Concussion: If in doubt, sit it out

(IRB.COM) Monday 18 November 2013
 Concussion: If in doubt, sit it out

Martin Raftery, the International Rugby Board’s Chief Medical Officer, has underlined the governing body’s ongoing commitment to promoting the best possible player welfare standards through strong concussion prevention, education, management and research programmes.

Concussion in sport has been a hot topic in the mainstream media in recent days, but the issue has been a long-term priority for the IRB, sitting right at the heart of the federation’s expert evidence-based approach to player welfare.

Speaking ahead of the IRB World Rugby Conference and Exhibition, where leading figures from the medical profession will gather to discuss concussion and other player welfare matters through the Medical Commission Conference, Raftery highlighted the IRB’s evidence-based stance.

“Concussion management is at the very heart of the IRB’s player welfare strategy designed to protect players at all levels of the Game and promote the very highest standards of education, coaching and medical care,” he said.

“Rugby is a physical contact sport and that is part of the fabric and attraction for those who want to play the Game. However, our duty is to ensure that the sport implements the very best standards of care to protect our players.”

Concussion is a complex and often emotive topic and the science continues to advance and progress and while the IRB is keeping its eye on the ball for the latest developments, its message to the community is clear and simple.

“We have a very clear message to the Rugby family – ‘If in doubt, sit it out’. Players, coaches, medics, parents and officials at all levels of the Game should all recognise the symptoms of concussion and remove any player from the field of play who they suspect to be concussed,” Raftery added. “They must not return.”

The IRB is a signatory to the 2012 Zurich Consensus statement on concussion, widely recognised as the world’s leading sports concussion forum and its concussion mitigation policies are based on the recommendations of the forum and other renowned experts such as Dr Bob Cantu.

“The IRB’s approach is focused on prevention, education and management of concussion founded on evidence-based research. It is driven by area experts, while having full input and support from the International Rugby Players Association and our national Unions,” Raftery said.

“It starts with prevention and the IRB has introduced a raft of strategies to minimise head impacts such as zero-tolerance towards tip and high tackles and the promotion of correct tackling technique.

“In terms of education, there are fantastic online and practical programmes such as IRB Rugby Ready as well as ‘Rugby Smart’ in New Zealand and ‘Boksmart’ in South Africa which teach people how to tackle properly, amongst other things.

“We are continuing to deliver concussion guidelines and online education modules for the public, players and match-day medical staff and referees. There will be mandatory accreditation for international team doctors and mandatory education at IRB events.

“On-field management sits at the centre and the IRB Pitch-side Suspected Concussion Assessment (PSCA) has been introduced in line with Zurich to further protect players.”

The PSCA protocols, which were introduced in elite rugby by the IRB and its Member Unions in 2012 following expert independent neurological input, is designed to give teams and match doctors time in a standardised and quiet environment to assess players in suspected concussion is not immediately apparent.

Raftery is quick to point out that it is not a diagnosis tool, but a triage or screening tool that enables players who have suffered a head injury leave the field for five minutes while the doctors determine whether they are fit enough to return to the pitch by asking a series of questions and balance tests. If players are suspected of having concussion, they are not allowed to return to the game.

“It is working,” he said. “Prior to the Pitch-side Suspected Concussion Assessment triage trial, players were being assessed on the field and on the run and it was determined that 56 per cent of players with a post-match confirmed concussion returned to the field of play. In the first year of the PSCA trial that figure has dropped to 13 per cent and will continue to reduce with greater compliance and education.”

However, the IRB has gone a step further in their concussion management guidelines through the introduction of Graduated Return to Play (GRTP) protocols which also give young players longer to recover from concussion.

“If you have been diagnosed as suffering from concussion you must be symptom-free for at least 24 hours following a Graduated Return to Play before being allowed back on the field, as recommended by the Zurich Consensus,” Raftery said.

“However, we decided to go further. For players in their late teens, we have insisted on a minimum of one week away from the field, and for under-16s it is a two-week minimum.”

Raftery insisted that the IRB is committed to driving education across its 118 Unions about all aspects of concussion, from prevention through to the GRTP stage.

“This is an evolving science for all sports and our role is to implement protocols in line with best-practice and ensure that we educate and train our stakeholders to ensure compliance.”

Raftery also said that the IRB acknowledges the suggested possible link between playing contact sports and Chronic Traumatic Encephalopathy (CTE), but that it is essential that Rugby commissions its own research too.

“CTE is a form of dementia, and there are studies about boxers and American football players who have suffered repetitive head injuries, so we recognise that there might be a potential link,” he added.

“However, prevention is key and we have implemented an approach that is in line with expert recommendations to mitigate risk of long-term implications. They are to eliminate deliberate hits to the head, which is banned in Rugby, implement strict graduated return to play protocols, which we have and educate best practice technique.”

Raftery is confident the IRB’s concussion prevention, education, awareness and management guidelines are making an impact throughout the sport.

“The message is getting out there,” he said. “Our Unions understand the importance and players are now much better educated and understand why it would be foolish to ignore protocols.”

“We continue to do as much as we can with respect to concussion research and the IRB is taking the issue very seriously.”

For more information about the Medical Commission, click here.