The importance of recognising suspected concussion

As you will no doubt be aware there has been some high profile incidents where a seemingly concussed player has been allowed back on to a rugby pitch, the most recent being the case of George Smith in the third Australia v British & Irish Lions test.

The incidents have caused Dr Barry O'Driscoll, the ex IRB Medical Advisor, to once again publicly critisise the iRB for their concussion management guidelines at elite levels where the 'Concussion Bin' trial is in use. The iRB have in defence restated their committment to player welfare as a signatory of the Zurich Consensus Statement. (The paper can be found here).

Part of the iRB's approach to reducing serious head injury in our sport is to educate as many people as possible about recognising the signs of a suspected concussion. The iRB's Player Welfare website (www.irbplayerwelfare.com) is very good and has a short course detailing how to recognise the signs of concussion, how to remove the player from the pitch, especially if they themselves are unwilling to come off, and how to use the Pocket SCAT2 guide to help you understand if further medical attention is required.

Unfortunately there have been a few deaths in our game, as a result of concussion, 17 year old Rowan Stringer from Canada died earlier this year after receiving a hard knock to the head, Benjamin Robinson, 14, died in 2012 after his concussion was not recognised earlier, and just last week, a 27 year old man died in NZ after collapsing heading to the changing rooms post match. Team management has stated that he had taken some big knocks during the game, but hadn't appeared to be concussed. Whether they used the pocket SCAT2 guide to assess this is unknown, but tragedies such as this are the last thing any of us want in our sport. The article on this tragedy is here. In this case concussion has not be confirmed as the cause

As referees, we have a part to play in recognising when a player has a suspected concussion. 99% of referees do not referee at Elite levels, so a team doctor is unlikely to be present, and in some cases they only medically trained person will be a first aider. So the use of the concussion bin, or advice from a medical practitioner is not applicable to them. So to assist in protecting the players welfare, it is advantageous for referees to be aware of all of the signs of a suspected concussion.

We are not asking referees to diagnose a player, most are not medically trained, and that's not what we are there for, however if a player is clearly showing the signs of a possible concussion, we do have a responsibility to ensure they take no further part in the game, regardless of whether a coach, physio or doctor thinks otherwise.

Law 3.9 gives us this ability, it reads:


So what are the signs of a possible concussion? The Pocket SCAT2 (shown left) has three sections to assist us with what signs to look for, and even gives us 5 easy question to ask if you are still unsure, though most times I would expect the team physio/1st aider to do this. The third section is to be used by the team further prove if a concussion is present, and if the player requires further medical assessment.

The guide states that if any one or more of the stated symptoms are present, a concussion should be suspected and the player should be immediately removed from play, our job as a referee is to ensure they are. Whilst some referees may be uncomfortable with this duty, it is very important that we do it, the consequences of what could happen if a concussed player continues, are much worse!

I recommend that all referees take the module on concussion management without a medical practitioner present, it's a very good & short course and you will certainly be more informed after. There are even a couple of good videos where George Clancy & Bryce Lawrence explain how they deal with a suspected concussion in their games.

The module can be accessed by clicking this link, there is no need to take the module with a medical practitioner present, as this goes into more detail about how to further diagnose the concussion.

So the next time a player has a head knock in your game, take a bit of time to just observe them, and what their physio is saying to them, and if you have any suspicion that the player is concussed, ensure that they leave the pitch. Most physios will already know they need to go, but when the game means a lot to the team, and the player is one of their stars, the requirement to do the right thing by the player is far more important than the result of the game, even if the coach doesn't agree.

All pictures courtesy of the iRB.