Ignore brain injury with impunity!

So a player gets 3 week ban for foul language but keeping a Brain Injured Player in the game no sanctions whatsoever.
Player Welfare ?????

That is the view of Peter Robinson whose 14 year old son died because he was allowed to continue to play in a rugby match despite being head injured.

After yet another example of terrible mismanagement of an obvious and serious head injury in the professional game the review has decided that no sanction is necessary. This despite them concluding..

"The CMRG’s view is that there was sufficient evidence to conclude not only from the video evidence but also George North’s history and risk stratification that he should not have returned to the field of play. Northampton Saints medical team has accepted that North may have lost consciousness and therefore should not have returned to play."

The message?

Go ahead and ignore an obvious brain injury, no problem. And when it happens in a grassroots game or school boy game they can point to the fact that the CMRG said...

"The CMRG considered the welfare of North was always at the centre of Northampton’s actions, and does not consider that the medical team (or the club) failed to complete the HIA protocol..."

What a disgrace!

See Kay and Flatman on Rugby Tonight for balance.

I agree this is an absolute disgrace.

The sport had a gilded opportunity to demonstrate it was serious about it's duty of care to players, but instead chose to duck the issue.

Yep, it's an absolute disgrace.

CMRG seem to contradict themselves. If there is video evidence that North should not have returned to the field then surely Northampton are guilty of further risking his health by sending him out again?

Even as a spectator it looked pretty clear that North should never have returned to play.

What message does this send out now? Maybe some coaches will just ignore obvious head injury and keep the players on the field. Northampton get away with it, why shouldn't they?

The real message being sent out is head injury is not being taken as seriously as we were led to believe.

I don't have BTsport so I can't watch the whole of the segment but I have seen the 3 min clip on twitter.

I get that the PVR guy might not have managed to see the clip but an entire stadium full of spectators saw North KO'd.

Are we to believe that not one member of Northampton saw that North was KO'd? What about coaches? Other players? Management? None of them saw North unconscious on the pitch either in real time or on the replays played on the big screens? Why did no-one question how on earth North was back on the pitch?

And this was North who has not only a very worrying history of head injuries but also a history of passing pitch side HIA after he has been clearly KO'd in the past.

If this was how your son/brother was treated would you be happy?

MrsP wrote:I don't have BTsport so I can't watch the whole of the segment but I have seen the 3 min clip on twitter.

I get that the PVR guy might not have managed to see the clip but an entire stadium full of spectators saw North KO'd.

Are we to believe that not one member of Northampton saw that North was KO'd? What about coaches? Other players? Management? None of them saw North unconscious on the pitch either in real time or on the replays played on the big screens? Why did no-one question how on earth North was back on the pitch?

And this was North who has not only a very worrying history of head injuries but also a history of passing pitch side HIA after he has been clearly KO'd in the past.

If this was how your son/brother was treated would you be happy?

If they are claiming that nobody from medical staff to coaching staff witnessed what happened, I would have to think they are lying? I mean what are the chances? Incredibly slim to zero, methinks.

If the PVR guy or medics didnt see the video of North then why was North asked was he had stayed still?

MrsP wrote:So a player gets 3 week ban for foul language but keeping a Brain Injured Player in the game no sanctions whatsoever.
Player Welfare ?????

That is the view of Peter Robinson whose 14 year old son died because he was allowed to continue to play in a rugby match despite being head injured.

After yet another example of terrible mismanagement of an obvious and serious head injury in the professional game the review has decided that no sanction is necessary. This despite them concluding..

"The CMRG’s view is that there was sufficient evidence to conclude not only from the video evidence but also George North’s history and risk stratification that he should not have returned to the field of play. Northampton Saints medical team has accepted that North may have lost consciousness and therefore should not have returned to play."

The message?

Go ahead and ignore an obvious brain injury, no problem. And when it happens in a grassroots game or school boy game they can point to the fact that the CMRG said...

"The CMRG considered the welfare of North was always at the centre of Northampton’s actions, and does not consider that the medical team (or the club) failed to complete the HIA protocol..."

What a disgrace!

Those excerpts read like the CMRG concluded that Saints followed the HIA protocol but also infer that the HIA protocol is not of a sufficient enough to prevent an obvious concussed player from returning to play.
Saints are off the hook by the CMRG, but Premiership Rugby, ERC, IRB/World Rugby have been called out for insufficient rules/protocol where it's known by investigative bodies that their HIA protocol is deficient in identifying and preventing concussed players from returning to the field of play.

Also Saints, and every club for that matter, HIA protocols are the bare minimum rules that are in place. There is nothing preventing Saints, or any other club for that matter, from putting a higher bar in place for their own players. It would be a qualitative differentiator in the market place that you place greater value in the well-being of your players, what player wouldn't want to see that kind of support from their team! Concussion is also a burning topic in the sport and being best-in-class would be the type of positive move that company's would love to be affiliated with. So it isn't just a silly rule, a club could improve the quality of their sponsorship both by calibre of company and money generated, improve the quality of their squad by being a more appealing club to join. The more you think about it, the more dumb it feels to be behind the curve on this.

As I said on another thread, I know many of the Saints medical team.  These are good guys, smart guys, whom I believe followed the protocols to the letter.  Unfortunately, in medicine, and in life, sometimes simple objective rules are not sufficient.  Sometimes, and more than anyone would want to admit, medical decisions are made by the judgment and experience of the doc.  Concussion is not a fracture; there is no simple test, and the concussion protocols are not, and cannot be, definitive.  Given any doubt whether North was out cold or not, whether he passed the Protocols with flying colours or not, they made a huge mistake and should never have let North anywhere near the pitch.  

The question about no one coming forth after seeing North out on the pitch is also strange (to be polite).  This is just like the situation in the Wales-England match when North hit the turf and was really out cold.  80000 people, plus people pitch side on both sides, plus tv and no one claimed to have seen it.  I didn't understand it then and don't now.  

One last point.  I know there are quite a few medical people al over who are very nervous once again.  I think people became comfortable the concussion protocols gave them professional and legal protection.  Pass or fail.  Now, it comes back that judgment, expertise, and player history can never, ever be ignored.  Docs are not paid to perform objective testing.  Monkeys can do that.  I was told when I was in training that doctors evaluate their patients with heart, mind, soul.  This is an elemental truth of medicine, and we see it again.

There's no doubt that he shouldn't have been allowed back on the pitch. And it is hard to believe that he was.

The review found that this was a mistake, that there was no deliberate cover up and staff did not deliberately ignore the players best interests. But that procedures could be improved which which would improve player safety in future.

So, if this was a mistake and medical staff were acting in the players best interests you have to ask why people want to see punishment.

Does that really help player safety in future or does it make teams less willing to come forward, admit mistakes and for procedural improvements to be made?

doctor_grey wrote:As I said on another thread, I know many of the Saints medical team.  These are good guys, smart guys, whom I believe followed the protocols to the letter.  Unfortunately, in medicine, and in life, sometimes simple objective rules are not sufficient.  Sometimes, and more than anyone would want to admit, medical decisions are made by the judgment and experience of the doc.  Concussion is not a fracture; there is no simple test, and the concussion protocols are not, and cannot be, definitive.  Given any doubt whether North was out cold or not, whether he passed the Protocols with flying colours or not, they made a huge mistake and should never have let North anywhere near the pitch.  

The question about no one coming forth after seeing North out on the pitch is also strange (to be polite).  This is just like the situation in the Wales-England match when North hit the turf and was really out cold.  80000 people, plus people pitch side on both sides, plus tv and no one claimed to have seen it.  I didn't understand it then and don't now.  

One last point.  I know there are quite a few medical people al over who are very nervous once again.  I think people became comfortable the concussion protocols gave them professional and legal protection.  Pass or fail.  Now, it comes back that judgment, expertise, and player history can never, ever be ignored.  Docs are not paid to perform objective testing.  Monkeys can do that.  I was told when I was in training that doctors evaluate their patients with heart, mind, soul.  This is an elemental truth of medicine, and we see it again.

This is why I think Saints should have faced sanctions. It seems clear that the medical staff made an error but it was an error which every player, coach, manager etc has a responsibility to prevent. If they missed North's LOC there should have been many many others creating merry hell when North was reintroduced.

Scottrf,

It isn't so much that people want to see Saints punished, as much as we want to see a strong message go out that helps ensure clubs take head injury seriously.

I simply don't buy that Saints medical and coaches staff were unaware of what happened. That seems a ludicrous claim, but one that ensured they got away unpunished.

If they had been punished, it certainly would help ensure player safety in the future. Unfortunately, now that they have escaped punishment, the reverse is true.

MrsP wrote:This is why I think Saints should have faced sanctions. It seems clear that the medical staff made an error but it was an error which every player, coach, manager etc has a responsibility to prevent. If they missed North's LOC there should have been many many others creating merry hell when North was reintroduced.

That's fair I think. But you can see why the management would trust the medical staff and their assessments, especially when North provided a reason for the seeming knockout (keeping still for fear of neck injury).

Anyway I don't think I'd have complained too much with action taken against the club but trying to provide a counterpoint as much as anything.

They could never take more points off of us than our handling errors do anyway.

Scottrf wrote:

MrsP wrote:This is why I think Saints should have faced sanctions. It seems clear that the medical staff made an error but it was an error which every player, coach, manager etc has a responsibility to prevent. If they missed North's LOC there should have been many many others creating merry hell when North was reintroduced.

That's fair I think. But you can see why the management would trust the medical staff and their assessments, especially when North provided a reason for the seeming knockout (keeping still for fear of neck injury).

Anyway I don't think I'd have complained too much with action taken against the club but trying to provide a counterpoint as much as anything.

They could never take more points off of us than our handling errors do anyway.

Fundamentally, I agree. I don't know if Saints can be sanctioned if they followed the rules, but something has to be done. For this to be our club, which I know has taken player health very seriously over the years, is still surprising.

I get that it all happened very very quickly but...

(1) North was not just lying still. He bounced off the turf with no muscle tone. He was pretty clearly unconscious to even an untrained eye.

(2) Asking a player if he was KO'd is a pretty pointless exercise. Most people who briefly lose consciousness will be unaware of that fact because they were, by definition, UN conscious of what happened. And, basing your management plan on the word of a brain injured person is not a good idea.

(3) This is a player who has been in a very similar position before but was unaware he had LOC then and also passed a completely inappropriately performed HIA on that occasion too!

Yes, clearly the error was in leaving the player on the pitch if there is any doubt.

Supposedly he is playing on Friday which hopefully means he's recovered and there is no lasting damage. Let's hope he avoids this in the future.

I am not sure which objective methods are currently used to assess RTP but, given North's apparent ability to appear "normal" while brain injured, I would have concerns about their accuracy in his case.

In the sports industry I believe it's called the 'Arsene Wenger' defence.

Jokes aside, I'm reminded of when I used to read FT Alphaville around the time of the Great Recession. They wondered why there wasn't more lawsuits around the "dog s***" (a Goldman Sachs technical term) that was sold. From memory there was only ever one high profile court case. In it the buyers basically had to stand up and argue their own incompetence as a defence. That they had no idea what they were buying and thus couldn't be held accountable for the losses.

Saints (and Wales to be fair) seem to going down the same route. They're absolved of responsibility because they weren't aware there was an issue with a player who has a long history of brain injuries. There medical staff can't be blamed for wilful endangerment, because they were too incompetent to see what even an untrained bystander could.

I would have thought that argument simply opens them up to a charge of gross negligence, but then I'm not a lawyer.

Sorry if this has been mentioned above but the latest info coming out now.seems 100% that North was knocked out as I think the vast majority would agree with. But North did tweet that he was fully concious but hurt his neck in the fall hence lay absolutely still. Haven't heard anything on this since though.

George North is playing this weekend as well isn't he?

I wouldn't have selected him if I was in charge...

GeordieFalcon wrote:George North is playing this weekend as well isn't he?

I wouldn't have selected him if I was in charge...

Agree totally. Wouldn't be playing him for a good while yet.

As others have said a absolute disgrace

We are led to believe no one at Saints watched the TV screen which showed North unconscious

Also what about the lie, and it was a lie, that they determined it to be a neck injury and that he was ok to come back on.

What is the official line re him missing 2 games - concussion or neck injury ?

Someone, I think it was Paddy Wallace, said after retirement that the HIA test wasn't worth the paper it was written on.
Had a couple of doctors on Radio 4 this morning saying the same and saying anyone going off for a concussion related assessment shouldn't return to the pitch under any circumstances

We are now getting to a crazy situation with yellowing carding tackles that are not dangerous in any objective way (see new guidelines for 2017) whilst at the same time sending players back on the pitch due to laughable off the pitch tests.

We need to re focus and damn quick

geoff999rugby wrote:As others have said a absolute disgrace

We are led to believe no one at Saints watched the TV screen which showed North unconscious

Also what about the lie, and it was a lie, that they determined it to be a neck injury and that he was ok to come back on.

What is the official line re him missing 2 games - concussion or neck injury ?

Someone, I think it was Paddy Wallace, said after retirement that the HIA test wasn't worth the paper it was written on.
Had a couple of doctors on Radio 4 this morning saying the same and saying anyone going off for a concussion related assessment shouldn't return to the pitch under any circumstances

We are now getting to a crazy situation with yellowing carding tackles that are not dangerous in any objective way (see new guidelines for 2017) whilst at the same time sending players back on the pitch due to laughable off the pitch tests.

We need to re focus and damn quick

Spot on mate. Im glad steps are being taken to address things however its got to be said....Some of the yellow and red cards have been absolutely absurd! And yet a player with numerous genuine head injury concerns is badly looked after and club get away with out repercussion??? And indeed are wheeling him out again this weekend!

Its just not on at all.

http://www.independent.ie/sport/rugby/six-nations/if-you-have-that-suspicion-hes-off-and-he-stays-off-barry-odriscoll-speaks-to-paul-kimmage-about-concussion-31049362.html

RiscaGame wrote:

GeordieFalcon wrote:George North is playing this weekend as well isn't he?

I wouldn't have selected him if I was in charge...

Agree totally. Wouldn't be playing him for a good while yet.

The other thing...is surely Saints have other wingers who are coming through so that North doesn't have to be played??

I really don't get what is going on at Saints. I think Mallinder has lost the plot!

GeordieFalcon wrote:

RiscaGame wrote:

GeordieFalcon wrote:George North is playing this weekend as well isn't he?

I wouldn't have selected him if I was in charge...

Agree totally. Wouldn't be playing him for a good while yet.

The other thing...is surely Saints have other wingers who are coming through so that North doesn't have to be played??

I really don't get what is going on at Saints. I think Mallinder has lost the plot!

The worst of it is that North hasn't been playing well and you can't help but think he's either being flogged or the head injuries are affecting his performances

Head injuries can affective your vision, memory, coordination and lethargy which aren't exactly helpful to a rugby player at the highest level

A prolonged break and chance to fully recover and come back fitter and sharper is surely in everyones interests?

But in reality none of you have any idea of the health he's in, whether extra rest will have any impact on his chances of similar incidents reoccuring etc. A lot of forum doctors about.

Scottrf wrote:But in reality none of you have any idea of the health he's in, whether extra rest will have any impact on his chances of similar incidents reoccuring etc. A lot of forum doctors about.

None of us are coaches and don't see training but regularly comment on selection

But at least you watch the matches and have an idea of what to look for. If the rules aren't right around return to play, find a medical basis and change them. But he's been determined fit and fine to play by the rules, and medical professionals who have examined him.

Well the Saints doctors know what to look for yet we knew he was concussed and they didn't so I think we are qualified

You don't know he was concussed and clearly don't know the difference between knocked out and concussed so I'll leave it there.

Scottrf wrote:You don't know he was concussed and clearly don't know the difference between knocked out and concussed so I'll leave it there.

I was using the word broadly, Ill simplify then for the pedant

He had a significant head injury that meant he should not have returned to the field of play which many of us saw was clear that the doctors didn't

That better?

We do know he was concussed.

For several reasons.

(1) He was KO'd and therefore by definition had suffered a brain injury. You don't have to be KO'd to suffer a brain injury/concussion but you are brain injured if you are KO'd.

(2) He is/has undergone the GRTP protocol.

I've joined this discussion late but is North really playing this weekend??
Lets say he get another head injury which is a possibility. I don't think I need to say more.

Surely from Norths own POV he should be taking some extended time off. I can only imagine his family would be putting some serious pressure on him to at least take a break. Hes only 24 he can afford to take a year off.

P.S. Hi Mrs P, Merry Christmas to you and yours

Hi Pete!

And to you!



Just out of interest, does anyone know why North was subbed off after ?20 mins?

Pete330v2 wrote:I've joined this discussion late but is North really playing this weekend??
Lets say he get another head injury which is a possibility. I don't think I need to say more.

I'm utterly amazed he's playing this weekend too and I really hope they are genuinely happy that he has no lasting effects from this latest incident. They have Sale at home too - they should have enough to win that with or without North playing so why not give him another week?

Former players with history of concussion are speaking out against the decision too

http://www.bbc.co.uk/sport/rugby-union/38403463

I rally do worry for him in the long term

He has already had to take a long time off to recover, seems to be 'easily' knocked out now (well in my unprofessional opinion anyway) and it is said it is the cumulative effects of multiple head injuries that is really dangerous.

If he has to take another year out, do you not think for his own health and long term survival he should consider retiring (I know noone would want that, but for his health it may be necessary)

There is a real possibility that if he gets another and does damage permanently, then criminal charges may be brought (again, my opinion)

an interesting read from Rory Lamont from 2013

http://www.bbc.co.uk/sport/rugby-union/23495774

North isn't selected.

BBC showing themselves up a bit recently.

Scottrf wrote:North isn't selected.

BBC showing themselves up a bit recently.

Good.

Scottrf wrote:North isn't selected.

BBC showing themselves up a bit recently.

Where did BBC say he was playing?

http://m.bbc.co.uk/sport/rugby-union/38383231

So they were essentially reporting what Mallinder says, those fools

Maybe the pressure from the media etc forced a rethink from him

Slightly off topic here MrsP but what are your views on other injuries caused by Rugby?

I had a collapsed lung a few months back and the doctors said that it was due to too much trauma on the rib cage from Rugby (and other incidents). I had suffered too many cracked ribs and one of the floating ribs had caused extra trauma thus leading to my collapsed lung.

A lot of focus is on the brain injuries but collapsed lungs can actually kill as well. I wonder if there is any investigation regarding that.

Lots of injuries can kill. I don't think anyone doubts that.

But deaths due to injury on a rugby field are, thankfully rare.

There are different ways of reducing risk. One approach is to try to make the injury less likely. Another is to try to make sure that the management of the injury is the best it can be to minimise the long term effects.

The thing which sets head injury apart for me is the fact that the potential long and short term effects of head injury are so terrible. If you fracture your leg it is potentially fatal but it almost certainly will heal.

If you damage your brain it will not regenerate to anywhere near the same extent that other tissues do.

And also, your brain function is essentially who you are. Mood, memory, affect, intellect are all effected by brain injury in ways which do not apply to other injuries.

So, yes I am concerned about other injuries but brain injury deserves special consideration in my opinion.

P.S. Rugby is still safer than some other incidents which may have been responsible for your collapsed lung!

I am not belittling head injuries as I think they are serious and far more attention should be paid to them. I am saying that, based on my own personal experience, that other injuries which can affect former players later in life may not be getting the attention that they deserve as well.

Players are far bigger and stronger now than when I played and far more injuries to the rib cage area are happening. I have a feeling that in many years time, this will become an issue for a lot of ex players.

Helicopters should be banned

Not to underplay your collapsed lung either but I have a friend whose risk factor for pneumothorax was that he played the trumpet!

eirebilly wrote:I am not belittling head injuries as I think they are serious and far more attention should be paid to them. I am saying that, based on my own personal experience, that other injuries which can affect former players later in life may not be getting the attention that they deserve as well.

Players are far bigger and stronger now than when I played and far more injuries to the rib cage area are happening. I have a feeling that in many years time, this will become an issue for a lot of ex players.

Helicopters should be banned

billy one of the huge differences between the two is that the symptoms of a head injury can be masked by players, Im sure you had some discomfort at least before your lung collapsed but shrugged it off like most do.

Things like depression etc don't show up on scans etc. Repeated concussions can lead to fits etc and MRIs and EEGs can show you having a healthy brain

marty2086 wrote:
billy one of the huge differences between the two is that the symptoms of a head injury can be masked by players, Im sure you had some discomfort at least before your lung collapsed but shrugged it off like most do.

Things like depression etc don't show up on scans etc. Repeated concussions can lead to fits etc and MRIs and EEGs can show you having a healthy brain

No discomfort and no warning, woke up struggling to breath thinking I was having a heart attack. Actually very scary and exceedingly painful which is why I posted that I feel its worthwhile looking into the dangers of high impact on players ribs and later effects in life.