervently wish, that I did not have to keep revisiting this issue. But, alas, it keeps on coming up.

In the last month, the IRB announced it was going to trial concussion bins - not dissimilar to a blood bin - at the Under-20 Rugby World Cup in South Africa. It was an excellent idea, not one that I recall having to be used on the squelchy pitches of a winter Stellenbosch, but a definite step forward.

However, it then followed up with a step backwards on-pitch. You will recall that, in the Rugby World Cup final, Morgan Parra of France appeared to be concussed - was certainly showing symptoms of concussion - left the pitch then came back on only to get concussed again and have to leave the pitch. It was in breach of the IRB Concussion Regulations, and downright dangerous. The failure of referee Craig Joubert to enforce the Regulations attracted comment on this blog and elsewhere.

You will also recall that, back in February, Wales openside and captain, Sam Warburton said that he was getting headaches for days after games - concussion symptoms. Again, nothing came of it.

In the third Australia-Wales test, refereed by Joubert, Warburton took a huge hit to the head from a knee, which you can see from various angles HERE, HERE and HERE (once more, the work by the poster Snedds on the Gwlad rugby forum in compiling this archive of clips is invaluable as a resource), and was unmoving for a while and wobbly on his feet when getting up - concussion symptoms under the Regulations. Warburton was not removed from play as the Regulations would require, but despite playing on, was clearly and visibly not right. Ten minutes later, Warburton was on all fours, being sick, as you can see HERE.

So, a referee with a record of leaving concussed players on the pitch in defiance of the Regulations did not comply with the duty to apply Regulations made for player safety in the case of a concussed player with a history of concussion symptoms. That sort of persistent refusal apply the laws made for player safety is asking for trouble.

One has the contrast of Kieran Read of the All Blacks being rested because of sustaining a second concussion in two weeks, even with the clearance periods (that the All Blacks could then move Richie McCaw to 8 and bring in his 20 year-old MiniMe Sam Cane shows why, even when you admire NZ rugby as much as I do, it's hard to love an opposition with that sort of limitless depth. Just a small bit of weakness like the rest of us would be so much more endearing). But the real lesson was in case of Michael Lipman.

Lipman, late of Bath and the Melbourne Rebels, had to retire this last week, after sustaining over 30 concussions in his professional career (which career spans more or less the time period since concussion was first being managed properly in New Zealand, and the last five years of which post-date the reported study on the success of that concussion management regime). He is now, it would seem, permanently symptomatic as a result, judging from the litany of symptoms he talks about in that article. The quotation at the start of this post is from him, and it reflects the simple truth of the matter.

The Concussion Regulations are in place for a reason, and that reason is to protect players. If those with a duty of care towards players, like referees, persist in refusing to apply those rules of the game, then players will get hurt, and those players who end up with symptoms for the rest of their lives as a result of that failure will, sooner or later, sue. No-one wants that, but it is coming, and coming closer each time a referee fails to do what he or she is supposed to do. There is no down-side in applying the Regulations, which makes that failure all the more baffling.

So, to once again make the plea: for the sake of the game, of the referees, and the players, please - apply the Regulation and do not let concussed players keep playing to get hurt worse.

Because sooner or later, not applying them will turn out to be much the more painful option, for all concerned.