Dr. Éanna Falvey:

I thank everyone for their questions. Deputy Kelleher asked about the longitudinal studies. Even though it is a small country, Ireland has an ideal set up for performing this research. We are a small country and our geography allows us to gather data on groups reasonably well. We are well set up in that we do not have many centres spread out all over the country. We have a number of centres to gather data. I agree we need to collaborate with international groups and if possible it would be better again to do so at governmental level, if this was possible. One wants to pool as much data as one can as early as one can to gather the information quickly and I echo that fully.

With regard to helmets, the concept is risk compensation. We all have an acceptable level of risk and if we do something that makes us feel less at risk, we will undertake more risky behaviour. This is an established fact. If one puts a helmet on a child, he or she will feel there is less risk involved and, therefore, they will go for a ball in hurling or into a tackle in rugby. There is, therefore, a side effect. We need to be extremely careful in legislating for safety equipment to ensure, first, it is doing its job and, second, it is not causing unexpected consequences. We must be careful that the standards relating to the equipment are met. There are stringent guidelines for that. Dr. Paddy Crowley has done the research on the micro helmet and he has shown the evolution of head injuries in hurling as a result of helmet use. However, strict guidelines have to be adhered to in the manufacture of helmets as a result.

Good studies have been done on protective helmets. In Australia, the use of bicycle helmets in cycling was analysed and over a ten-year period during which extensive money was spent on education and advising people on health risks, the use of helmets increased from 20% to 32%. Legislation was introduced and helmets became mandatory. Helmet use increased from 32% to 95% in one year. There is, therefore, definitely a role for legislation; it just needs to be directed and informed. We need to be careful of jumping in with legislation but doing the right stuff with the strength of legislation behind it could be powerful.

I echo Professor Ryan's comments on compulsion. Making it compulsory to do anything means we could potentially lose volunteers but there is a gap for a body such as the faculty of sports medicine to step in and help to provide a basic first aid set up that can be delivered. This is usually done by sports and rugby is doing a good job at the moment. Referees are all indoctrinated now in concussion management while all coaches involved in the AIL this year have to partake in the course before being allowed to be involved. That is obviously at a higher level but significant education is not needed for this to filter down to the grassroots. The SCAT tree can be used on the sideline. If one not is medically trained, this tool will help one decide whether one should sit the person out. If one is medically trained, one can make the call but if one is not, this tool can be used if one is worried about a player. It is easy to use and we could educate people about it easily if there was an initiative and support. Perhaps this could be legislated for. If one is involved in a team, it is important that one, for example, takes an online module. I urge members to go the IRB's website because it contains a good module on how to complete the SCAT tree for non-medical people. One reads it and then one is asked a few questions to make sure one has read it. That could easily be done.

It is low cost and with some support it could be very effective. We need to not just educate the players and the coaches, but, to echo Dr. Sheeran's point, if we start at the bottom in schools, the change will become a fact. I was cycling recently with my daughter and she asked me why someone was not wearing a helmet. I struggle to wear a bicycle helmet because I did not use one growing up. She takes it for granted that one does not get on one's bike without using a bicycle helmet. If we start at the bottom, we will see change. The schools' initiative is a really big one.

With regard to protocols, the doctor must be independent. One of the biggest struggles when one is involved in a team is not being a fan but one is a person as well. It is hard not to be a fan but one must try to be as impersonal as one can. The nice thing about protocols is that much of the time it takes the situation out of one's hands. If one follows the protocol and one is honest about it, then the protocol will do the work. If one is worried about someone and one asks the questions such as whether the person is oriented in time and place or if he or she steady on their feet, one will remove the person if the situation dictates. If one follows the protocol, it helps one to be as professional as one can be. We need to see a cultural change.

In response to Senator van Turnhout’s question about players feeling like guinea pigs, it is important that research takes place. It must happen in a professional setting as the required group of people are available. The current players are guinea pigs in the sense that they have seen a dramatic change in rugby in the course of their playing careers. The average forward is 10 kg heavier and the average back is 8 kg heavier than when they started to play rugby. That is why there is a big change. The protein supplement companies would be delighted to hear Senator van Turnhout’s comments. If it were true that just taking a protein supplement made one bigger, they would be really happy. What is happening is that athletes are training much harder now. Taking supplements help the process but if one just took a protein supplement without putting in any effort, nothing would happen.