Knock out

Despite some great performances and a very welcome win what will stick in my mind is George North. He d already had 1 concussion check and took another hefty blow to the noggin and stayed on. How and why it was allowed is beyond me. Its too serious a pointtobe ignored. Does the tmo need to be involved more here?

I'm sure we'll hear a lot more in the media this week. He looked out for the count.

Massively disappointed with the Welsh medical staff.

He shouldn't have come back on after the first one, and leaving him on after the second was surely bordering on medical negligence (if that's a thing!).

He was clearly not right all game - had to go off.

Don t want it to get anyway a dig Welsh staff. The medical guys obviously make their decisions on their years of training. The 2nd time tho its possible they didn t see, neither did the ref. TMO must have though? Isnt it the his responsibility to tell the ref get him off for a check?

Someone saw it........... some of the players saw it I'm sure.  Just falling like a stone - not protecting himself with his arms.... gone.

I realise the heat of the moment, and the passions, and the yearning to win, and the desire not to see a central player go off (if you're a fellow Welsh player) - but some players knew he'd been off earlier and some of them saw him go down again.  The game isn't the most important thing - it doesn't have primacy over a player's health.

Someone should have said something and brought the ref's attention to it.

A player doesn't have the right to choose - they are in battle mode - adrenalin makes them want to stay put and disguise the clouds in their head as much as possible.  Thus the rules - taking the decision out of their hands for their own sake.

Yep - he was in a bad way and should have been off.

No 7&1/2 wrote:Don t want it to get anyway a dig Welsh staff. The medical guys obviously make their decisions on their years of training. The 2nd time tho its possible they didn t see, neither did the ref. TMO must have though? Isnt it the his responsibility to tell the ref get him off for a check?

Why should the medical staff be immune from criticism on this? They are the ones assessing the player, and they are the ones that have the ultimate power - walking him off the pitch and telling the management he needs subbed. They are solely responsible IMO.

I'd be very surprised if Dr James Robson would have left him on the pitch.

There were loads of replays of the second one - no doubt shown on the big screens - so they will have seen it.

I also don't understand why they left him on - he was having an average game, made worse by his head knock, and Williams is a more than adequate replacement!

Also, there are many documented cases of '2nd hit syndrome' causing serious injury and even fatalities - it  Is completely indefensible that he was left on.

I hope someone is keeping a close watch on him tonight.

The second one was strange - looked like nothing more than a fend from Brown, and yet GN was definitely out cold for a moment. Suggests to me that the first knock was quite serious and had left him still groggy.

Certainly disappointing that neither the medical staff nor the match officials spotted it or did anything about it given the increased awareness of concussions and the longer term effects.

Once a union gets sued for a few million due to brain damage then they will start to take this seriously - until then sadly they will not. North should have been taken off as he was clearly knocked out on the second head clash. Every players wants to carry on but they have to be protected for their own good. Everyone else in the stadium saw he was knocked out - plus tv evidencxe should have meant he was withdrawn.

dummy_half wrote:The second one was strange - looked like nothing more than a fend from Brown, and yet GN was definitely out cold for a moment. Suggests to me that the first knock was quite serious and had left him still groggy.

Certainly disappointing that neither the medical staff nor the match officials spotted it or did anything about it given the increased awareness of concussions and the longer term effects.

It was slightly obstructed from the camera angle, but he had a head clash with Hibbard just behind Brown.

RDW_Scotland wrote:

No 7&1/2 wrote:Don t want it to get anyway a dig Welsh staff. The medical guys obviously make their decisions on their years of training. The 2nd time tho its possible they didn t see, neither did the ref. TMO must have though? Isnt it the his responsibility to tell the ref get him off for a check?

Why should the medical staff be immune from criticism on this? They are the ones assessing the player, and they are the ones that have the ultimate power - walking him off the pitch and telling the management he needs subbed. They are solely responsible IMO.

I'd be very surprised if Dr James Robson would have left him on the pitch.

There were loads of replays of the second one - no doubt shown on the big screens - so they will have seen it.

I also don't understand why they left him on - he was having an average game, made worse by his head knock, and Williams is a more than adequate replacement!

In relation to the 1st 1 I was meaning. They assessed him and he was ok. Im giving them the benefit of the doubt on the 2nd by saying they may not have seen it. Im just trying to highlight the serious issue in general as sometimes it has been known that people get a little defensive if they see posts as a dig. This for me is player safety in general.

They just don't seem to get it.

North should not have been undergoing the pitch side concussion tests. He was clearly KO'd from the first impact with someone's boot and should therefore have been removed from the pitch and not been allowed to take any further part. It matters not a jot if he passed any test. He had been KO'd therefore he leaves the game.

I did not see the second incident but then again no-one should have seen the second incident because it should not have been allowed to happen.

Someone needs to start to take the people making these decisions to task!

Aside from the safety considerations, it just seemed a poor rugby decision. North's physicality noticeably dropped. By keeping him on, they were placing a player in danger while not getting the benefit of his greatest attribute.

Utterly stupid. Of course he should have been off.
When a player drops like a stone, it is a sign the player needs a rest for a few weeks not a few minutes. I was shocked to see him out there again.

There is no defence for the Welsh medical team on this. I'm really not sorry if that offends some people. it was clear that he was suffering with trauma to his head. After the first incident he should never returned, and after the second, whoever from the medical staff made the decision that he did not need to come off needs to be struck off for negligence.

The Welsh management (coaching and medical) had an opportunity to make a bit of a statement last night. Bring North off and make it clear that the welfare of a player is more important than the result of a rugby match.

Unfortunately, despite clearly seeing all the shots that we did at home, they decided not. I hope North is ok but I can we'll see this being an issue that cuts his career short.

That'a a good good point - the Welsh management all have laptops and see every replay available, so they certainly would have seen him knocked out twice.

As has been said, it was a poor rugby decision to keep him on anyway - he clearly wasn't right!

This is why it should be a neutral doctor who makes the call.

TJ wrote:This is why it should be a neutral doctor who makes the call.

+1

The thing is, how far down the rugby ladder is it feasible to have a neutral doctor?

We need the medics to be able to apply the rules despite their allegiances.

Both of these incidents with North were very clearly reasons to remove him from that match, they were not borderline calls.

What we need is a sea change in attitude from the entire medical community involved in rugby. I know some are already doing a good job.

I think he should of stayed off after the first clash of heads. But when it happend again i cannot understand why the ref did not tell him the leave the field.

Great start. Hard luck Wales..

TJ wrote:This is why it should be a neutral doctor who makes the call.

This with bells on. There must be all sorts of conflicting pressures on a doctor employed by one of the teams; aside from anything else, it's not fair on them as it brings their competence or integrity into question even if they've made a sound decision. A neutral doctor would probably err on the side of caution which is surely the right thing.

Is it really going to take a serious trauma or even a death for showbiz rugby (and other sports, the number of guys returning to the field in the soccer world cup after clear head clashes without any kind of examination was shocking as well) to start taking this seriously?

I am a bit confused as to who actually has the final say in terms of if a player is fit to return after suspected collision. I was watching the game with Italian commentary and they said on more than one occasion that the decision is made by an independent doctor not the medical team of the player's team. Is this true? Or was it the welsh medical team that made the decision.

MrsP wrote:The thing is, how far down the rugby ladder is it feasible to have a neutral doctor?

We need the medics to be able to apply the rules despite their allegiances.

Both of these incidents with North were very clearly reasons to remove him from that match, they were not borderline calls.

What we need is a sea change in attitude from the entire medical community involved in rugby. I know some are already doing a good job.

Pro level I would say. Its clear thatthe current protocols only work if the medics are neutral

TJ. I don't think that is true. There are some teams out there who are doing a good job with head injuries. In fact, I have seen someone complain that a player was removed for concussion testing when they had not seen any injury. It turned out the medics were correct. The player was allowed to return, presumably having passed the tests but was not playing the next week.

The thing is that a player who is KO'd is off and stays off. There is no wriggle room. There is no place for the pitch side tests in these cases apart from in deciding how urgently the player needs fully assessed.

I know i'm going to get stick for this, but here goes.  There must have been a reason for him staying on, or rather not being taken off. More so than 'we need him, he must stay on'. There must be a reason why these trained medical professionals thought better than us lot watching it on TV and posting on 606. Why would they risk throwing their careers away if, like 606 is suggesting, they were deliberately negligent? We're assuming he was knocked out by the Atwood kick. But was he? Or was he kicked in the lips (or similar). I've seen players lying motionless when they've had a knock to the shin so I'm not sure we know for definite he was knocked out then.

My point here is that the trained staff would have followed protocol. If they did the concussion test thingy and he passed it then why take him off? We won't know until the management team tell us I suppose. But are they wrong to keep him on if he passes the concussion test, or is it the system/protocol/standard that's wrong?

For the second incident I have no idea what happened? There didn't appear to be contact. Some english posters accused him of a dive. Was it? Seemed odd. Did he just black out. IF, and it's a big if. IF the management saw him blacking out like that (assuming it wasn't a dive) then yes of course they should take him off. But did they see it??? What happened afterwards? I don't recall. Did he get up or was he treated???

I want to make it clear here that I'm questioning the logic and playing Devil's advocate, rather than justifying the decision. If he was concussed he goes off. No question. But as always on 606 we're guessing a bit.

Just to add that Halfpenny had a similar knock but that has not been mentioned. How come???

Griff,

If someone gets kicked in the head and then lies motionless face down on the pitch with no attempt to put his hands to where he was kicked you have to assume he was KO'd. He did not receive immediate attention so the medics have to go on what we all saw. There is absolutely no point in asking the player if he was KO'd. He can't know the answer to that question.

The second time he was very clearly unconscious before he hit the floor (suffering yet another potentially concussive injury as he hit the deck). I have only seen the replay of that incident so I don't know if he was even assessed after that one on the pitch?

And, you shouldn't get any stick for discussing this at all. The more discussion the better.

MrsP wrote:TJ. I don't think that is true. There are some teams out there who are doing a good job with head injuries. In fact, I have seen someone complain that a player was removed for concussion testing when they had not seen any injury. It turned out the medics were correct. The player was allowed to return, presumably having passed the tests but was not playing the next week.

The thing is that a player who is KO'd is off and stays off. There is no wriggle room. There is no place for the pitch side tests in these cases apart from in deciding how urgently the player needs fully assessed.

I meant neutral in attitude not payroll. I agree some do it properly, some do not. some put seem to allow their aleigence to the club / enthusiasm / whatever overcome their Hippocratic oath.

North should have been off after the first head knock. NO way can he have passed toe concussion protocols if dispassionatly applied. It should be "if in doubt - take him off" I think some medical staff apply it as " if in doubt play on"

MrsP wrote:Griff,

If someone gets kicked in the head and then lies motionless face down on the pitch with no attempt to put his hands to where he was kicked you have to assume he was KO'd. He did not receive immediate attention so the medics have to go on what we all saw. There is absolutely no point in asking the player if he was KO'd. He can't know the answer to that question.

The second time he was very clearly unconscious before he hit the floor (suffering yet another potentially concussive injury as he hit the deck). I have only seen the replay of that incident so I don't know if he was even assessed after that one on the pitch?

And, you shouldn't get any stick for discussing this at all. The more discussion the better.

Absolute bollix MrsP. I've been on here for years and know how it works!!!

MrsP wrote:Griff,

If someone gets kicked in the head and then lies motionless face down on the pitch with no attempt to put his hands to where he was kicked you have to assume he was KO'd. He did not receive immediate attention so the medics have to go on what we all saw. There is absolutely no point in asking the player if he was KO'd. He can't know the answer to that question.

The second time he was very clearly unconscious before he hit the floor (suffering yet another potentially concussive injury as he hit the deck). I have only seen the replay of that incident so I don't know if he was even assessed after that one on the pitch?

And, you shouldn't get any stick for discussing this at all. The more discussion the better.

So what's the reason for keeping him on then? That's what I'm trying to get at. Was there a clear case of deliberate negligence? Should we/the players Union be suing on behalf of North. Should the staff be struck off? In normal medical practice this would be the type of question asked, right?

He may well have passed the pitchside tests.

The important thing to remember is that those tests are not designed to decide whether a player who has been KO'd is okay to return to the pitch. They are designed to assess if someone has had suffered a head injury when you are not sure.

Some people are using those tests as an excuse to put clearly KO'd players back on the pitch.

I suppose it's a bit like deciding a try is legit by just looking at the grounding when the ball was grounded on the 22, not the goal line. "Right answer to the wrong question" type of thing.

Normally in the medical world actually we would be asking Was there an adverse outcome? Could this have been prevented? Why did this happen? What can we do to prevent it happening again?

Griff wrote:

MrsP wrote:Griff,

If someone gets kicked in the head and then lies motionless face down on the pitch with no attempt to put his hands to where he was kicked you have to assume he was KO'd. He did not receive immediate attention so the medics have to go on what we all saw. There is absolutely no point in asking the player if he was KO'd. He can't know the answer to that question.

The second time he was very clearly unconscious before he hit the floor (suffering yet another potentially concussive injury as he hit the deck). I have only seen the replay of that incident so I don't know if he was even assessed after that one on the pitch?

And, you shouldn't get any stick for discussing this at all. The more discussion the better.

So what's the reason for keeping him on then? That's what I'm trying to get at. Was there a clear case of deliberate negligence? Should we/the players Union be suing on behalf of North. Should the staff be struck off? In normal medical practice this would be the type of question asked, right?

If North was my son those are the questions I would be asking.

Regarding Halfpenny, it looked to me that the impact with Haskell's leg jarred his head back and strained his neck, rather than knocking him out. From memory that is. Different situation entirely.

Regarding North, don't remember seeing the after effects of the kick so I'll leave that one. The second one with Hibbard, well I just can't see how they could have missed it. It was replayed several times, I can't see the Welsh team not viewing the BBC feed, even if they have more views. Just don't understand it.

And back on Dr James Robson, he was the Lions doc last time round wasn't he? The one who said he wouldn't allow injured players to play? The who then let injured players play, not only not getting the best out of them, but also lengthening their recovery time? He talks a good talk but I'm not convinced he's walking the walk (from memory the injured players were: Healy, Bowe, Youngs, Tuilagi)

The summary of the latest research on concussion injuries put forward by the IRB contains a lot of 'aren't we doing better' (12% of players playing on after pitch-side assessment found to have suffered concussion later, but was 56% previously) while ignoring the fact that 12% is still far too much given the potential for significant health damage later in life. To me that's like celebrating a 30 point stuffing because you lost the last game by 100. I do fear that many players will pay for this in the future.

To quote Gatland...

“He passed all the protocols first time. We’ll have to see how he is over the next few days.”

If you have to see how he is over the next few days then he shouldn't have been playing!

Much as everyone loves to hate them, I do really like Saracen's approach with the head sensors and hope that gets some traction and can be used effectively to keep players safe.

Big wrote:The summary of the latest research on concussion injuries put forward by the IRB contains a lot of 'aren't we doing better' (12% of players playing on after pitch-side assessment found to have suffered concussion later, but was 56% previously) while ignoring the fact that 12% is still far too much given the potential for significant health damage later in life.  To me that's like celebrating a 30 point stuffing because you lost the last game by 100.  I do fear that many players will pay for this in the future.

To quote Gatland...

“He passed all the protocols first time. We’ll have to see how he is over the next few days.”

If you have to see how he is over the next few days then he shouldn't have been playing!

Much as everyone loves to hate them, I do really like Saracen's approach with the head sensors and hope that gets some traction and can be used effectively to keep players safe.

Currently they're no good at assessing live. They're used to retrospectively look at impacts and probably relate to after effects. Although the newer technology does allow live feeds, where this data could be used pull players ( but as Mrs P says, it should supplement, not be the overriding factor. So if a player is spark out but his impact monitor is green then he comes off)

HammerofThunor wrote:
Currently they're no good at assessing live. They're used to retrospectively look at impacts and probably relate to after effects. Although the newer technology does allow live feeds, where this data could be used pull players ( but as Mrs P says, it should supplement, not be the overriding factor. So if a player is spark out but his impact monitor is green then he comes off)

That's a shame - and even if it was as useful as I'd hope I'd absolutely I agree that it can only ever supplement a decision. Still, the only way you are ever going to get useful in game feedback is if you run these studies and do the analysis so I hope they get something good out of this, and still say good on them for giving it a go.

Did anyone see Dr O'Driscoll on BBC breakfast this morning? He had some damning words for the pitch side assessments.

Griff wrote:
So what's the reason for keeping him on then? That's what I'm trying to get at. Was there a clear case of deliberate negligence? Should we/the players Union be suing on behalf of North. Should the staff be struck off? In normal medical practice this would be the type of question asked, right?

Well, Griff - you say the critics don't know why the medics put him back on (inference being they must have made a precise medical judgement based on their assessment procedures).

Well, the same is true for your outlook in suggesting they had their legitimate reasons for putting him back on - you can't 'know' that is true any more than some of us can 'know' that our concerns about North's concussion signs are true.

But I will point out that a player being mercilessly put back out on a field having sustained gruesome head injuries of a mind-boggling kind aren't exactly without evidence.  

A year or two ago a French player (can't remember his name) was totally knocked out, was dragged stumbling'n'mumbling off the the field, was quickly doctored up by the medics and quickly dropped back into play by an impatient coach who wanted one of his best men on the field - medics seemingly over-ruled - player seemingly over-ruled too considering he didn't seem to know up from down and wasn't in a position to say he was okay.
Then you had O'Gara who was left to play on in that infamous Lions game with the heavy bandage and the 'not-got-a-clue' what was going on rolling around in his head.  Do we think of negligent medics about that one?  Nope, we just have a good old sneering laugh at O'Gara making schoolboy errors.
Sexton last year - virtually out of it for most of the second half against England but played on even as players were looking at him with concern and I was screaming at the TV to get him off.

It happens, it has happened, it'll happen again.  We don't need docs to tell us a player's brain has gone to mush.  Mush is mush, our human instincts can see vulnerability - we can smell it and see it.  North was not up to it - even towards the end of the game you could see him walking around with a pronounced hunched shoulders strut - to me evidence of him trying to shake off the fuzziness.  He looked uneasy but was trying to strut himself out of it.

I personally don't care what doc would tell me my reading of him was all wrong - I'll go with my instincts and say my reading of him in the second half was all right. I don't 'know' but I fully believe North was mentally not onsong.

I think Sarries are using them retrospectively to study head injuries over the season but they can be used in real time to tell you how hard a player's head was hit.

The way things are at present it seems some folk would use that data to say,

"The impact was below the threshold so we will just revive this unconscious player and stick him back on the pitch!"

If they took the proper precautions during his assessment period, and he passed the tests to be allowed back on, then that's fine. The really dodgy thing is that he wasn't immediately taken off again after his clash with Hibbard. That's what Gatland didn't answer.

chris_501 wrote:The Welsh management (coaching and medical) had an opportunity to make a bit of a statement last night..........

They did, mate. They absolutely did.

the Sarries sensors are for research I think - to give information about the impacts so in future we will have more data to decide things. One of the issues is its not just the amount of energy in the impact - its also what direction ie is it straight on or rotating. rotating the head has different effects from simply linear accelerations.

It seems from the above comments that in reality Halfpenny, North and Biggar should have gone off and not come back. Maybe some England players too but I don't remember any incidents. All had head injuries. All seemed 'groggy'. How could the medics be sure that there were no underlying problems?

Again I'm playing devil's advocate, but it does make me question if this sport has much future in its current format when head knocks are as common as shoulder knocks. Are we on course for rule changes that will change our game forever, in the interest of player safety? Maybe that's what we need... I'm all for it to be honest. We cannot carry on saying that all head knocks should mean a player leaves the game but at the same time have a sport that allows/encourages players to run headfirst into other players with no protection (and no I'm not talking about wearing helmets as they've been shown in studies to be counter reproductive!).

I know the present always looks like it was always that way but that's always only an optical illusion.  A person who died only 5 years ago, if they came back to life now they'd see major changes in society, in sport etc.  We don't see it just like we don't appreciate ourselves growing older until we see a bloody wedding photo and ask: "who the hell is that ugly asswhole on the extreme left??"

But the truth is that players are bigger (musclewise), are mostly talller, are stronger, are faster, are boosted by the very best technology and diets and training methods (and maybe other stuff for a few )
But that does make the questions about 'player safety' more apparent than perhaps even 5 years ago.  

Even the styles of play demanded by...demanding...coaches adds to the concern.  
This desire to charge at speed headlong into two or three heavy opponents, this desire to be absolutely animal in the breakdown area, and constantly expecting to come out of those collisions ok, and do that for a full 80 without worrying about cumulative minute head injuries piling on top of each other - well, concerns do grow as the game itself seems to become more and more violently explosive for consistently longer periods through an 80 minute game.

Griff, I now you are playing devils advocate and thank you for doing so, as it prompts debate, but nobody is suggesting that every player with a head knock should go off and not come back.  As I recall, Halfpenny never looked 'out of it' or as if he had lost consciousness at any point, and therefore after being properly asessed I would say he should be fine to continue.  Similarly, Biggar looked to be 'all there', just bleeding heavily after his bump.

North was entirely different.  He looked like a punch drunk boxer at times, and hit the deck on the second occasion without putting his arms out to break his fall which is a clear sign of a loss of consciousness.  In those circumstances, he has to be removed from the field for his own safety.

If I can liken it to boxing, if a fighter is getting repeatedly punched in a corner, but is bobbing around trying to evade the blows, or throwing punches back, or even just managing to keep his arms up to defend himself, the referee will let it continue.  The minute his arms go down and he clearly does not have the thought processes in place to be able to defend himself the referee steps in and ends the contest.  That second example was George North last night.  He could not save himeslef whne he was falling because his brain would not tell his arms to move so break his fall.  At that point it's game over.  No ifs, buts or maybes.  Player safety is paramount, and the IRB or whatever they are now called, need to clear on this.

Ozzy3213 wrote:Griff, I now you are playing devils advocate and thank you for doing so, as it prompts debate, but nobody is suggesting that every player with a head knock should go off and not come back.  As I recall, Halfpenny never looked 'out of it' or as if he had lost consciousness at any point, and therefore after being properly asessed I would say he should be fine to continue.  Similarly, Biggar looked to be 'all there', just bleeding heavily after his bump.

North was entirely different.  He looked like a punch drunk boxer at times, and hit the deck on the second occasion without putting his arms out to break his fall which is a clear sign of a loss of consciousness.  In those circumstances, he has to be removed from the field for his own safety.

If I can liken it to boxing, if a fighter is getting repeatedly punched in a corner, but is bobbing around trying to evade the blows, or throwing punches back, or even just managing to keep his arms up to defend himself, the referee will let it continue.  The minute his arms go down and he clearly does not have the thought processes in place to be able to defend himself the referee steps in and ends the contest.  That second example was George North last night.  He could not save himeslef whne he was falling because his brain would not tell his arms to move so break his fall.  At that point it's game over.  No ifs, buts or maybes.  Player safety is paramount, and the IRB or whatever they are now called, need to clear on this.

I've highlighted some things above that makes the debate interesting, and I think this is the point that others were making. Halfpenny was lying motionless for a while if I remember correctly. Because he didn't look knocked out it is fine? Slippery slope. Also, what does properly assessed mean? We've already argued that these tests are not fit for purpose and cannot detect the unknown. Biggar 'looked' groggy to me when it happened. But what do I know? Again, looking ok or looking groggy - is that a good, objective measure?

And yes, I'm enjoying the role as Devils advocate! I just do not know the answer so I'm asking the questions. But I do know that we cannot go on how a player looks or seems. That's dangerous ground! So do we need to take a blanket approach? And how do we do that in a contact sport with no head protection as its likely that every player on the pitch will knock their head at some point during the game.