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TheBFG
29-09-14, 13:09
A player receives a bang to the head and is seen pitch side by a "physio", the physio says he has concussion and isn't allowed to play for 23 days, is he competent to make that statement. After the match the boy is taken to A&E where he is seen by doctors, they give him the all clear and state there is no sign of concussion and that he is fit to play.

So as his club coach who do you go with? If I tell the parents I'm not picking their son as the physio has said he has concussion, they're likely to come back, but a highly qualified doctor in a hospital has said he's fine!

As much as I can choose not to pick him, I have no control over school matches or other sides he might choose to play for, but if he does play will he be "insured"?

dave_clark
29-09-14, 13:09
doctor, every time.

(assuming of course you're happy as to the accuracy of the stories, but i guess that's another question.

buff
29-09-14, 13:09
I coach school rugby, so I have to deal with players coming back from concussion (or not coming back) every season. I would go with the doctor's opinion, but in the interest of legal self-preservation, I always require written permission from the doctor, and the player must be specifically cleared for rugby, not just sports or physical activity. On top of that we always follow the gradual return to activity protocol and I will be in touch with his teachers to see how he is doing in class.

Dixie
29-09-14, 14:09
have you considered the possibility that they are both right as regards the concussion? Which is to say: the lad suffered a concussive head injury evidenced perfectly clearly, even to the untrained, by (for example) grogginess , unsteadiness, slurred speech, impaired memory of the event. But by the time a qualified medical practitioner got to see him, those signs of concussive injury had passed, and there were no residual signs for the doctor to hang his hat on.

That seems to me to be entirely possible - even likely. If it is the case, then someone needs to weigh up the risks and rewards of playing the lad for the next three weeks. As those risks include death, I would suggest that only the boy's parents are qualified to make that judgement. But as they lack the detailed medical information needed to evaluate those risk properly in the absence of a privately paid-for brain scan and neurologist's specialist opinion, it may be advisable for all concerned to go with the RFU's "prudent" strategy - give him a break from the game in the interests of safety.

If you had recently buried your own child an the autopsy indicated that cause of death was a repeat concussive incident on top of a recent previous one, would you (or possibly your wife) feel inclined to sue the responsible adults who had overruled the precautionary principle in the interests of the Somerset Youth Vase? If the answer to that is that it might cross your mind, then multiply that by a factor of about 10 for a parent who is not so heavily steeped in the rugby mould as we all are.

I think in your shoes I'd be looking to persuade the parents not to allow Johnny to play for ANYONE, and I'd be digging out some of the relevant material from the likes of BOD's uncle(?) to support my case. If they overruled, I think I'd overrule them unless they themselves have detailed medical knowledge - in which case I may want a signed waiver.

Phil E
29-09-14, 14:09
Wot Buff said .

Dan_A
29-09-14, 14:09
Some useful stuff here to suppport a decision not to play him:- http://www.rfu.com/headcase

Daftmedic
29-09-14, 15:09
Physio. The kid could of seen a very junior FY2 in a busy ED. The physio saw him at the point of impact. And if ever you get someone say, "don't worry I'm a GP" ejaculate them from the incident.

- - - Updated - - -

Physio. The kid could of seen a very junior FY2 in a busy ED. The physio saw him at the point of impact. And if ever you get someone say, "don't worry I'm a GP" ejaculate them from the incident.

Lee Lifeson-Peart
29-09-14, 15:09
I'd get the parents to read this (http://www.bbc.co.uk/news/uk-northern-ireland-23943642) and if they're still adamant he plays then so be it.

TheBFG
29-09-14, 15:09
Physio. The kid could of seen a very junior FY2 in a busy ED. The physio saw him at the point of impact. And if ever you get someone say, "don't worry I'm a GP" ejaculate them from the incident.


and what would be the physio's qualification for assessing a concussion?

crossref
29-09-14, 16:09
and what would be the physio's qualification for assessing a concussion?

doctors come in all shapes and sizes - it may well be that the physio for a large well reseourced club has more experience and knowledge regarding concussion than many doctors. If you are an ENT specialist, or gynocologist, or oncolcogist you wouldn't encouter any concussions in the course of your work.


I must say if I had an injured 14 yr old and two professional disagreeinig over whether he is concused, I'd err on the side of safety.
But I appreciate this question is about recovery plan rather than whether or not he stays on the field, so more difficult.

Pegleg
29-09-14, 16:09
Don't we just follow the IRB / union protocols?

Browner
29-09-14, 16:09
and what would be the physio's qualification for assessing a concussion?

This lad went to hospital
http://www.rte.ie/news/2014/0324/604269-student-secures-2-75m-damages-after-rugby-injury/


. His mother asked that a scan be carried out of his head, but said she was assured that was not necessary.

BFG,
FWIW, I advise all parents of a concussed player( under my coaching wing) to insist the hospital scan their son, and if the hospital decline to do so, then show them this to change their mind !
I retain evidence emails saying this.

DrSTU
29-09-14, 22:09
If at the point of contact the physio thought that there was at least cause for concern and a subsequent check by a medically trained individual presented no signs of concussion then I would insist on a scan and blood work being done to determine what the actual situation. If the parents are willing to accept the medical advice given to them, then it's not up to you to decide for them.

andyscott
29-09-14, 23:09
then I would insist on a scan and blood work being done to determine what the actual situation.

Thats because you worked in the US ;)

Err if you have doubts dont play him, simples if the parents arent happy, well tough

Daftmedic
29-09-14, 23:09
and what would be the physio's qualification for assessing a concussion?
I would suggest a physio at a rugby club should be trained in PHTLS. The RFU run a very similar course.
DrStu. I've not come across bloodwork that shows a concusion antibody. You would have to LP to check for Erythrocytes in the CSF but that would suggest a historic bleed and not an acute presentation of cerebral trauma.
see I can be a grown up

pwhaling
30-09-14, 02:09
A couple of weeks ago i had a girl's head take a nasty bounce off of the turf. Physo comes out and tells me she's done, she says she's fine. Dumbass coach asks me if we have to listen to thw physio. I ask him 'Do you have a MD?'. He says 'No'. 'Ok, we listen to the physio'.

That shut him up. Dumbass

Simon Thomas
30-09-14, 07:09
The RFU are currently setting up a series of visits to Society meetings and CB Club meetings to deliver a 45 minute session on concussion. You should see it before the end of the year.

From RFU Training & Development

"Gents,

I would like to offer a workshop to the societies and Federations in the early months of the season. We have developed a 45min-1 hour information session on concussion, in conjunction with Dr. Mike England, which will be rolled out to the game over the coming months. Ideally, this would be offered to all active referees via their society training nights. We will attempt to get around each society before Christmas to deliver.

To enable us to plan our deployment, could you please return the information below, stating your 3 preferred dates, times and venues? Once confirmed, I would also like to open the session up to local clubs to attend. Please state if this is NOT preferred by the society."

DrSTU
30-09-14, 08:09
Positive correlation between tau levels and trauma, please try to keep up at the back:biggrin:

http://archneur.jamanetwork.com/article.aspx?articleID=1846622

I'd just do the tests myself though :pepper:
I would suggest a physio at a rugby club should be trained in PHTLS. The RFU run a very similar course.
DrStu. I've not come across bloodwork that shows a concusion antibody. You would have to LP to check for Erythrocytes in the CSF but that would suggest a historic bleed and not an acute presentation of cerebral trauma.
see I can be a grown up

Lee Lifeson-Peart
30-09-14, 08:09
The RFU are currently setting up a series of visits to Society meetings and CB Club meetings to deliver a 45 minute session on concussion. You should see it before the end of the year.

From RFU Training & Development

"Gents,

I would like to offer a workshop to the societies and Federations in the early months of the season. We have developed a 45min-1 hour information session on concussion, in conjunction with Dr. Mike England, which will be rolled out to the game over the coming months. Ideally, this would be offered to all active referees via their society training nights. We will attempt to get around each society before Christmas to deliver.

To enable us to plan our deployment, could you please return the information below, stating your 3 preferred dates, times and venues? Once confirmed, I would also like to open the session up to local clubs to attend. Please state if this is NOT preferred by the society."

We at South Yorkshire saw it a couple of weeks ago. The NI schoolboy story I linked to up the thread is in it. We had an A&E trauma doctor in our group who also added to the debate and it was he who suggested as above that some medical specialists will never come across a concussion in the course of the their working lives - dermatologist was the example used but is not as funny as gynaecologist or proctologist - and as such "I'm a doctor" can be of limited use.

Where we were all agreed was that cases such as George Smith v Lions type symptoms there was no doubt in anyone's mind that he would not continue to play if (God forbid) we were refereeing.

We were provided with some Corex posters and little wallet cards to distribute as we trotted round the clubs. I have not been in every changing room but of the few clubs I've been round so far I haven't seen the same posters as I've been given even though we were assured all this stuff has gone to the clubs.

It's the same logo/strap line as daftmedic uses in his signature.

Taff
30-09-14, 08:09
What's 3 weeks after all?

I mentioned the latest WRU push re concussion in my PMB - sadly both coaches said they hadn't received anything. Sometimes you could be forgiven for thinking this is 1914 and not 2014.

Daftmedic
30-09-14, 09:09
Positive correlation between tau levels and trauma, please try to keep up at the back:biggrin:

http://archneur.jamanetwork.com/article.aspx?articleID=1846622

I'd just do the tests myself though :pepper:

We have 40k race in our blood?

http://i902.photobucket.com/albums/ac230/Truehyuga/fwphp-1.jpg (http://s902.photobucket.com/user/Truehyuga/media/fwphp-1.jpg.html)

But in all fairness that is not a test that you would do in A&E/ED.
That's a test you would use in conjunction with CT,MRI and nerve conductivity to help diagnose what kind of MS your dealing with.
Think of it as a brain version of a troponian cardiac enzyme markers but take a lot longer to show.

Dixie
30-09-14, 22:09
What's 3 weeks after all? The time it takes for Arsenal to lose touch with the premiership title contenders year after year - usually in February.

Daftmedic
01-10-14, 08:10
Dixie. Cheeky. But I like it

TheBFG
01-10-14, 09:10
The time it takes for Arsenal to lose touch with the premiership title contenders year after year - usually in February.

MODS!!!!!!

I think there should be an official warning issued there for a genuine rugby related thread being hijacked with a WENDYBALL reference!!!! :wink:

Lee Lifeson-Peart
01-10-14, 11:10
MODS!!!!!!

I think there should be an official warning issued there for a genuine rugby related thread being hijacked with a WENDYBALL reference!!!! :wink:

Right! Who mentioned football?

3022

davidgh
06-10-14, 08:10
Was he assessed using the new approved RFU pitchside assessment system?

The basic answer is obvious.

You know that the Physio who assessed him pitch side says he was concussed.

You have no choice but to keep him out of all rugby for the requisite period. At a minimum tell the parents in writing that it is mandatory that he doesn't play

If he plays for your team within the timescale, you will get zero support from the RFU if something goes wrong, in fact they will crucify you. The other people who are likely to crucify if you let him play and there is an adverse consequence are the assertive parents!! They will likely suddenly forget all the discussions and blame it all on you!

http://www.rfu.com/takingpart/playerhealth/concussion/~/media/files/2013/taking%20part/concussion/assessment%20of%20suspected%20concussion.ashx

Ricardowensleydale
06-10-14, 13:10
FWIW, I advise all parents of a concussed player( under my coaching wing) to insist the hospital scan their son, and if the hospital decline to do so, then show them this to change their mind !


As usual you are forgetting the risks involved in a CT scan. In the order of 1 in 7000 people who have a CT scan will develop a tumour as a consequence of the radiation used. That's why hospitals only scan people who need it rather than because the "parents insist"