Dr. Adrian McGoldrick:

I thank the Chairman and the committee members for their kind invitation to this hearing on concussion, an area in which I have a particular interest. Before I start, Deputy McLellan earlier asked what country could be seen as a role model and I would recommend South Africa. Twenty years ago Sports Concussion South Africa was set up by Dr. Jon Patricios and Dr. Ryan Kohler, who have now renamed it BokSmart. This is a Third World country, yet every child in South Africa playing rugby has baseline concussion assessment. Their website would be an ideal model for this committee to look at in drawing up their recommendations. Having watched what has happened in the US over many years, as I attend the American college on an annual basis, it is my belief that we in Europe are at least ten years behind. However, Irish different sporting bodies are not very far, if at all, behind their European counterparts. There is still much more to do and I will address this at the end of my presentation.

Concussion in sport has been the hottest topic in sports medicine for the last ten years, with more peer-reviewed articles published on concussion than on all other topics in sports medicine. Some 90% of concussions occur in young athletes and recreational sportspeople, rather than elite athletes, so it is very important that we not concentrate on elite athletes; we must look at young athletes in particular and recreational sportspeople.

The Irish Turf Club and the Irish National Hunt Steeplechase Committee view concussion extremely seriously. We follow the most current evidence based, internationally accepted, best practice standards of prevention, identification, treatment and management of riders suspected of, or having been diagnosed with, concussion. The presentation we have submitted to the committee touches on second-impact syndrome and chronic traumatic encephalopathy. I think those aspects of the matter were dealt with adequately at an earlier stage of this meeting.

I would like to comment briefly on the incidence of concussion in sport. We know from American figures that as many as 3.8 million concussions occurred in the US in 2012 during competitive sport and recreation activities. This is twice the number of concussions reported in that country in 2002. It is reckoned that as many as 50% of concussions may go unreported. Given that the US has a population of 317 million, it is probable that between 2% and 2.5% of Americans suffer concussion on an annual basis. Currently, there are no statistics available for the rate of concussion in sports and recreational activities in Ireland.

With respect to racing, I must point out that I am possibly unique in this area in so far as I am dealing with a very defined cohort of athletes - approximately 170 professional flat and national hunt riders and approximately 450 amateur riders, all of whom must be licensed on an annual basis. Additional criteria in respect of baseline concussion assessment have been in place since 2010. On race days, races take place every 30 minutes, on average. This means we have more time to assess concussions than those involved with rapidly moving sports like Gaelic games, soccer and rugby. There is a 15% fall rate in point-to-point racing and a 5% fall rate in national hunt racing. This means there can be multiple fallers - perhaps ten or 12 - during each race. We have to assess these riders quickly. One of the conditions written into our rule book is that riders can be stood down for as long as it takes to assess them for concussions. As a result, our doctors have to assess riders for concussions on a daily basis. This leads to improvements in their skills.

The number of participants in racing has fallen in line with the decline in the economy. We currently have approximately 40,000 runners per annum, with approximately 2,200 fallers over approximately 450 meetings. We have approximately 290 recorded injuries per annum, of which 10% are concussions. Therefore, approximately 1% of falls result in concussions. My predecessor, Dr. Walter Halley, introduced concussion guidelines in 1991 in conjunction with Professor Jack Phillips of the department of neurosurgery at Beaumont Hospital. The 1991 guidelines, which were based on the current knowledge of that time, provided that a rider with a concussion of a minor nature was stood down for two days, a rider with a brief loss of consciousness was stood down for seven days and a rider with significant loss of consciousness and amnesia was referred to hospital and stood down for 21 days.