Head Injury Assessment (HIA) – do you think it is working?
“The criticism of the HIA, I think, is fairly isolated. It is probably a misunderstanding or blinkered view by some people. We are not trying to make a diagnosis with an HIA on the sideline. I don’t know how many times I have to say that. What we are trying to do is identify which players should be permanently removed from the field of play or temporarily.
"People say if a player is removed they should not go back on but if we take that view we go back to the past which is a small number of players being identified. We know the 60-second assessment in the heat of the game does not work. Before we brought in the HIA, 56 per cent of concussed players returned to the field of play. During the World Cup, zero percent with concussion returned to play."
What is your view on the HIA being used in the amateur or underage game?
“In the elite level of the game we had to re-train experienced doctors to provide clear-cut guidelines to get where we are today. So below the professional game it is ‘if in doubt sit them out’ or ‘recognise and remove’.
“I don’t see where there are any indications for changing that approach because it is hard enough to bring about cultural change of the way the elite level of the game manages head injuries. With our younger athletes we should be ultra-cautious.”
In American Football we have seen rules changes, amateur boxing has different rules to professional boxing, what changes can rugby make?
“We are doing a review of 600 video clips of head injuries that have led to HIAs. We are three quarters the way through a massive project to analyse the mechanism of every incident then we will identify what are the common causes and how can we, if we can, bring about change to protect the athletes. You can’t just flick a switch and give a simple answer.
“We are trying to protect our players through evidence. It’s not medically correct to make changes based on emotion. We are moving towards a definite plan – we improved the recognition, improved the management and now we are at stage three: starting to look at prevention.
“We may find that the tackle technique of players is not good enough. We don’t know what it is yet.”
Is rugby sustainable at underage and amateur level in light of the number of concussive blows we are seeing in the game?
“I really do think it is. Everyone takes on a different risk in life. There is a risk riding a bike, there is a risk playing in the playground, there is a risk hopping in the car, there is a risk in skiing.
“There is a risk in playing football, there is a risk in playing rugby.
“People like to play contact sport. If they can’t play one contact sport they will go and play another contact sport. Our responsibility is to minimise the risk associated in the game at the elite and junior level by making evidence-based decisions.”
Has the rate of concussive blows increased in rugby?
“We know now the incidents of concussion are much higher. What we don’t know is if that’s because of the game – my personal view is it is not and I’ll give you statistics why – or is it because of the greater education and awareness?
“There has been a sudden doubling-up of concussive incidents since the introduction of HIAs in the Premiership and Junior World Championships.
“We looked back at the number of other major traumatic injuries which have shown no difference in these past two years so I tend to think the reasons we are seeing the increase in diagnosed concussions is awareness.”
