Medical move on ‘injury subs’

Dr Pat O'Neill

The GAA’s Medical, Scientific and Welfare Committee is considering a rule permitting temporary replacements for injured players who may require more thorough evaluations off the field of play.

The association already operates a ‘blood sub’ rule in Gaelic football and hurling and the possibility of extending that principle for other afflictions is a recognition that some issues simply can’t be diagnosed immediately and may merit more time.

Dr Pat O’Neill, former Dublin football player and manager, a member of the committee and a Consultant in Orthopaedic and Sports Medicine at the Mater Private Hospital and Cappagh National Orthopaedic Hospital, has explained the backdrop.

“That is under consideration by the GAA Medical, Scientific and Welfare Committee and there is a meeting now to be held with the GAA doctors which is going on at the end of this month to see if, rather than a head injury or a concussion sub, that it can be rolled into an injury sub.

“Because there are other injuries that, in the heat of battle, can be very difficult to assess on the field or even on the sideline and that there may be a format where you could rotate it and so it would be multi-purpose.”

Dr O’Neill was speaking in Croke Park on Saturday at the second National Concussion Symposium, hosted by Bon Secours Health System in partnership with the University of Pittsburgh Medical Centre and in association with the GAA.

The idea of a temporary sub is perfectly commendable in principle but putting it into practice isn’t so straightforward.

It was suggested to Dr O’Neill, by way of example, that there would be a significant difference between its operation at senior inter-county levels and junior and underage levels.

Human nature being what it is, there is also the likelihood that some would seek to abuse any new ruling for, as Dr O’Neill put it himself, ‘strategic and tactical’ purposes.

So it would necessitate some watertight law-making if it were to come to pass.

“We have actually seen that with the blood substitutes in Gaelic games and in other sports as well where it is used, so it is getting the balance,” said Dr O’Neill.

“The main thing here is to protect the player and also to protect the people making the decisions.”

This isn’t the first time the GAA has wrestled with this sort of conundrum but it is in the tighter confines of the debate surrounding concussion to which it has been mostly restricted until now.

A motion proposing the introduction of temporary replacements purely for suspected concussion cases failed to get the support it needed to pass at Annual Congress in 2015 with the association opting against rugby’s decision to use pitchside head injury assessments (HIAs).

These protocols have prompted intense levels of debate in rugby. Some claim the system has improved player welfare. Others make the point that anyone suspected of needing a HIA in the first place should automatically be pulled from a game and not allowed to return.

Whatever about rolling subs for injuries in general, there seems to be a determination on the part of the GAA to stick to the working principle that any player suspected of concussion should not be allowed linger on the field, or return to it once examined.

“The message has to come down through the whole pathway that if there is a suspected concussion then they have to come off,” said Dr O’Neill when asked about the changing culture surrounding concussion throughout sport.

“That is the policy that the GAA have followed.

“There is this attitude - and it’s probably because people are trying to keep players in sport - of a head injury assessment for a period of time with a view to doing an assessment and then putting them back in.

“Certainly in the GAA ... they have not adopted that situation. They don’t return and that gives a window for an assessment in the immediate and intermediate term that follows that.”


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