Concussion warning for rugby bodies

Irish players are amongst those being left at increased risk of concussion-related injuries due to the failure of the PRO12, Heineken Cup and Six Nations to adopt IRB guidelines, according to a leading player advocate.

Rob Nichol, chief executive of the International Rugby Players Association, was speaking at the IRB’s first annual conference and exhibition in Dublin, where he urged all bodies to adopt the Pitchside Assessment Concussion Assessment (PSCA).

“We have a couple of days to have some dialogue in the medical commission conference and get people up to speed and hopefully they might jump on board the boat and get constructive and do the right thing,” the New Zealander said. “The direction I can sense it going is you will be leaving yourself out on a limb and significantly exposed if you don’t get on the boat and, from a player welfare perspective, we’d expect most people in positions of governance with strong influence to do the right thing by their athletes.”

The Six Nations are currently holding discussions over the PSCA guidelines but have yet to come to a decision. However, there are no plans to introduce the protocols into the RaboDirect PRO12 while the ERC, who run the Heineken and Amlin Challenge Cups, have opted to await the outcome of the trials. Nichol was among a panel of medical experts, rugby administrators and player representatives who briefed media.

IRB chief executive Brett Gosper accepted not everyone sings from the same hymn sheet on how to treat suspected concussion cases.

“We do put pressure on unions who we do feel are a bit shaky on it,” he said of the PSCA. “At the end of the day it is a trial and there is the possibility for certain organisations to opt out if they so feel differently.

“But our belief is that the evidence is there and it is a very strong process and the overwhelming support of the majority of unions and competitions would be behind that, with the odd exception.”

Concussion has jumped front and centre in terms of player welfare recently, with Brian O’Driscoll and Australia’s George Smith among the more high-profile players involved in suspected cases in the recent past.

O’Driscoll’s uncle, Barry O’Driscoll, a former medical advisor to the IRB, relinquished his role with the body in protest over the five-minute rule for assessing potentially concussed players pitchside and told the BBC that it effectively amounts to putting “brain-damaged people” back on the field of play. The IRB, while accepting that the science behind concussion prevention and treatment is evolving, rejected criticisms of the PSCA protocol, with their chief medical officer Dr Martin Raftery among them.

“That seems to be a poor argument because they have zero minutes at the moment so I don’t understand the argument. Five is better than zero. There is no evidence out there as to how long the time should be.”

Nichol added that a pilot study of 173 PSCA cases revealed that not one failed to be completed within the designated five-minute span and that there had been no complaints received that sufficient time had not been allocated.

“The only evidence we have is that (the examination) should be multimodal,” said Raftery who held a similar role with the Australian Rugby Union, played rugby league for Cronulla Sharks and was team doctor to the Wallabies. “It should be symptoms, balance and memory.”

The IRB has undertaken a number of initiatives on the wider question of concussion in rugby in the areas of prevention, education, management and research but the PSCA remains the very public face of the issue.

Figures assembled by the body assert the percentage of players to remain on the field of play after confirmed concussions has dropped from 56% to 13% under the five-minute protocol.


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