Video replays might provide an essential tool in diagnosing concussion in games, says Dr Kevin Moran.
The Donegal medic, who is currently assisting the Ireland International Rules team in Australia, readily admits there are difficulties for team doctors in assessing players for head trauma during matches.
Moran has represented the GAA at several concussion forums such as the Berlin Consensus Conference and was one of the organisers of the National Concussion Symposium. An opponent of the concussion sub rule, he favours players who pick up head injuries being replaced permanently.
The more information team medics receive about a suspected concussion the better the chance they have of treating the injured player appropriately, he argues. “Doctors would like to see the impact back again because seeing it is very important, to be absolutely accurate.
“A rugby league representative demonstrated this very well at a meeting in Croke Park. They used HawkEye with 17 different views to witness an impact. Seventeen! They’re probably looking at it from a different perspective – looking to see if a player can be put back on (the field) whereas we’d be looking at it from a player welfare perspective.”
Because both Eoin Cadogan and Lee Keegan were fitted with GPS units in the Allianz Division 1 Round 1 game between Cork and Mayo in Páirc Uí Rinn last year, the scale of impact when they collided, both sustaining concussion, was ascertained. “It’s a very fine clinical judgement based on experience and clinical acumen to a certain extent,” said Moran. “Firstly, you must know the concussion history of the individual — for instance I know the concussion history of all these (Ireland IR) lads because some have had a significant number of concussions. We must know the history and see the impact because although 90% fall to the ground, 10% don’t.
“The impact depends on the kinetic energy transferred — half mv2: half the weight of the player by the velocity at which they’re travelling squared — so if you have a high-velocity collision like Lee Keegan and Eoin Cadogan, who were wearing GPS’s, so it was measured how fast they were travelling.
“What’s emerged from professional sports is that in the first three minutes afterwards there are a lot of signs that an experienced doctor will pick up and there’s only very limited examination you can do on the pitch.” Moran knows indemnity is always on team doctors’ minds. “There’s an indemnity issue arising now and we’re waiting to see a number of cases coming up in rugby. Could the floodgates open? It only takes one case in the GAA and the floodgates open and indemnity comes into it, which makes it very difficult for doctors in the GAA, who are mostly working pro bono.”
Interestingly, Dr Moran suggests the practice of the blanket defence has helped to mitigate the number of concussion cases. “One of the things that might have protected us in the last number of years is the blanket defence because the impacts, even though they could be significant, weren’t high-velocity. Fellas just didn’t get the room to build up momentum.”
It worries Moran that so many games are played without a GP in attendance.
“Only about 5% of our games have a doctor present. So we’ve 95% of games where there’s no medical or trained professional. Therefore our main thrust has to be education, making everyone aware.
“I think every club should have a welfare officer and on their agenda concussion should be a priority: keeping a concussion log on any player in the club, particularly under-age because now we have players playing Gaelic today, rugby tomorrow and soccer the next day. That’s one of the big problems. You could have a fella who had a couple of concussions and nobody knew about them because they happened in other sports.”
Moran also touched on the virus dilemma encountered by the Ireland squad last week. Players had been supplied with hand gels before flying to combat the winter vomiting bug. They had also been instructed to drink five litres of fluid during their 24 hours of travel.
“There are two different infections that you can get on an airline: one the air can be contaminated because it’s re-circulated and the surfaces on airplanes can also become infected. We did everything we could to contain it but it’s very hard once it gets into the camp.”
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