Dr. Rod McLoughlin:

The IRFU welcomes the Oireachtas Joint Committee on Health and Children’s invitation to address the committee on sports concussion. I am here in my capacity as head of medical services with the IRFU. I am also director of medicine at the Irish Institute of Sport and medical officer at the Olympic Council of Ireland, as well as having been a member of the GAA’s medical scientific and welfare committee.

Medical information about concussion in sport has already been presented to this committee. For this reason, I will present how the IRFU is managing concussion in rugby. Concussion education and management sits at the very top of the IRFU’s player welfare strategy aimed at educating, supporting and protecting players at all levels of the game. The strategic vision of the IRFU is that all players, coaches, referees and medical personnel involved in rugby union understand the importance of concussion, how to recognise concussion and manage it, therefore enhancing player welfare. The union is providing leadership to change the culture in rugby. The culture to which we aspire is one in which concussion is considered a serious injury, actively monitored for, recognised and proactively managed with player safety the ultimate consideration. We are working to achieve this vision and culture change by concussion education, regulation, prevention, management and research.

Education is at the heart of driving awareness and cultural change. The IRFU is delivering its educational programme in concussion roadshows. Almost 2,000 people have attended 54 concussion roadshow talks nationwide. Almost 900 participants have attended one of 46 SAFE rugby courses, a one-day practical course with one instructor to every six participants. These courses include concussion management protocols, basic life support, defibrillator training and first-aid management of sport injuries. Up to 30,000 concussion education wallet cards and posters were distributed last season to every club and school in July 2013 and January 2014. The medical section of the IRFU website was redesigned with educational content on concussion. We are developing child-friendly material. The IRFU's medical staff has presented educational talks to the emergency medicine, sports and GP doctors. The IRFU is targeting schools, adolescent children, coaches and referees with educational material specific to each group to inform them of their role in concussion management with specific guidance for each.

Rugby recognises the association between concussion and CTE, chronic traumatic encephalopathy. Regulation which includes mandatory components, coupled with strong education, is key to mitigating the risks. Concussion management strategies have been supported and reinforced by the following mandatory components. The IRFU introduced mandatory time out of the game for those with a suspected or confirmed concussion of 21 days for adults and 23 days at underage level. All coaches attending an IRFU coaching course must complete an online concussion educational module. Club and school funding has been linked to completion of concussion education by coaches. Referees report all concussion and suspected cases of concussion in the Ulster Bank League.

In the area of prevention, coaches are being educated on proper tackle techniques and appropriate training schedules, while referees are being educated on their role in injury prevention and the dangers of foul play. A medically supervised graduated return-to-play protocol that recognises the importance of treating youths more conservatively is at the heart of our approach.

The IRFU operates a zero-tolerance stance towards playing with concussion or suspected concussion. The message is, Stop – Inform – Rest – Return.

Any player with any symptoms of concussion must be removed and cannot return to play that day. Under IRB law 3.9, the referee may order an injured player to leave the playing area. Referees have been reminded of their powers under this law and its use in suspected concussion.

The IRFU is continually updating its concussion management strategy in line with new developments in this evolving area of sports medicine. We are at all times guided by the Zurich guidelines of 2012 and ongoing research. As I have already said, we have introduced mandatory time out of the game for those with a suspected or confirmed concussion and the linking of funding to coach education and we are monitoring compliance with these things. The IRFU is also developing bespoke adult education videos for Irish coaches.

Research drives IRFU’s concussion policies. The IRFU is currently supporting a study of schools rugby injuries, including concussion, in Ulster rugby. The union have developed an online reporting system to allow referees to advise us on any suspected or confirmed concussions during a game in the all-Ireland league. This enables us to audit the incidences and engage directly with the player and the club to ensure they follow the return to play guidelines. The research will inform the IRFU about how effective our concussion strategy has been and guide future developments in concussion management.

We recommend the following considerations. They include the development and distribution of concussion education material throughout the schools system and the development of "return to learn" guidelines for schools, similar to the return to sport guidelines and education of teachers and parents on the importance of this part of management. We have "return to sport" guidelines but we do not have any "return to learn" guidelines. Other recommendations include concussion education and training of all medical personnel who are involved in managing this issue, improved access to specialist care and a consensus on minimum return to play timelines across all sports nationally.

The IRFU is leading the drive to change the culture within Irish rugby with regard to concussion and its management. The union has been proactive in driving a concussion awareness campaign, which has been underpinned by an initial broad-based educational programme. This is now moving to focused education at multiple levels of the game supported by mandatory components. The IRFU operates a zero tolerance stance towards playing rugby with concussion and the message to all is "Stop - Inform - Rest - Return". The IRFU has been proactive in its management and continues to evolve its strategic approach to managing concussion which is based on the most up-to-date scientific evidence.