Saturday 1 October 2016

Lee Keegan concussion will lead to far greater awareness

GAA satisfied head injury guidelines are robust enough

Published 02/02/2016 | 02:30

Mayo’s Lee Keegan is assisted off the pitch by Dr Sean Moffatt during Mayo’s defeat against Cork. Photo: Diarmuid Greene / SPORTSFILE
Mayo’s Lee Keegan is assisted off the pitch by Dr Sean Moffatt during Mayo’s defeat against Cork. Photo: Diarmuid Greene / SPORTSFILE

It is somewhat ironic that the most high-profile case of concussion in Gaelic games in recent years involved the one player who has probably done more to create awareness about the issue in the sport.

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Dublin full-back Rory O'Carroll staggered through the last 15 minutes of the 2013 All-Ireland final against Mayo after coming off 'second best' in a full-blooded collision with an opponent Enda Varley.

O'Carroll was checked out at the time - Dublin had already used their full complement of substitutes - and it only came to light afterwards that he had sustained a concussion. His colleague Jonny Cooper had also showed symptoms of concussion and was replaced minutes earlier.

O'Carroll was then and still is an ambassador for Acquired Brain Injury Ireland and they were swift in their contention that the decision to play on should have been taken out of the player's hands, given the condition he was in.

Vocal

Since then O'Carroll has been quite vocal on the subject, admitting last year that he would consider retirement from the game if he got just one more concussion and taking time out to write a letter, in a personal capacity, to the Irish Times questioning the return of Rory Best to duty for a Six Nations match against France having sustained a heavy knock to the head the previous weekend against Italy. Best had completed the return-to-play protocols.

The knock that O'Carroll took to the head in the biggest of the match of the season, allied to the blow that Clare hurler John Conlon had taken earlier in the summer that left him so badly dazed that his blood pressure began to soar, brought home the need for fresh thinking on the matter of head injuries and may have been the spark for a motion that found its way to Congress last year.

That motion considered the introduction of a 'concussion substitute' to allow for off-pitch assessment, with the player only being allowed to return to the field of play if the result of the test is negative.

There was potential exposure to exploitation of such a rule. Unlike a 'blood substitute' where blood must be visible to the match official, the avenue to deceive by replacing a player after the full quota of substitutes had been used would be far harder to detect in the most unlikely event that a team management needed to go down that route.

The motion was set aside for the GAA's medical, scientific and welfare committee to consider, which they duly did. They rejected it late last year on the basis that they felt it wasn't the right fit for the Association or the players and instead concreted the mantra that if there's a doubt, a player should sit it out.

That re-inforces the requirement for a player about whom there is any suspicion of concussion being removed from the field and not being permitted to return.

In theory they are strictest concussion guidelines of all that take any element of risk or chance out of the equation.

The 'return-to-play' protocols now in place for the GAA involve six steps: an initial period of 24-48 hours' rest followed by light activity, a walk, cycle or swim at 70pc maximum permitted heart-rate. The third step involves running followed by non-contact and then training drills before a medical doctor can consider a full return-to-play.

But with no set time frame these steps can be completed in six days provided the player is symptom-free and medical clearance is given at the end of the process.

Lee Keegan's suspected concussion from his collision with Cork's Eoin Cadogan, who himself was removed, has brought the matter into focus again.

It should be acknowledged that concussions cases in the GAA, while very serious, are not altogether frequent.

Mayo were quick to put the hand up and admit Keegan should have joined Cadogan on the sidelines as a precaution. If there were obvious signs of concussion symptoms at the time, it's very safe to assume that their experienced medical team would have swiftly taken him off. The symptoms only subsequently developed, before he was withdrawn.

It may trigger some thought as to whether a concussion substitute would be an alternative option but the GAA remain very satisfied that their existing policy works very well.

One voice which resonated loudly yesterday was that of Cliff Beirne, of the Santry Sports Surgery Clinic, a former member of the GAA's medical scientific and welfare committee.

He told RTE radio that protocols were often not adhered to in sport and raised the question of independent doctors being employed to make such decisions or even sanctions being imposed on teams if governing bodies felt "an adverse event had taken place".

But is there a guarantee that independent doctors can get it right in such a short space of time?

The chairman of the GAA's medical, scientific and welfare committee, Ger Ryan, commended Mayo on the way they dealt with the matter on Sunday evening.

"It shows that there is a high level of awareness and we would very much congratulate Mayo on coming out and dealing with the matter in the positive and constructive way that they did," he said.

"Cork obviously dealt with the matter perfectly. There is a high level of awareness of our guidelines."

Irish Independent

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