[TRC] SBW lack of HIA

L'irlandais

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Yes that sounds reassuring, until you read an article about the IRFU U20's from earlier this year ; entitled Everybody’s winging it – including the doctors’ – Players and doctors tell the story of concussion in Irish rugby
(I choose an article about my home Union, so nobody feel I am mud slinging at the NZ setup.)

As well as being a consultant neurologist at St. James’, Dr. Doherty is also a leading member of The Concussion Research Interest Group based in Trinity College, which is currently conducting research into concussion in sport....

He tells us symptoms are our body's way of protecting us from threats/dangers. He finds it worrying that some players get concussed and don't experience the same symptoms as everybody else. It doesn't necessarily mean he hasn't bruised his brain.

Anyway, as didds said earlier, hopefully SBW will be fine and looked after well.
 

Ian_Cook


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All Blacks management has been cleared of misconduct by SANZAAR

http://www.newstalkzb.co.nz/news/sp...sconduct-over-sonny-bill-williams-head-knock/

In a statement, Sanzaar said the review, which involved match-day and team medical staff determined:

•The incident was not identified during the game via the appointed HIA specialist, the match day doctor, the team doctors or the match officials
•The available post-game video confirms ataxia, which would trigger immediate and permanent removal under World Rugby protocols
•While no process is entirely failsafe, the review panel determined that the missed HIA incident should have been identified during the match



So, they ALL missed it, all eight of them

However, I don't like the last bit..

"Additionally, New Zealand Rugby has confirmed that Sonny Bill Williams is being managed in line with World Rugby HIA protocols, including HIA 3 and computer neuro-cognitive assessment, and will progress to a graduated return to play if asymptomatic,"

SBW has been selected to play this weekend. IMO, he should not be, regardless of whether he is asymptomatic. If he has suffered from ataxia, that the means was actually concussed. I think he should be stood down.
 
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Camquin

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read the statement as meaning SBW was concussed and was still showing signs of concussions.
Therefore he should only enter GRP at the point he is asymptomatic.

Ergo - he cannot be selected for next week.

If he is on the team sheet the ref should tell the AB captain SBW is not permitted on the pitch as the ref has evidence he was concussed last week and therefore has not fully completed the GRP.
 

didds

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If he is on the team sheet the ref should tell the AB captain SBW is not permitted on the pitch as the ref has evidence he was concussed last week and therefore has not fully completed the GRP.

Bet he won't.

didds
 

L'irlandais

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Thanks miniref for pointing out my link in #19 is broken. Thankfully, World Rugby player welfare have an Online copy of the HIA protocol.
The Head Injury Assessment protocol is a three-stage process introduced by World Rugby for elite professional teams to assist with the identification, diagnosis and management of head impact events with the potential for a concussion. It consists of the following three stages, summarised in Figure 1:
Only applies to the Elite game however. If you want guidance for grassroots level, most Unions have their own document available online.
 

L'irlandais

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stuff(dot)co and the question that won't go away.

...Williams interrupted and wandered away, saying: "Thanks guys, thank you."

Earlier, Williams declined to answer questions about whether he had suffered concussion during the series opener in Sydney, when replays showed officials should have sent him for a head injury assessment.

He said of his indifferent performance in the All Blacks' narrow win in Dunedin: "I was really happy with how it went. Never a bad game, always a learning experience. Just glad that we wrapped up the Bledisloe Cup."
So was his "indifferent performance in the All Blacks' narrow win " proof that he should have been rested?

If you look at the protocol in the previous post SWB must have failed the HIA1 off field test
[LAWS]Medical room assessment of players with the potential for concussion, but without clear manifestations. Consists of a clinical evaluation supported by the off-field screening tool and video review.[/LAWS]He clearly manifested signs of a potential concussion. The discussion should have ended there, NZRU are being completely irresponsible. (In the same way as the IRFU were irresponsible in their management of BOD's and Jonathan Sexton's HIA.)

[LAWS]Table 1. Criteria for permanent removal from play or medical room head injury assessment.
Immediate and permanent removal from play criteria (Criteria 1)
.
Not orientated in time, person, or place
Clearly dazed
Definite Behavioural changes
etc

Off-pitch screening tool criteria (Criteria 2)
Head impact event where diagnosis not immediately apparent
Possible behavioural changes
Possible confusion
etc..
[/LAWS]When the medical doctor reviewed this 48+hours after the game (HIA protocol stage 3), he can clearly see that HIA1 was failed by the player; along the lines of _ was SWB clearly dazed, Yes, were there signs of possible confusion, Yes.

Zero credibility! SWB contributed little to the Dunedin game, why on earth could he not have sat it out?
 
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Ian_Cook


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He said of his indifferent performance in the All Blacks' narrow win in Dunedin: "I was really happy with how it went. Never a bad game, always a learning experience. Just glad that we wrapped up the Bledisloe Cup."
So was his "indifferent performance in the All Blacks' narrow win " proof that he should have been rested?

Err, no

His poor performance in Dunedin was largely down to how well his opposite, Kurtley Beale, played. You should not underrate just how good Beale was. He was outstanding; IMO, over all the best Wallaby back (probably the best player overall in either team) on the park. Its also down to some poor service he received from his inside backs, Barrett and Smith. Flat, hard, misdirected passes being the worse aspects of this.

The All Black management has a transparent track record of not taking risks with players as far as concussion is concerned. If SBW was still suffering the after effects of a concussion on the weekend, it would certainly have shown up during the rigorous training schedule the week before, I have no doubt whatsoever that had he actually shown any signs of concussion during the week, he would have been stood down.
 

L'irlandais

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Well no Ian. By failing the HIA he should have been stood down for 21 days.
[LAWS]Players displaying obvious on-pitch signs of concussion (Criteria 1, Table 1) are immediately and permanently removed from play, and the completion of the off-field screening tool and medical evaluation is not required.[/LAWS]He failed at the first hurdle, all the other checks apply to those who have not shown clear signs of possible concussion. A screening to make sure no injury slips thru' in SWB's case it was clear and obvious, so his 21 days recovery was effective immediately. There is no debate in the way the Team's management suggest. The medical doctor has failed in his duty of care to the player. You are right in one thing it is transparent, despite the obvious signs of a potential concussion the player was not stood down. This is why World Rugby medical adviser Dr Barry O'Driscoll quit, back in the BOD days.
The NZ setup are not taking player safety seriously, they are winging it. Like all the other Unions. And WR not bring them to task suggests that they too are not taking this seriously. :sad:
 
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crossref


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let's face it -- the whole HIA regime is a device for getting injured players back on to the pitch ....
 

L'irlandais

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HIA 1 was the player Clearly dazed. Yes
It doesn't ****ing matter that the coaching staff missed it on the day. Footage shows it to clearly be the case. The notion that because the HIA 1 wasn't carried out means you progress to HIA 2 and 3 is wrong. See #29

Perhaps the very lack of objectivity being referred to in this news article
Dr Simon Kemp, the RFU's chief medical officer

"There is currently no reliable or proven biomarker or objective test for the diagnosis of concussion and this lack of objectivity is the biggest challenge facing medical professional in dealing with this type of injury."


Source: BBC
 

Ian_Cook


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Perhaps I need to clarify

Should he have been rested/stood down? Yes, absolutely he should have been.

Was his concussion the reason for his poor performance? No, not IMO

If he was so concussed that a week later, it effected his performacne to the degree that you are suggesting, then it WOULD have been very noticable during trainig in the week leading up to the test. The team doctor and medical staff attend every training, they will have watched SBW very closely for ANY sign that he wasn't right.

The All Blacks team doctor is Dr Tony Page. He has been a lecturer in the Department of Musculoskeletal Medicine at the University of Otago. He is also very experinced in sport medicine and head trauma, having worked with many major sports teams including Canturbury NPC, the Crusaders and the Collingwood Magpies AFL team. I refuse to beleive that a doctor of his standing in the medical comminity would compromise his medical ethics by gaming the system.
 
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L'irlandais

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Sorry I had misunderstood. I hope you are right Ian.



Loopholes already built into the study. :sad: In the case of SWB incident, no HIA So no samples would have been collected. [LAWS]If there are no Head Injury Assessments (HIAs) or confirmed concussions in a match, then no samples will be collected.[/LAWS]

The wording "confirmed" needs to be removed and replaced with suspected/potential/possible,* take your pick. I don't think doctors are gaming the system, but I do feel they are failing in their duty of care to the patient. This duty of care, goes above and beyond any loyalty they owe to their employer, or in the case of independent medical cover, to rugby as a whole. The doctor involved knows the player suffered a POSSIBLE concussion, the protocol asks for no further proof. In the interests of his safety, he should have hung his boots up and stayed home. Our Unions are playing with words, and with fire.

The good thing from a referee's perspective is that there no longer needs to be proof positive of a head injury to send the player from the field of play.

*In line with the current WR protocol.
 
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Ian_Cook


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I think crossref has made a valid point; the HIA, in its current form, seems to be more of a tool to get players back on the field then to ensure their medial well being

However, as I posted earlier, a line has to be drawn somewhere. If you start taking players off for any old head knock, then both sides will have used up all their subs by half-way through the first half.
 

crossref


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Although that's pretty much how grass roots rugby works ..
 

Pinky


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All Blacks management has been cleared of misconduct by SANZAAR

http://www.newstalkzb.co.nz/news/sp...sconduct-over-sonny-bill-williams-head-knock/

In a statement, Sanzaar said the review, which involved match-day and team medical staff determined:

•The incident was not identified during the game via the appointed HIA specialist, the match day doctor, the team doctors or the match officials
•The available post-game video confirms ataxia, which would trigger immediate and permanent removal under World Rugby protocols
•While no process is entirely failsafe, the review panel determined that the missed HIA incident should have been identified during the match



So, they ALL missed it, all eight of them

However, I don't like the last bit..

"Additionally, New Zealand Rugby has confirmed that Sonny Bill Williams is being managed in line with World Rugby HIA protocols, including HIA 3 and computer neuro-cognitive assessment, and will progress to a graduated return to play if asymptomatic,"

SBW has been selected to play this weekend. IMO, he should not be, regardless of whether he is asymptomatic. If he has suffered from ataxia, that the means was actually concussed. I think he should be stood down.

Ian, like you I don't like the last bit of the SANZAAR review either. Whilst it would have been preferable for all if the incident had been noted at the time and SBW had had a HIA, the fist bit seems to suggest that there was an incident to consider. However my reading of the GRTP protocol says that there is a compulsory 24 hours rest and that the GRTP programme can only be set aside if the player is diagnosed as not in fact having been concussed. Although there are faster work throughs of the GRTP for elite players under appropriate clinical supervision, that would not have returned SBW to play this weekend, so I presume someone has decided there was no concussion?
 

L'irlandais

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That is the crux of the matter, yes.
By pretending not to have noticed the FACT the player has suffered a probable head injury, then the coaching staff can by pass the protocol entirely. Like it never happened. The HIA 3 doesn't come into play since he actually suffered a concussion. Such assessments are only if a concussion has not been detected. Only I suspect sentences that long are sadly a little beyond the grasp many in the coaching business.
Only let's not forget what happened to the last doctor to be led astray by such "blazer logic". Dr Wendy Chapman lost her job, but did avoid being struck off, in the end. (after 5 worrying months)

Team doctors would do well to avoid being pressured into doing the wrong thing, just because it suits the coaching staff's objectives. The protocol is in place to protect player safety at Elite levels, it needs to be adhered to. Hefty fine might help those in the pro game to understand just how important it is to follow medical advice. Rather than pressure doctors into playing word games.
 
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Ian_Cook


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By pretending not to have noticed the FACT the player has suffered a probable head injury, then the coaching staff can by pass the protocol entirely. Like it never happened..

You are assuming facts not in evidence. Lets be clear about this

1. The referee didn't notice.
2. The AR didn't notice.
3. The other AR didn't notice.
4. The TMO didn't notice.
5. The All Black team doctor didn't notice.
6. The two other All Black medical Staff didn't notice.
7. THE APPOINTED INDEPENDENT HIA SPECIALIST (an Australian doctor) didn't notice.

Your accusation that ANY of these people intentionally ignored/pretended not to notice what happened to SBW is bloody well outrageous!!!


Only let's not forget what happened to the last doctor to be led astray by such "blazer logic". Dr Wendy Chapman lost her job, but did avoid being struck off, in the end. (after 5 worrying months)

Oh please! you can NOT liken this to Bloodgate FFS!!

Dr Chapman wilfully inflicted an injury on a player (she used a scalpel to cut the inside of his mouth) thereby violating her Hippocratic Oath (first, do no harm). That was a criminal offence!

You are accusing the All Black management and medical staff (including their doctor) of a criminal offence. If this is the path you are heading down now, then you are going completely OTT, and I want no further part in this discussion.
 
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L'irlandais

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This is how arguments start on here. Neither of us is listening to the other. I am not accusing them. None of those people noticed during the game. I agree. However 48 hours after the incident, when they sat down to conduct the HIA 3, everybody viewing the footage could see that he was clearly dazed and probably worse for wear. That means he had failed the HIA 1, even though it went unnoticed. The fact that it went unnoticed is immaterial, the doctor retrospectively declares the player to have a possible concussion and calls an end to HIA 3 which is not required if the player was seen to be clearly dazed on the pitch. Notice that by the Magic of television, the coaching staff can be in no doubt about that synthom. The protocol is clear simple and easy to apply. Except of course, as crossref pointed out, they want to use it to show players never had a confirmed concussion and so the protocol does come into play.

Any medical doctor who clears a player to play the week after suffering from a concussion is running the risk of falling foul of medical profession's tribunal system and face disciplinary action for his misinterpretation of data and the subsequent impact on the patient's care.

In the game of rugby, as played in the sticks, we have a lot of leeway. This gentlemen are professionals, or supposed to be. That means that health and safety at work applies to their actions and the gay abandon they show is out of place in a professional sport environment.
 
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