Thursday 18 January 2018

Brendan Fanning: Stump up for independent medics at all pro games to combat concussion

Conor Murray is treated for injury against Glasgow last Saturday. Photo: Stephen McCarthy/Sportsfile
Conor Murray is treated for injury against Glasgow last Saturday. Photo: Stephen McCarthy/Sportsfile
Brendan Fanning

Brendan Fanning

We wouldn't be in the habit of answering the phone when in the park of a Monday morning, running the hounds, but when the caller is a man who has spent his entire working life in the neurology business it's a race to press the right button before you lose the call.

A rugby head through and through, this man has a short enough fuse for some of the stuff written about concussion. And when he started giving out about bodies like Premiership Rugby and EPCR conducting reviews into head injuries, and how they were handled, we were unsure of where he was going. He reached the destination quickly enough though. "Take it - the whole thing - out of the hands of team medics who are inevitably compromised," he said. "And put independent medics in charge."

When we mentioned that this was already in place in Test rugby he acknowledged as much. And observed that cost should never be the issue, so it should be extended across the professional game. Sooner rather than later.

His comments are not unique, rather in the current climate they are further evidence of the unease that spreads around the rugby world every other weekend when someone who should be taken off the field, and kept off the field, is allowed back on, under the release mechanism that is the Head Injury Assessment.

When the HIA was introduced into law at the end of the 2014/15 season we welcomed it as an improvement on what had gone before: a hurried on-field exam where the player would battle to sound coherent - and stay in the game - and the medic would try to ascertain whether or not the player's brain had been scrambled.

The HIA is a comprehensive process covering cognitive, balance and memory tests. As part of the information programme a bunch of hacks were brought down to the Aviva one day where we witnessed it in operation. It was on a guinea pig, naturally enough, a colleague who did a passable impression of someone with cognitive impairment. We went home thinking it was a useful tool in the trade of making a dangerous game safer.

The sad reality, however, is that it is patently unreliable. Its very presence has added to the positive culture change where concussion is no longer something to be 'run off,' but it is possible to be knocked out one minute and to pass the HIA a few minutes later.

For this reason, Dr Barry O'Driscoll has been its most vocal opponent. You don't have to peel back too many layers in World Rugby to discover that they don't see eye to eye with O'Driscoll. A former chief medical officer of that organisation, when it was the International Rugby Board, his policy is unbending: if you think a player may have been concussed, you take him off. Period.

He takes this stance because diagnosing concussion can be like chasing shadows. So don't take any chances. Cliff Beirne, a consultant maxillofacial surgeon with the Santry Sports Clinic, came out last week in the same vein.

"We know that if a player fails it, yes they are concussed," he said. "But if they pass it, it doesn't mean, in my opinion, they're not concussed."

The elusiveness of the target was illustrated further in a tweet last week from consultant neuropathologist Dr Willie Stewart, a world leader on the subject: "A list of all the proven diagnostic tests for concussion (also those that can confidently exclude diagnosis): 1 . . . "

This grey area surrounding the grey matter has led to some horrendous mistakes, the most obvious being in the Northampton versus Wasps game in December when George North - the game's reluctant poster boy for concussion - returned to the game having been knocked out cold. It beggared belief that the Saints' staff hadn't picked up on it. Most teams have technology that allows them within seconds to rewind and analyse match footage as it happens. So if you see a player's head bouncing off the ground and he's struggling to get up then it seems a good idea to get him off, and keep him off.

So at every professional game there should be an independent medic with access to exactly this technology so that he can make a call, unencumbered by an attachment to either team. Simple enough, if expensive.

There would be incidents where the player claims he is fine and wants to continue. Take last weekend in Glasgow. In the press box we had no access to replays and missed entirely the gravity of Conor Murray's clash with Tim Swinson. Subsequently Murray has come out and said explicitly that it was a neck injury, and his head was fine. With respect to the man himself, we don't believe that testimony from players at the heart of the issue is reliable.

The latest injury audit in England (Professional Injury Surveillance Project), published last week, finds - for the fifth season running - that concussion is top of the hit parade, accounting for 25 per cent of all match injuries.

We know it's a scourge. The job now is two fold: keep tweaking the laws to promote safety; and stop faffing around on the manpower and technology to monitor it.

Sunday Indo Sport

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