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IRB Laws Exam
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IRB Passport
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Up to date information • Will help Society to have an accurate list of members • Will help RFU to have accurate data and a real time view of the game • Applies across the board to anyone involved in Rugby.
Concussion – the landscape has changed Zachary Lysadt Law
RFU Concussion Risk Management Strategy – Summary Prevention Education Management Research Communication Across communities of practice (Priority = coaches) Evidence based, independently reviewed, and effectiveness evaluated
Concussion
Welcome • Part of the RFU “Don’t be a headcase ” concussion awareness and education programme - Launched Jan 2013 • Superseded previous campaign – “Use your head” launched in 2007. For more information visit - www.englandrugby.com/headcase. For resources email – health@rfu.com Follow - @EnglandRugbyCoach
RFU Survey 2009/10 of 16 – 18 year olds • Regarding personal concussion history: – 66.2% of this group did not leave the field after a concussion; – 37.9% did not report their concussion. – Only 9.8% of concussed players waited the stipulated 3 weeks before returning to play. • Coaches = key source of information
What is concussion? • The brain is injured as a result of a blow to the head or body • It is a traumatic brain injury • ? Functional disturbance – routine brain scans are normal • Usually mild with complete recovery • Loss of consciousness in only 10 - 15% of cases • Variable threshold • Recognition can be difficult • Symptoms may be delayed up to 72 hours • Repetitive concussions, particularly before full recovery can have potential for serious and/or long term consequences
What have we started to understand? • Concussion takes longer to resolve than previously thought • The brain is more vulnerable to further injury immediately after and during recovery from a concussion: – Risk of further concussion – likely to be more severe and prolonged – Other injury - slowed reactions and poor coordination – Further brain injury – very rare but fatal brain injury in young players (second impact syndrome) • Repetitive concussions: – Increase the risk of prolonged concussion symptoms – May cause early onset cognitive and memory impairment in latter life – Potential association with degenerative brain disease in latter life.
Where do head injuries occur? • Road traffic collisions e.g. cars, cyclists • Falls e.g. playground • Assaults e.g. Saturday nights out! • Sport and recreational activities
Concussion Rates Sport Concussion rate per 1000 player hours Horse racing (Amateur) 95 Horse racing (Jumps) 25 Horse racing (Flat) 17 Boxing (professional) 13 Australian football (professional) 4 - 20 Rugby union (professional) 7 – 11 Ice Hockey (NHL) 1.5??? Rugby Union (Youth) 1 – 2 Rugby union (amateur adult) 1 – 1.5 Soccer football (FIFA) 0.4 NFL football (NFL) 0.2??? Source – 4 th Int Concussion Conference Presentation – Dr M Turner + subsequent publications
Prevention
ALL have a part to play BUT – Coaches & Referees have a key role because: • Primary source for concussion information for players • Set culture within the team/squad/club • Develop players: – Techniques – Influence behaviours – Provide information/education • Select who plays and plan training sessions • Often first or only adult on scene • Manage replacements
Prevention • Reduction in head trauma is key: – Tackle technique – Player behaviour in contact – Zero tolerance of foul play: • Collision “tackles” • High tackle • Tip/spear tackle • Taking out player in the air • Targeting head in contact and punching – Playing/training ground conditions
Injuries Injuries by Ev by Event ent - Youth outh
On field Management
TAKE CONCUSSION SERIOUSLY RECOGNISE – know the symptoms and signs of concussion. Remember you do not need to be knocked out to have a concussion. REMOVE – any player with suspected concussion, right away. Continuing to play increases their risk of more severe injury, and longer lasting concussion symptoms, as well as increasing their risk of other injury. RECOVER – take time to fully recover as you would with any other injury. RETURN – all players must follow a step-wise Graduated Return to Play (GRTP) and must not go back to rugby/sport until they have been cleared to do so by a doctor For more information visit - www.englandrugby.com/headcase.
RECOGNISE • Obvious: – Actual or suspected Loss of consciousness – Convulsion or posturing – Loss of coordination/balance – Vomiting – Confusion – Memory loss – Clearly dazed
3.9 THE REFEREE’S POWER TO STOP AN INJURED PLAYER FROM CONTINUING If the referee decides – with or without the advice of a doctor or other medically qualified person – that a player is so injured that the player should stop playing, the referee may order that player to leave the playing area. The referee may also order an injured player to leave the field in order to be medically examined.
RECOGNISE – Headache/pressure • Less obvious: in head – Nausea – Dizziness – Drowsy – Blurred vision – Irritable – Sensitive to – Emotional light/noise – Fatigue/low – Difficulty energy concentrating – Anxious/nervous – Feeling in a fog – Poor memory – “Don’t feel right” – Neck pain
RECOGNISE
REMOVE 1. First Aid principles 2. Head injury + reduced conscious level +/- neck pain = treat as NECK INJURY and DO NOT move. 3. Concussion/suspected concussion = REMOVE 4. NO RETURN 5. If in doubt sit them out 6. Player to be assessed by healthcare professional
Danger Signs • Danger Signs = dial 999 – Deteriorating conscious level – Increasing confusion or irritability – Severe or increasing headache – Repeated vomiting – Unusual behaviour – Seizure/convulsion – Double vision of deafness – Weakness/tingling/burning in limbs
What to do next – CHILDREN? • Injury event but no suspected concussion or other injury: – Assess and observe – BUT “if in doubt sit them out” • Suspected concussion but no LOC, no seizure, no significant memory loss, no danger signs : – REMOVE – Notify parents/carer and provide HI instructions – Player to be assessed by a doctor (school nurse if not possible) that day • Any LOC, seizure, significant memory loss, danger signs, or concerned : – REMOVE (if safe to do so, if not, do not move and wait for ambulance) – Dial 999 for ambulance service – Notify parents/carer
RECOVER & RETURN - RTP Guidelines U19 and Adult below Return to 2 weeks rest + 2 weeks rest + Academic Studies symptom free symptom free Clearance by Clearance by HCP Doctor Recommended Recommended GRTP 24 hrs per stage Clearance by GRTP 48 hrs Doctor per activity Earliest RTP stage = 19 days Clearance by Doctor Earliest RTP = 23 days
RECOVER & RETURN • RECOVER: – Rest: • Initially avoid TV, computers, reading, load noises/flashing lights • From exercise e.g. PE, sport training sessions (no different from ankle sprain!) • May require a few days off school/work - usually only one or two if symptoms e.g. headache, dizziness, fatigue. • RETURN: – To academic activities before return to sport – Graduated Return to Play – Medical clearance to return to play
Graduated Return To Play Stage Rehabilitation Exercise Allowed Objective Stage 1 Rest Complete physical and cognitive rest without symptoms Recovery 2 Light aerobic exercise Walking, swimming or stationary cycling keeping intensity, Increase heart rate and assess <70% maximum predicted heart rate. No resistance recovery training. 3 Sport-specific Running drills. No head impact Add movement and assess exercise activities. recovery 4 Non-contact training Progression to more complex training drills, e.g. passing Add exercise + coordination, drills drills. May start progressive resistance training. and cognitive load. Assess recovery 5 Full Contact Practice Normal training activities Restore confidence and assess functional skills by coaching staff. Assess recovery 6 Return to Play Player rehabilitated Safe return to play once fully recovered. Note: • Must be symptom free after each stage before progression • Students must return to academic work symptom free before return to play
Repeated Concussion Guidance Second concussion in a 12 month period Must be assessed by GP (referral to concussion specialist) If cleared - Conservative RTP Technique/Behaviour Modification
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