The Florian Fritz concussion incident

by GLove39 Sat 10 May 2014, 1:42 pm

First topic message reminder :

Last night Toulouse played Racing Metro with a spot in the play offs at stake.

18 minutes in and Fritz takes an accidental, but sickening knee to the face.

https://www.youtube.com/watch?v=bdNQQFm5tdo

Fritz is clearly in a terrible state, he looks as if he's been in the ring with Tyson for 8 rounds. He's unstable and dazed, having trouble walking and as he tries to leave the pitch he collapses.
The Florian Fritz concussion incident - Page 2 BnOHKRUIcAA_Ald

The Florian Fritz concussion incident - Page 2 BnOHKRUIcAA_Ald

Yet despite this, unbelievably 10 minutes later he comes back onto the pitch and plays for the rest of the first half.

What the hell were the Toulouse medical team and coaching staff playing at allowing a player in his state back on to the field? How could he be deemed fit? And where was the duty of care?

by marty2086 Mon 12 May 2014, 4:25 pm

MrsP wrote:
What exactly can a doctor do if the coach says he is putting a player back on and the player says he wants to play?
He can certainly say it is wrong. He can say it is unsafe. He can express his concerns at the time and afterwards but I am not sure he can do very much else at the time if the coach insists the player goes back on.
He could resign if he is not happy with how the players are treated but I don't see how he stops the thing in real time?

Should it be made mandatory to have an independent assessor on hand to carry out any relevant checks then?

It takes out the issue of pressure from teams to put players back on

by doctor_grey Mon 12 May 2014, 4:27 pm

MrsP wrote:Grey.

I agree that it would be "cast iron" if Fritz will say he had amnesia but I meant that we should not have to rely on that. He could be persuaded to say he was fine but the evidence we all saw is, in my opinion, more than enough to say he was clearly concussed.

You are thinking about the player and his welfare. And from that context you are obviously right (besides you probably wouldn't let me disagree with you anyway!).

The difference is I want someone to pay for this. I want a shining example of irresponsibility, someone hung from the gallows, if you will. We have too long been afraid that change will happen only as a result of catastrophic injury. We just got closer to that and the next time may be worse.

by MrsP Mon 12 May 2014, 4:28 pm

There is certainly merit in that view Marty.

The other side of the argument is that someone who knows the player well is actually in a better position to notice minor and subtle changes in their demeanour which could be important.

Obviously the changes in Fritz were neither minor or subtle.

by Submachine Mon 12 May 2014, 4:53 pm

I can't see how any doctor could feel pressure to put a player so obviously brain shook back on to the pitch against their recommendation. Whatever about coaches pressurising for a pain killing injection for a swollen knee or saying a few prayers to St Jude for Tommy Bowes wrist.
He was obviously not recovered enough to go back on the pitch and when not operating at 100% mentally was even more at risk of getting another knock.
I'm glad we are only discussing the concussion as we could easily be talking about the death of a rugby player on the field of play. Hopefully this icindent will be the line in the sand. But I agree that somebody needs to be made an example of here.

by MrsP Mon 12 May 2014, 5:01 pm

My point is that the doctor did not put the player back on, the coach did.

What could the doctor have done to prevent this happening at the time? He can not physically stop the player. Even if he was physically strong enough to do that he would be potentially committing assault.

The only thing I can see that he could have done was to go onto the pitch and speak to the ref. I know I have said I am willing to do that but that would have been to protect a young player at schools match. Would I climb over the barrier at Ravenhill or Lansdowne Road to stop a pro-player going back on the pitch?

by AsLongAsBut100ofUs Mon 12 May 2014, 5:03 pm

MrsP wrote:My point is that the doctor did not put the player back on, the coach did.

What could the doctor have done to prevent this happening at the time? He can not physically stop the player. Even if he was physically strong enough to do that he would be potentially committing assault.

The only thing I can see that he could have done was to go onto the pitch and speak to the ref. I know I have said I am willing to do that but that would have been to protect a young player at schools match. Would I climb over the barrier at Ravenhill or Lansdowne Road to stop a pro-player going back on the pitch?

I'll bring the step-ladder Whistle

by MrsP Mon 12 May 2014, 5:13 pm

So long as you don't climb it in that skirt of yours!!!

That was how you got the Asbo to start with wasn't it?

by Portnoy's Complaint Mon 12 May 2014, 5:21 pm

Is the only thing that the rugby lawmakers can feasibly do is for the doctor to accede to the coach's request to reintroduce the player?

Something has to be done.

All this goes only to confirm the potential dangers of a physical, contact sport especially in a professional context where success/failure is the sole arbiter of livelihoods.

Keep on nagging MrsP! thumbsup

You are so, so right.

by doctor_grey Mon 12 May 2014, 5:22 pm

MrsP wrote:

So long as you don't climb it in that skirt of yours!!!

That was how you got the Asbo to start with wasn't it?

Have you seen his legs?
Are they slender and cute?
or the bone-ivory white, rather flubby and hairy, with pustules?

by MrsP Mon 12 May 2014, 5:23 pm

I am trying Port.

Some would say "very trying"!

And, yes Grey, I have seen his legs.

by doctor_grey Mon 12 May 2014, 5:26 pm

Portnoy's Complaint wrote:Is the only thing that the rugby lawmakers can feasibly do is for the doctor to accede to the coach's request to reintroduce the player?

No, no, no. The doctor stands his or her damn ground. Eff 'em all.
THIS is why the medical staff is there!

If I took someone off and anyone dared to go around or convince me to accede to pressure to put the player back, there would be hell to pay. Guaranteed.

by Portnoy's Complaint Mon 12 May 2014, 5:31 pm

Doc, (btw) Is it true or just apocryphal that American football body armour and helmets cause more injuries than they prevent?

And that serious concussive injuries are more likely to occur because the equipment imbues players with false faith for their own personal safety and and those of others?

by Portnoy's Complaint Mon 12 May 2014, 5:36 pm

doctor_grey wrote:
Portnoy's Complaint wrote:Is the only thing that the rugby lawmakers can feasibly do is for the doctor to accede to the coach's request to reintroduce the player?
No, no, no. The doctor stands his or her damn ground. Eff 'em all.
THIS is why the medical staff is there!

If I took someone off and anyone dared to go around or convince me to accede to pressure to put the player back, there would be hell to pay. Guaranteed.

Isn't that all part and parcel of the Hippocratic Oath?

And the fuzzy lines they draw?

by MrsP Mon 12 May 2014, 5:41 pm

That would stop the doctor from saying the player was fine.

It doesn't really cover Head Coaches.

by AsLongAsBut100ofUs Mon 12 May 2014, 5:44 pm

MrsP wrote:I am trying Port.

Some would say "very trying"!

And, yes Grey, I have seen his legs.

More just the knees than the full magnificence of the entire hurdy package!

by doctor_grey Mon 12 May 2014, 5:44 pm

Port,
My short answer is I believe it is the nature of the game. In the 1950s the armour/padding was minimal. As players became bigger, stronger, faster, and the collisions more violent (see the parallel to Rubgy?) American Football, led by the NFL, starting building up the armour/padding to where we see them today. The padding was and is to protect the players.

However, I think it is unquestioned the padding imbues the players with a tangible sense of safety and protection. Unfortunately, the confidence coupled with the incredible competition for places on the teams drives players to take chances. These chances include leading with their heads (now technically illegal) and throwing their bodies all over the field.

So I think, yes, the helmets prevented and caused injuries. I am not sure the answer for American Football. I can tell you at youth level, the number of kids, at least here in Jersey, playing American Football is shrinking. Parents are worried about injury. The sports growing and taking some advantage of that are soccer and Rugby.........

by doctor_grey Mon 12 May 2014, 5:47 pm

MrsP wrote:That would stop the doctor from saying the player was fine.

It doesn't really cover Head Coaches.

The Head Coach wouldn't dare. It's a career-ender.
If the doc caves, then he should be fired.

by doctor_grey Mon 12 May 2014, 5:53 pm

I think one of the great aspects of being associated with American pro sports teams (myself rather peripherally, other docs in the practice more directly) is the med staff cannot be over-ruled by anyone. Maybe this is part of being involved with mature professional sport. Pro Rugby is only 20 years old. Maybe we are not there yet? The old club mentality needs to be excised.

by yappysnap Mon 12 May 2014, 8:02 pm

AsLongAsBut100ofUs wrote:
MrsP wrote:I am trying Port.

Some would say "very trying"!

And, yes Grey, I have seen his legs.

More just the knees than the full magnificence of the entire hurdy package!

Where's that vomit emoticon when you need it??!

by Feckless Rogue Mon 12 May 2014, 8:48 pm

I heard that President Theodore Rosevelt considered banning American Football in the early 20th century due to dozens of deaths and serious injuries. He proposed reforms to the game and protective gear in order to allow it to continue. A quick google seems to suggests that's true. It also seems that the helmet was the last bit of equipment to be accepted, around 1940, after a lot of resistance.

That's interesting because there was a lot of resistance to helmets in hurling in Ireland too. Mostly from the players, who believed it would restrict their vision. They've only become mandatory in the last 10 or so years I think. Too many bad eye injuries, rather than concussions. I definitely remember in the 90's most players still didn't wear helmets. I believe there was resistance to helmets in Ice Hockey too until to many injuries forced a law change.

In the long run more protective gear probably will come to rugby, if incidents like this keep happening. Or we could just have common sense and remove concussed players from the field. For a number of weeks, not just that game. Can the collisions get much harder than they are now?

by MrsP Mon 12 May 2014, 9:01 pm

I am still unsure what exactly the doctor could have done right there and then to stop Fritz taking the field against his advice?

by Golden Mon 12 May 2014, 9:43 pm

Good interview with Dr Barry O'Driscoll here

http://www.newstalk.ie/player/podcasts/The_Right_Hook/Highlights_from_The_Right_Hook/53047/2/my_advice_to_parents_is_to_get_their_kids_out_now

by doctor_grey Mon 12 May 2014, 10:08 pm

MrsP wrote:I am still unsure what exactly the doctor could have done right there and then to stop Fritz taking the field against his advice?

MrsP,
At the pro level, it is a hard thing to do when a coach, and more so a powerful coach like Noves, apparently says the player should/will/must play. The doc must stand his ground and let the coach know he is crossing a line of no return. If this standoff is not enough for the coach to know he has overstepped his bounds, the doc is to tell the coach he will go to the media. This is the advise given to medical staff in all 4 pro sports in the US, their uni sports as well. I know a lot of people, and no one has ever mentioned that the threat has ever needed to be carried out.

There is a problem, however. It is not uncommon for some sideline, pitchside medical people to enjoy the perks of being right there with the teams. These people who jealously guard their privilege and are the dangerous ones, in my opinion.

by MrsP Mon 12 May 2014, 10:14 pm

That is true.

The problem is the balance of power in the relationship between the coach and the doctor. I suspect this varies considerably between clubs but I would not be surprised to hear that Toulouse is closer to the norm in that regard than either you are I would be happy with.

by doctor_grey Mon 12 May 2014, 10:16 pm

Agree. There are a number of intermediate steps I didn't mention, including reporting the coach(es) to the league medical authorities, league disciplinary boards, etc..

by MrsP Mon 12 May 2014, 10:24 pm

I understand but I don't think any of that would have been of use on Friday night. Maybe in the time since then but not at the point where Noves takes Fritz from the medical room.
It is possble that the doctor doing the stitches was not even the team doc. He might have been part of the stadium medical staff. That is not unusual.

by doctor_grey Tue 13 May 2014, 12:29 am

MrsP wrote:I understand but I don't think any of that would have been of use on Friday night. Maybe in the time since then but not at the point where Noves takes Fritz from the medical room.
It is possble that the doctor doing the stitches was not even the team doc. He might have been part of the stadium medical staff. That is not unusual.

But I don't care whether the doc is a team guy or someone off the street. We have a job to do. This is what we signed up for when we took that damn oath. Is non-negotiable.

The medical person failed. The conversation to keep the player off may not be civil nor polite all the time. Don't care. If any doc agreed to let that bloke back on the pitch, their licence to practice must be pulled. It is not acceptable to lay down just because a coach (a coach!) wants a player to play.

by TJ Tue 13 May 2014, 12:37 am

I agree with Drgrey.

The 10 mins is to assess if the player is concussed or not, not to see if they can recover enough to play. Any signs of concussion and they should be subbed. No if, but, or and

by Portnoy's Complaint Tue 13 May 2014, 6:57 am

There are so many people here kicking on the same open, rotating door in essentially in passionate full agreement.

I still say that what is required from leagues/IRB/whoever to put these decisions in the remit of the medics and away from the coaches.

[ed] p.s. This was the aftermath of the 'Bloodgate' affair for Dr Wendy Chapman http://www.theguardian.com/sport/2010/aug/31/dr-chapman-harlequins-leinster-tom-williams

by yappysnap Tue 13 May 2014, 9:03 am

Just watched the video and I am shocked by that. Not only is it a terrible risk for the player to come back on after sustaining such an injury but it sets a dangerous example to youngsters playing the game as well. They wont see the medical support and backroom staff, they'll just see that you can get pole axed and 10 mins later come back on no problem.

by lostinwales Tue 13 May 2014, 9:38 am

I can see some mention of 5 minutes or 10 to assess if there is concussion or not. Is this something that formally exists?

Is it covered by the blood bin or do we need to have a blood and concussion bin?

(And if you did have one could you stop a team getting a headache when they needed to bring a kicker off the bench?)

by Golden Tue 13 May 2014, 9:41 am

Just out of curiosity how did Fritz playwhen he came back on?

by MrsP Tue 13 May 2014, 9:54 am

The concussion bin is to allow a player to be assessed and return to the pitch.

It was intended to be used to prevent potentially concussed players from continuing to play because their coach would not have wanted to take them off to check because they would then have to stay off.

Instead it is being used by coaches to put concussed players back on the field if they can pass some tests which were never intended to be used for that purpose.

It should NEVER be used when a player is showing ANY signs of concussion. It was intended to be used on those who have taken a bang on the head but do not yet show any signs of concussion.

The ref can order a player to be assessed as I understand it.

And Golden.

I read that he had no involvement in the game in any way between coming back on and half time. Thank goodness.

by doctor_grey Tue 13 May 2014, 11:50 am

MrsP wrote:The concussion bin is to allow a player to be assessed and return to the pitch.

It was intended to be used to prevent potentially concussed players from continuing to play because their coach would not have wanted to take them off to check because they would then have to stay off.

Instead it is being used by coaches to put concussed players back on the field if they can pass some tests which were never intended to be used for that purpose.

It should NEVER be used when a player is showing ANY signs of concussion. It was intended to be used on those who have taken a bang on the head but do not yet show any signs of concussion.

The ref can order a player to be assessed as I understand it.

And Golden.

I read that he had no involvement in the game in any way between coming back on and half time. Thank goodness.

MrsP says it right. It is being used, absolutely backwards from the original intent.
Noves should lose his job over this.

by HammerofThunor Tue 13 May 2014, 1:15 pm

Except according to (I think) the RFU stats more players ARE coming off with concussion. We see the ones that go back on but the guys who are pulled off, assessed and kept off go by without a sound. Thing HAVE improved from where they were. Is it perfect? No. Is it good enough? Not yet. Is it better than it was? Yes.

by MrsP Tue 13 May 2014, 1:42 pm

Can we be sure that those figures represent an improvement?

It could be that more players are suffering from concussion also.

by Feckless Rogue Tue 13 May 2014, 9:08 pm

Maybe things have improved but this incident is making us all think things are worse than they are. It's the worst I've ever seen.

by Portnoy's Complaint Wed 14 May 2014, 8:51 am

doctor_grey wrote:
MrsP wrote:The concussion bin is to allow a player to be assessed and return to the pitch.

It was intended to be used to prevent potentially concussed players from continuing to play because their coach would not have wanted to take them off to check because they would then have to stay off.

Instead it is being used by coaches to put concussed players back on the field if they can pass some tests which were never intended to be used for that purpose.

It should NEVER be used when a player is showing ANY signs of concussion. It was intended to be used on those who have taken a bang on the head but do not yet show any signs of concussion.

The ref can order a player to be assessed as I understand it.

And Golden.

I read that he had no involvement in the game in any way between coming back on and half time. Thank goodness.
Just as the doctor failed in his duty of care. He should be hauled up in front of the French equivalent of the GMC who should consider his case very carefully and critically.
MrsP says it right. It is being used, absolutely backwards from the original intent.
Noves should lose his job over this.

by HammerofThunor Wed 14 May 2014, 9:28 am

Daily Mail have been running a campaign on this (even they can get some things right sometimes).

http://www.dailymail.co.uk/sport/rugbyunion/article-2592471/Doctors-shunning-rugbys-concussion-test-fear-sued-concerns-continue-increase.html

http://www.dailymail.co.uk/sport/rugbyunion/article-2576417/Rugbys-concussion-tests-laughable-claims-England-star-Alex-Corbisiero.html

by Portnoy's Complaint Wed 14 May 2014, 10:56 am

HammerofThunor wrote:Daily Mail have been running a campaign on this (even they can get some things right sometimes).

http://www.dailymail.co.uk/sport/rugbyunion/article-2592471/Doctors-shunning-rugbys-concussion-test-fear-sued-concerns-continue-increase.html

http://www.dailymail.co.uk/sport/rugbyunion/article-2576417/Rugbys-concussion-tests-laughable-claims-England-star-Alex-Corbisiero.html

To be fair, HoT, the Mail's sports pages should be generally treated differently from the rest of the garbage they dump on the public through their massive organ.

by doctor_grey Fri 16 May 2014, 12:44 pm

Mes amies,
One week has gone by and France is quiet. I have to wonder why. I have wonder what political machinations are at play here. If this was in UK or Ire, the league and/or Union officials would over this like white on rice.

Clearly, I am one of the people baying for blood from the people involved with allowing Fritz back on the pitch. I have to wonder why there is no news, no update, no.....anything. Granted I have had not time to start searching through the French news or sports web sites. Anyone know or hear anything?

by MrsP Fri 16 May 2014, 12:54 pm

Gallic shrugs all round?

by **Notch** Fri 16 May 2014, 1:02 pm

Very disappointing if true. Too dangerous to be swept under the rug.

by whocares Fri 16 May 2014, 2:03 pm

doctor_grey wrote:Mes amies,
One week has gone by and France is quiet. I have to wonder why. I have wonder what political machinations are at play here. If this was in UK or Ire, the league and/or Union officials would over this like white on rice.

Clearly, I am one of the people baying for blood from the people involved with allowing Fritz back on the pitch. I have to wonder why there is no news, no update, no.....anything. Granted I have had not time to start searching through the French news or sports web sites. Anyone know or hear anything?

not much developments... FFR medical commission has apparently launched an investigation but I doubt there will be any terrific conclusions.

here's my take on this :
- Fritz was sent out of the pitch for bleeding (and not concussion) hence the 15 minutes break (concussion suspicion protocol last 5 minutes btw)
- Noves went to see Fritz after 14 minutes (after stiches etc) and asked the medic and him if he was fine , both said yes so he went back. Apparently during that break there was a nurse and doctor who asked the player a few questions but the priority was to stop the bleeding and one could say that they might not have been aware of what clearly happened on the pitch.
Someone should have told Noves or the medic that he had clear signs of someone who suffered concussions (which everyone saw on TV).

the other issue lies with accountability as 2 persons can ask to trigger a suspicion for concussion protocol :
- the referee i.e. Jerome Garces but that's assuming he follows the player from the moment he's down to the moment he leaves the pitch - very unlikely
- the doctor(s) (club one).

having shared responsability means that no one will likely take the blame (human error). french pro players "union" (provale) is therefore asking for an independent doctor to supervise games and be 100% accountable.

by munkian Fri 16 May 2014, 2:23 pm

There's a bit on the current Lions documentary where the coaches ask Hibbard if he OK (post match) and he just says Yeah and wanders off, they both look at each other and shake their heads in disbelief #granite

by MrsP Fri 16 May 2014, 2:28 pm

Well that is just not good enough.

Which members of the Toulouse medical staff were attending to him on the pitch? Did Noves not see his player become aggessive, stagger, collapse before he could reach the touchline?

There were members of staff with the player through all of that.

I can accept that the doctor doing the stitching might not have seen what happened on the pitch but everyone else in the stadium and at home could see that this was a seriously injured man.

If the doctor doing the stitching was expected to make the call then he should have been informed of the state of the player.

The tests to check for concussion were not needed here to decide if the player could return to the field.

It would be a disgrace if anyone in a position to stop the player from returning says they did not know what was happening when thousands of lay people could see be was clearly concussed.

Thanks for the update Whocares!

by No 7&1/2 Fri 16 May 2014, 2:30 pm

Following on from the George Smith collision was it? He came back on didn't he after looking for all the world done in or is my memory shot?

by munkian Fri 16 May 2014, 2:53 pm

No 7&1/2 wrote:Following on from the George Smith collision was it? He came back on didn't he after looking for all the world done in or is my memory shot?

Hibbard seemed to shrug it off, don't think he even left his feet, Smith was completely out of it, staggerring about like he'd had 10 pints but came back on - very dodgy

by MrsP Fri 16 May 2014, 2:53 pm

munkian wrote:There's a bit on the current Lions documentary where the coaches ask Hibbard if he OK (post match) and he just says Yeah and wanders off, they both look at each other and shake their heads in disbelief #granite

I don't remember this specific incident but if it followed a concussion the hash tag should really be

#braindamagedsonotabletojudge

by munkian Fri 16 May 2014, 2:57 pm

How do you tell with someone like Fatrick Swayze ?

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