Football

Brain injury charity wary of GAA concussion rules

<span style="font-family: Quicksand-Regular, 'Trebuchet MS', Arial, Helvetica, sans-serif;">Dublin footballers and ABI Ambassadors Michael Darragh Macauley (l), Rory O'Carroll (r) and George Hook at the Aviva Stadium on Wednesday&nbsp;</span><span style="font-family: Quicksand-Regular, 'Trebuchet MS', Arial, Helvetica, sans-serif;">&nbsp;</span>&nbsp;
Dublin footballers and ABI Ambassadors Michael Darragh Macauley (l), Rory O'Carroll (r) and George Hook at the Aviva Stadium on Wednesday Dublin footballers and ABI Ambassadors Michael Darragh Macauley (l), Rory O'Carroll (r) and George Hook at the Aviva Stadium on Wednesday   

A LEADING brain injury charity says the GAA’s decision not to introduce a ‘concussion sub’ to Gaelic games could prevent “more accurate investigation” into potential concussion incidents.

However, Donegal team doctor Kevin Moran argued that lives could potentially be placed in danger if the GAA alters its rules regarding the treatment of players with suspected concussion.

Arising from a motion at April’s annual congress, the GAA’s medical, scientific and welfare committee were asked to consider the implications of introducing a temporary substitute for players suspected of having concussion. It released its findings on Wednesday, with the recommendation that it was not advising the introduction of a ‘concussion sub’ and that the existing concussion guidelines were “the best approach for the association”.

The GAA’s current guidelines are based on international best practice and recommend that a player suspected of concussion “should be removed from play and not resume play that day”.

A spokesperson for Belfast-based charity Brain Injury Matters acknowledged that while the GAA’s current practices were in line with international guidelines, introducing a rule allowing a temporary replacement would allow more time for assessing players with suspected concussion.

“Any strategic decisions made that minimises the risk to players in terms of concussion should carefully be considered to ensure both the short and long-term impacts of concussion are managed," the spokesperson said.

“We acknowledge and appreciate that there are good international management guidelines being used in GAA. However, providing the extra time for assessment at pitch side, through use of a concussion sub, would allow extra time for information finding to determine if a concussion has occurred.

“Although this will not change management when a clear concussion incident has occurred, this would allow more accurate investigation in potential concussion incident, where medical staff perhaps missed the incident and therefore previously players would be allowed to play on as sufficient time was not provided for a decision to be made.

“At Brain Injury Matters (NI), we fully understand the long-term impact of concussion and see the potential impact it has on both the person with the concussion and their wider family circle, therefore any strategies which can minimise this impact is strongly welcomed.”

World Rugby adopted a temporary replacement into rule in May this year, which allows rugby players suspected of suffering from concussion to be substituted until they have been assessed. If deemed to have suffered a concussion, rugby players are also then governed by a strict return-to-play protocol, which includes them being symptom-free before they return to any exercise.

However, the motion for a temporary replacement was strongly rejected by the GAA's medical, scientific and welfare committee, who explained exactly why the current procedures must not be altered on Wednesday. The GAA contend there is no test that can be conducted on a sideline that definitively concludes concussion hasn't occurred. 

Crucially, if a player suffering from concussion is mistakenly allowed to return to play and a second knock is suffered, then the fatal Second Impact Syndrome can occur. So far, there have been no instances of this in the GAA, though athletes in other sports have died from Second Impact Syndrome.

In 2011, 14-year-old Carrickfergus Grammar School rugby player Benjamin Robinson collapsed on a county Antrim pitch and later died in hospital as a result of two heavy impact tackles, which occurred within four minutes of each other.

The GAA’s MSW report states that international best practice is already being adhered to by the GAA and to deviate from this based on the congress motion would be a major concern.

Dr Moran used the example of a concussion suffered by All-Ireland winning Donegal forward Ryan Bradley in 2013 to highlight how difficult it can be to accurately diagnose concussion.

"I am nearly sure it was the [Ulster] semi-final against Down in 2013 and Ryan had two concussions that year," said Dr Moran.

“Anyway, he felt a bit funny and I was the pitch side doctor that day and I went in and he seemed a bit dizzy. While I was talking to him, he jumped up, the ball had been kicked out from the other end, he ran over, caught the ball and turned around and soloed up the field and kicked the ball over the bar, soloed about 30 yards.

“Then he went down again. I was on the sideline still, so he called me back in. I went back in and he said, 'look, I can see four, six goalposts, everything is waving all over the place'. I said, 'Ryan, you're coming off'. So I was bringing him off and Rory [Gallagher], who is our present manager, asked me very politely where was I going with him?!

“I said, 'he's concussed'. Rory said, 'how can he be concussed, he's after doing that?' I actually, for a finish up, had to put Ryan into hospital that night because that injury did evolve over the subsequent 24 hours. I think that one case is a good example of how difficult it can be to diagnose.”

The congress proposal was, to its credit, based on the belief that allowing a substitution to take place may make it more likely for players to come off and get an assessment.

Dublin full-back Rory O'Carroll famously remained on the pitch for the last 16 minutes of the 2013 All-Ireland final after suffering concussion because they'd used all their substitutes.

Since then, the GAA and O'Carroll himself have been proactive about getting the message out that any player showing any of the symptoms of concussion must be removed from play immediately. Dr Moran believes the message has generally been heeded about the dangers of brain injury.

"I do think so, certainly at county level and it's filtered down to the clubs as well," he said.

“What we couldn't overemphasise is that, for 95 per cent of the cases, where there isn't a doctor present, then the manager or the coach, whoever takes players off, must do so, particularly underage players where there is a suspicion of concussion because of the risk of Second Impact Syndrome.

"Thankfully, we haven't experienced that yet in the GAA. It's a very, very rare occurrence but, when it does happen, it's devastating because there's no treatment for it. That's it. It's irreversible."

The MSW report also ruled out the introduction of appointing independent team doctors, stressing the "high levels of confidence in the professionalism" of those currently in place.