– This article originally appeared on stuff.co.nz and is reproduced with permission
World Rugby has issued a statement defending its concussion policies after a former member of their own medical team accused them of taking unnecessary risks with players’ brains with the use of “unscientific” HIAs (head injury assessments).
Dr Barry O’Driscoll, who resigned from World Rugby in 2012 due to his growing unease at how they were treating concussion, told the Off the Ball podcast in Ireland that the recent incidents involving Ireland No.10 Johnny Sexton and prop Jeremy Loughman showed that the HIA system wasn’t working.
“The whole thing is subjective, and up to the appreciation of someone measuring their cognitive function, their memory,” O’Driscoll said.
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“It’s not scientific. If one person finds it positive and five days later it’s OK, it’s quite likely to be positive 15 days later.
“We are playing Russian roulette with our players’ brains.”
However, World Rugby shot back, arguing that any attempts to “diagnose a serious medical condition like concussion from afar, without all the relevant information including a player’s medical history, is irresponsible.”
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“Concussion in elite rugby is formally diagnosed by qualified doctors at the HIA2 and HIA3 assessments as part of the Head Injury Assessment protocol, with the exception of any player displaying obvious symptoms who will be immediately removed from play,” World Rugby said in a statement.
“The in-game HIA1 off-field assessment combines video review and clinical observation to determine suspected concussion and informs the need to remove a player as a precaution.
“Any player who has not displayed obvious concussion symptoms and who compares to a pre-recorded baseline on HIA2 and HIA3 assessments, which take place 2 and 36 hours after an incident respectively, is deemed by medical professionals to be clear of concussion.
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“There is an open and frank discussion about head injury in rugby which is to be welcomed. Everyone wants the game to be the safest is can possibly be, and to encourage new players to benefit from all the good that rugby does.
“It is the duty of any individual or organisation commenting on the Head Injury Assessment process to do so using the facts….doctors are supported by the Head Injury Assessment and recently updated return to play protocols put in place by World Rugby. These protocols are developed using scientific evidence and independent expert opinion which are kept under constant review, as we never stand still on player welfare.”
Sexton has been selected at No.10 to face the Al Blacks in Dunedin on Saturday, with Ireland coach Andy Farrell insisting that best medical practice had been followed.
“We always as medics and coaching staff and players alike, we always err on the side of caution first and foremost and go through the right process,” he said.
“The process was passed and he’s he’s fit to play.
“He’s bright as a button and he has been all week. It wasn’t concussion and we move on with the rules and as I said, the only thing that matters is the health of the player, and we’ve certainly done that this week.”
But O’Driscoll said that the HIAs used in rugby simply weren’t as comprehensive as the assessments used on a member of the public who suffered a brain injury in an accident.
“It hasn’t got any scientific standing,” he told the Off the Ball podcast. “It’s got a certain position clinically looking at somebody, but you cannot come to any conclusion as a result of the HIA.
“They use similar sorts of things a doctor’s surgery or in A+E and they will put that into the overall picture, and the overall picture won’t be complete for over 24 hours.”
All Blacks lock Sam Whitelock was this week ruled out for 12 days after self-reporting a concussion after the Eden Park test.
All Blacks coach Ian Foster was measured when asked about the Whitelock and Sexton cases on Thursday, but indicated that he understood why the rugby public was muddled.
“I can’t answer that question [about Sexton’s availability] from their perspective because I don’t know the circumstances,” he said.
“What I do know, from our perspective, like with Sammy, the protocols are crystal clear.
“If it looks like you’ve taken a knock and then you fail an HIA, you go to a 12-day process. And that’s pretty crystal clear to us.”
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