Archaic Thinking/Management of Concussion Not Just a N. American Issue

I have cataloged this problem many times in many sports across the world.  It seems that perhaps the focus and glare is greatest here with North American sports (mainly football and hockey), but this problem extends further.  This issue perhaps came to a head in the UK over the past week with this article by Tom English;

Barry O’Driscoll played rugby for Ireland in the Five Nations championship of 1971.

As a respected doctor (whose son was team doctor for Ireland and the Lions in the recent past) with a background as an international full-back he became an important figure on the International Rugby Board where for 15 years he held positions on the medical, anti-doping and disciplinary committees. Until late last summer, when he resigned.

Dr. O’Driscoll left his post because of the way the International Rugby Board (IRB) was/is handling concussions on the field and in general.  As an aside, the IRB is a founding partner of the Zurich statement as well.

What would make a highly trained and well-respected doc – with rugby in the blood – step away?  Take a look, specifically at what happened to his nephew;

After one collision too many that day Brian O’Driscoll lost his bearings, was clearly unsteady on his feet and had to be helped from the field, like a boxer assisted from the ring. You did not need experience in pathology to know that the great man was out of it for a moment in time. Yet a few minutes later he was back on the pitch, supposedly as bright as a button and fully recovered.

He was back on the field because ?????;

There is an accompanying rule now – still on trial – and it states that if a player with suspected concussion can pass a series of tests lasting five minutes then he can be allowed back into the fray: the Pitch Side Concussion Assessment (PSCA) – or the five-minute rule.

Even worse the “new” rule was not even in place when his nephew sustained his concussion, leading the good doc to question what the sanctioning body and the medical board was doing;

“Rugby is trivialising concussion,” he says. “They are sending these guys back on to the field and into the most brutal arena. It’s ferocious out there. The same player who 18 months ago was given a minimum of seven days recovery time is now given five minutes. There is no test that you can do in five minutes that will show that a player is not concussed. It is accepted the world over. We have all seen players who have appeared fine five minutes after a concussive injury then vomiting later in the night. To have this as acceptable in rugby, what kind of message are we sending out?

“If a boxer cannot defend himself after ten seconds he has to have a brain scan before he comes back. And we’re not talking ten seconds for a rugby player, we’re talking maybe a minute that these guys are not sure what’s going on. They don’t have to have a brain scan, they have to have five minutes where they have to stand up straight without falling over four times, they have a basic memory test – ‘What’s the score? Who are you playing against? Which half did it happen in? And do you have any symptoms?’

“These questions should serve as a landmark for when you examine them six hours later to see if they’re getting worse or if they’re bleeding into their brain. That’s why you ask them, not to see if they can go back on. They are already concussed at that point. You don’t need to ask questions to find that out. If six hours later their responses are worse than they were earlier you say ‘Wait a minute, this shouldn’t be the case, is this guy going to bleed?’ That’s why you ask the questions and so it has always been. But we’re going in the other direction now. We’re going from being stood down for three weeks to one week to five minutes with players who are showing exactly the same symptoms. The five-minute rule came out of the blue. I couldn’t be a part of it so I resigned from the IRB. It saddened me, but I couldn’t have my name attached to that decision.”

As you can clearly see some places are not quite ready to accept the real issue of concussions – not the actual injury – the mismanagement of the injury once it occurs.  If the IRB places the new “five-minute pitch side rule” into place they are going in the absolute wrong direction.

If any player in any sport shows clear signs of concussion they should be removed and not allowed back in, period.  Even Zurich, which the IRB is part of states this.  Dr. O’Driscoll is merely saving his reputation by stepping aside, and in my opinion it is the exact correct move.


One thought on “Archaic Thinking/Management of Concussion Not Just a N. American Issue

  1. Karen Walton April 4, 2013 / 13:22

    I am the step father of Benjamin Robinson, the schoolboy who died in 2011 as a result of second impact syndrome through failure to diagnose concussion in an under 15 rugby match for Carrick Grammar. The IRFU had been warned of a fatality through concussion mismanagement one month prior to Benjamin’s death. This appears to be indicative of the various Unions’ ambivalence toward the subject. The old guard in rugby hierarchy have simply failed to move dynamically with the exponential growth of player size,strength and pace. This has been manifested through comments I have overheard from older players, much senior to myself, (I am 45 now and played a long career as a player with a physical reputation) I do not wish to see the physicality of the game diminished, but to fail to safely mitigate against the associated risks, and for the IRB to work to their own agenda is negligence, plain and simple. It speaks volumes that the the IRB chose Dublin to launch its revised May 2011 guidelines to the world, but the very referee who had been officiating at Benjamin’s match was blissfully unaware of the new directives, and indeed openly admitted that the first he had been appraised of these was in August 2012, meaning he had officiated for a full season, ignorant to the guidelines that were applicable.
    On the subject of Brian O’Driscoll’s concussion, he was clearly spark out, and the guidelines state any player concussed does not return to the field. A spark out concussion is obvious. Perhaps not obvious enough. But this is not the first case the Irish team has displayed blatant disregard for player safety; in last year’s 6 nations Cian Healy was spark out against Italy and was revived with smelling salts to play on.
    It also raises the question if O’Driscoll was cleared to play after his 5 minute patch up, sorry concussion assessment, then why did he have to undergo extensive cognitive testing prior to playing in the final match against Italy the following week? If the explanation that is volunteered for that is because it is more in depth and accurate, that raises the question why allow a player to play on in the immediate aftermath of a suspected concussive incident, when the risk of second impact syndrome is dangerously elevated?
    It appears the IRB is talking the talk, but not walking the walk, unsteady as it may be, if you will excuse the pun.

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