[TRC] SBW lack of HIA

Phil E


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Saw that on Facebook, clearly concussed, #bambilegs
 

Lee Lifeson-Peart


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Difficult to believe someone from the NZ medical staff didn't see what the TV audience saw???

That's all you need after getting a wobbly head - two more tackles and Sam Whitelock falling on your head.
 

Ciaran Trainor


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That really is Shocking. I wonder if he has had any sort of assessment since
 

Ian_Cook


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When are the top teams going to learn they have to take this seriously?

IMO, the NZRU take concussion more seriously than most other rugby organisations; certainly more so than Top 14 managers (Monsieur Noves, I'm looking at you). We stand our players down well beyond the minimum time, and on their return if there is the slightest sign of trouble, they are stood down again (Dane Coles, Ben Smith, Charlie Ngatai, Keiran Read, Richie McCaw et al). We were doing this before PCAT, HIA and concussion protocols were even a thing!



I've watched the match twice now, plus a couple of times in extended highlights reels including the first few minutes. I never noticed it until this thread. While its obvious when pointed out, its not that obvious if its not (the Moonwalking Bear effect) evidenced by the fact that none of the match commentators (neither Aussie Fox Sports nor NZ Sky Sport), nor the post match analysis guys on either side of the Tasman saw it. This first time anyone raised this issue in the media was in the Sporting News in the the early hours of Sunday morning. Even the daily telegraph didn't pick up on this until 2 hours ago.

Difficult to believe someone from the NZ medical staff didn't see what the TV audience saw???

I not believe for one second that the NZ medical or coaching staff would have seen that and ignored it. That type of thing simply is not part of the culture in NZ rugby any more... especially at the top end of the game.

I don't know how you operate in the NH, but in NZ and Australia, we have sideline medical staff and an independent doctor watching on their own video device which they have control over as regard replays. In essence, if they see something, they don't have to ask for a replay, they just do it themselves; they can play back any part of the play independently (rather like a TiVo or a MySky decoder). Its a great system, but like any such system, it has a flaw.... you actually have to see or notice something first. If you miss it in real time you aren't going to know to check for a replay.

I disagree with your suggestion that the TV Audience saw it. They didn't at the time, otherwise something would have been said on Saturday night.

Did you notice it before it was brought up? Be honest now!

ETA

SANZAAR are investigating

"Williams appeared lucid in a television interview after Saturday's game and All Blacks coach Steve Hansen said the following day that no one had noticed him suffering any adverse effects from the collisions.
"I think everyone missed it to be fair, otherwise the HIA doc would have taken him off," Hansen told reporters referring to the Head Injury Assessment personnel.

"Our doc certainly would have taken him off."
 
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L'irlandais

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I agree, it is the sort of thing that can be missed in the heat of the "battle". You need only think of Rory Best breaking his arm during the November series 2013. The difference being that a hooker with a broken throwing arm is getting away with it, only until the next break in play. With a head injury the damage can't be seen. You would honestly think it would show up as a pretty big anomaly on his GPS stats, as his work rate suddenly drops for a minute for no "apparent" reason. Odd it was missed there.

Anyway now that NZ staff are aware, they'll be putting the player thru' the proper return to play protocols. So 21 days before he takes to the field of play...

Then again the NZ staff bent the rules, for SBW's returning to play following his ban, so they may try it on here too. :-(
Should they say, he's seen a doctor, it is nothing really, "return to play" protocol doesn't apply in this case. Then that's bad news for player safety in NZ, "do as we say, not as we do" attitude. A second concussion in that game could have killed him. Not dissimilar to IRFU keeping, BOD, J Sexton and others on the field of play when prudence suggested otherwise.
linked article said:
Johnny Sexton was ruled out for four months by his doctor in France, but there’s really no evidence to say that that was the right amount of time – was it too little? Too much? We just don’t know.”
When winning is more simply important than HIA protocols, then there is still a problem for Elite players.
 
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didds

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All this demonstrates is that no system is 100% perfect.

Hope SBW recovers well and quickly with no ill effects going forward.

didds
 

L'irlandais

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Yes, but...

My point is, not whether they were right or not, since as the neurologist pointed out in that (fourth) article, we simply don't know enough about the subject. My point is they must be seen to be doing the right thing and right now that is not the case. They are winging it, since we simply don't know enough about the effects of concussions.
“But the coaches and other medics in underage teams, amateur setups etc., I think that is absolutely key that the top, top players in the country are willing to admit they might have a head injury and are willing to be honest about their symptoms, and can come off if they get a head injury.
“Then everyone else will follow in their footsteps and school players watching will be able to replicate what the stars on television are doing.”

Staff missed it sure. But SBW bloody well knew he'd taken a knock. SBW bruised his brain and stayed on the field of play. Not good! Not for him and not for those who look to him for example.
The problem for our neurologist is the players that don’t come off the pitch, the players who are left in there to battle away none the wiser.
“The evolutionary sense of pain is a very good protective factor,” added Dr. Doherty.
“If someone chops your arm off it’s probably a good thing that nature confirms a painful stimulant on you because it makes you retreat from whatever force has caused that.
“Similarly, if you get a bang to the head, if you get symptoms, that’s protective. What we worry about are the people that don’t get any symptoms, because they’re getting the same force but they’re continuing to play.”
if he honestly didn't notice the synthoms that is worring for his future health. A better safe than sorry attitude is what WR needs to impose.
 
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didds

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If you get concussed does that stop you from realising you have concussion?

My son aged 6, knocked his head at school.

We only knew because school sent him home at the end of the day with a note to say so. Unimpressed - and I let them know it.

didds
 

crossref


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I would go with Ian's post and accept that on the day no one noticed.
So the question to ask is what actions they took on the Sunday when it was pointed out -- was he then assessed, is he going through the return to play protocols etc.
 

L'irlandais

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Interestingly, Brian O' Driscoll's uncle, who has been very vocal on the subject had this to say about the HIA
Source
HIA is to be applied where there is the possibility of a concussion that may not at first be apparent. This is different from a suspected concussion. If there is any suspicion of concussion or any apparent symptoms, we have directed that the player be immediately removed from the game, permanently. In this instance an HIA is not needed and should not be undertaken.”
This playing with words is highly disturbing. If the Doctor suspects the possibility of a concussion that may not at first be apparent, then the Dr is suspicious of a potential concussion.
The protocol comes into play for any suspected concussion, not just if the player fails the HIA. Elite staff are playing with words, and with player safety. SBW has a potential concussion, doesn't matter that he didn't do a HIA.

"Put your feet up Sonny Bill, see ya in 3 weeks."

You are probaly right didds. I got a concussion when U16, was aware of bleeding from my eyebrow, but those around me knew I was out of sorts, as I was swearing like a trooper. Absolutely no memory of the swearing. I remember getting stitches after and being watched overnight at home. That was in the '80´s lucky my Mum was a nurse and knew what was needed.
 
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Rich_NL

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You absolutely don't necessarily know that you're concussed. In fact, you can become quite obstreperously convinced that you're *not* concussed, precisely because you're concussed.
 

ChrisR

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Listen to the commentators starting at 2:40 of the clip.
 

Ian_Cook


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If you get concussed does that stop you from realising you have concussion?

My son aged 6, knocked his head at school.

We only knew because school sent him home at the end of the day with a note to say so. Unimpressed - and I let them know it.

didds

Yes it can.

Some years ago I got a head knock in the field in a cricket match when I collided with another player. I was concussed but I had no idea and continued to play. Apparently, I took a couple of catches in the slips and scored a quick fire 80. I say "apparently"; the only reason I know these things was because they showed me the scorebook. At the time, I had absolutely no recollection of any of it.
 

Ian_Cook


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Listen to the commentators starting at 2:40 of the clip.

I don't think that means what you think it means.

He's talking about SBW being knocked down and getting back up. Yes, I know he uses the term "KO'd" but I'm convinced he's using it the way it is used in boxing because I have heard Phil Kearns use the term before. In boxing, a knockout is awarded when one participant falls to the canvas and is unable to rise to their feet within a specified period of time, typically because of exhaustion, pain, disorientation, or unconsciousness. For example, if a boxer is knocked down by a body punch which breaks a couple of ribs and is unable to get up due to pain and breathing diffuculties, they are counted as having been knocked out (even though they have never lost consciousness or been concussed) and their opponent is awarded the KO victory.

I am pretty sure that if Kearns had meant SBW was concussed, he would have followed up on that in commentary. The producer didn't go back to SBW's original head knock in the tackle on Hooper either, so that means neither Kearns or Kafer asked for it, and no-one in the broadcast nor any of the camera men picked up on it, and neither did the TMO.
 

Not Kurt Weaver


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I am pretty sure that if Kearns had meant SBW was concussed, he would have followed up on that in commentary. The producer didn't go back to SBW's original head knock in the tackle on Hooper either, so that means neither Kearns or Kafer asked for it, and no-one in the broadcast nor any of the camera men picked up on it, and neither did the TMO.

My guess is that the next time SBW is in the lineup, his opponents and their coaching staff probably didn't notice the concussion either.

Glass jaws do not repair overnight or fortnight. SBW is as tough as they come, but any chink will be investigated.
 
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Paule23


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Agreed, Iain makes a good argument here that no-one did anything wrong intentionally. You cannot see everything that goes on in real time, even with access to all the camera feeds as you need to know what you are looking for on which feed.

THey key in this for me will be how the AB deal with this going forward. From the interviews they have clearly said they missed a concussion, I don't think they need to change in game protocols, but I'm am interested in how SBW is treated over the next few days/weeks.
 

Ian_Cook


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Agreed, Iain makes a good argument here that no-one did anything wrong intentionally. You cannot see everything that goes on in real time, even with access to all the camera feeds as you need to know what you are looking for on which feed.

THey key in this for me will be how the AB deal with this going forward. From the interviews they have clearly said they missed a concussion, I don't think they need to change in game protocols, but I'm am interested in how SBW is treated over the next few days/weeks.

Yep. Show me a referee or a match official in any sport who claims he sees everything that happens and misses nothing and I'll show you a liar.
 

L'irlandais

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The underlying problem with the WR HIA Protocol is that NZRU can simply say that there was no confirmed concussion. Our doc has looked him over and he's right as rain, never been better. In the starting XV...

[LAWS]Step 3 (c)
The participation or attempted participation of any player in a Match who has sustained a confirmed concussion and who has not fully complied with the Graduated Return to Play protocol shall constitute Misconduct on a strict liability basis by the Team Medical Staff, head coach and Team Manager, whose direct responsibility it is to ensure compliance therewith, and by any other person who fails to comply with the Graduated Return to Play protocol where required.[/LAWS]
One would hope the team management chose to act responsibly.

However, as has cropped up previously, medical doctors have a duty of care to their patients, over and above any loyalty due to their employer. Whosoever decides SBW is fit to play the next test, would do well to bear that in mind. Not for the sake of SBW, since he's an adult, if he is daft enough to disregard his own health and safety, he ultimately will pay the price of such a poor choice. But rather for the sake of a generation of young players who look on SBW as a role model.

(Hopefully our beloved rôle model doesn't lead to an increase in reckless swinging arms in underage rugby for the coming season. "But sir, it is part and parcel of the game, I've seen it on the Telly" :norc:)
 
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Ian_Cook


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The underlying problem with the WR HIA Protocol is that NZRU can simply say that there was no confirmed concussion. Our doc has looked him over and he's right as rain, never been better. In the starting XV...

Thing is (from what I am hearing) is that the non-team doctor hired by he host nation, was Australian. He examined SBW the next morning when the head knock first come to light. He passed the concussion tests so that doctor cleared him.

Some people are more susceptible to concussion than others.

http://www.ozarksfirst.com/news/hea...e-athletes-more-prone-to-concussions/69807164

Some people are really, seriously susceptible to concussion; remember actress Natasha Richardson? She had a minor fall while having a beginner ski lesson on the nursery slopes of Mont Tremblant, Canada. She hit her head and got straight to her feet. An hour later she started to feel ill, and two days later she was dead.

I think SBW is probably one of those who is not so susceptible, otherwise it would have shown up during his time in boxing. That isn't to say that he should not undergo some rigorous testing., its just likely to be the reason why he's not showing any signs.

One of the big hurdles getting in the way of consistency of treatment is this variation between people's susceptibility. Some argue we should take the safest approach (lowest common denominator), but if you draw the line below someone like Natasha Richardson, you will be standing everyone down every week.

Concussion is a tough problem with no "one-size-fits-all" solution.
 
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