Concussion – what’s our role as referees?

Occasionally I am approached by people to collaborate on articles or sponsored link. Usually rubbish commercial stuff so I don’t, but the following was suggested by a company working for a firm of personal injury lawyers*. Some interesting thoughts for us officials and certainly an area I think will be more important focus at grass roots level in the future, particularly when we see the outcome of this inquest in Ireland following the tragic death of 14year old Benjamin Robinson [see update below]. Thought provoking stuff.

Concussion Bin for Aviva Premiership and how referees can help protect players

Earlier this year, RefBlog highlighted rule changes proposed by the IRB in relation to Television Match Officials (TMOs) and the increased responsibility they have in terms of assisting with on-pitch officials during a game.

At the same time, however, a change that was not mentioned was that the IRB also introduced a trial run of the “Concussion Bin” for all Aviva Premiership games for the current season. This may have already been noticed by spectators at games this season, where a player is allowed to leave the field if a member of the medical staff or the referee feels it is necessary following a hit. The player in question will then remain off the field until they have completed cognitive tests to determine whether they are fit to return to the game. A temporary substitution will take place for the time the tests are being conducted and it will be made permanent if the player fails the cognition tests.

Impact on the sport, players and officials?
Firstly, it enhances the importance placed on player well-being and ensures that appropriate measures are taken to prevent the “second impact syndrome”. The second impact syndrome occurs when there is a second hit on an already concussed brain; this second hit is more likely to cause severe, permanent damage and even death.

Rugby players are regarded as warriors on the field; there is unquestionably a physical element to the sport that does not exist in many other sports. Impacts of some tackles have been likened to being hit with a force, similar to a car crash. When coupled with a strong, competitive ruck, powerful mauls and crashing scrums, players can experience several brutal impacts during a game and anyone of them can be detrimental to the player’s health.

A recent study conducted at Boston University** has found that repeated blows to the head are linked to depression, stress, anxiety, sleep disorders and even suicide. The study has been conducted using the donated brains of former NFL and high-school American football players who have experienced repeated hits to the head throughout their career. Many of the brains donated were by former NFL players who committed suicide following a period of depression or chronic headaches.

There is a stigma associated with sports people where is it seen as wrong to walk off a field, particularly in a physical sport like Rugby. Whilst it is certainly entertaining to the spectator to see tackles of epic physical proportions, who is concerned about the possible long term effect of these impacts.

It is for this reason the rule change should be embraced within the sport. It allows players the opportunity to leave the field of play to get themselves assessed by a medical professional to ensure they are not displaying any symptoms of a concussion. The new rules will place some responsibility on the players to admit to feeling the symptoms of concussion following a tackle. This can only work if it is combined with education to club staff and players about the damage that can be done if head injuries are not properly treated or monitored.

While this relates to players and clubs, the officials also have an important role to play. Aside from fellow players, officials are closest to the action and therefore an important pair of eyes to have on the players during the game. The symptoms of concussion and head trauma should be taught to all players, coaches and officials to ensure symptoms are picked up quickly and rapidly assessed.

But then comes the question. If a concussion isn’t picked up immediately and long term implications occur, who is to blame for not spotting it and reacting at the time of the impact?

The result of the trial may be hard to quantify in such a short period of time but you can be sure that is it not doing any harm to the brains of the players on the field. The results will only be evident over time if there is a reduction in reported depression, stress, anxiety and sleep disorders of retired rugby players.

What is your opinion on the introduction of the concussion bin?

This guest blog was written on behalf of Pannone. Pannone specialise in personal injury resulting from head trauma.

* I have received no fee or other recompense for publishing this article

UPDATE: One of my readers commented on the iRB concussion assessment documents referred to in the BBC article. If you’re interested, you can see more of this at the IRB Player Welfare website