Mr. Omar Hassanien:

I thank the Oireachtas joint committee for allowing me to speak on the hugely important area of concussion in sport. To provide some degree of background, I am a former professional player who currently acts in the role of chief executive of the Irish Rugby Union Players' Association, IRUPA, a body whose underlying mandate is to protect and promote all aspects of player welfare in the professional side of the game in Ireland. To be clear, IRUPA is a body that sits independently from the IRFU, employing a primary focus of protecting players' interests whilst also promoting the broader game.

In addition to my domestic obligations to the Irish professional player group, I also act as a director on the board of the International Rugby Players' Association – a role that is perhaps more relevant here given the global nature of the issue. While I do not come from a medical background, my experiences both as player and my involvement in these collective player representative bodies would hopefully qualify me to offer a unique perspective in this area.

This forum presents us with a wonderful opportunity to analyse the issue of concussion not only in promoting the dangers of mistreating head injuries from a medical perspective but also in discussing the mechanisms by which we are promoting education and awareness in our respective sports. Generating this awareness is crucial with respect to those within the sport as well as members of the broader public who play the game and who idolise those in the professional game - looking up to them as role models.

While my colleague, Dr Rod McLoughlin, has spoken more about the management and research side of concussion, I will focus more so on the educational and awareness building side. Also, while Dr McLoughlin has addressed the game of rugby in its entirety, I will be focusing on the professional game only – the group of players for which we are responsible as a players' association.

Education and general awareness are such important aspects here as essentially they are the keys to mitigating risk. When addressing this aspect, it is important to recognise that we are talking about a cultural change of attitude, which Dr. McLoughlin has also touched on. Along with educating medics at the highest level, all other stakeholders including players, coaches, management and referees must understand their respective roles in the ongoing management of head injuries.

The education of players is critical in driving the overall cultural shift required here. IRUPA works closely with the IRFU in ensuring that players are well aware of the risks. During the most recent 12-month period, the IRFU, with the involvement and cooperation of IRUPA, has been around to all provinces in Ireland taking leading neurosurgeons with it to provide the players with an in-depth presentation on concussions, the symptoms and effects. Additionally, wallet cards have been issued and informative posters are at the respective provincial training bases. In its quarterly magazine, IRUPA promotes awareness of the potential long-term effects of head injury mismanagement so we are constantly trying to inform our players.

We also believe that there must always be a focus on loud vocal messaging from the right type of people. Obviously, the medical advisers in the sport need to be active here but equally and perhaps even more significantly, it involves the senior players themselves speaking out and breaking down long-held attitudes of "tough it out" and "you'll be right" that perhaps have been culturally embedded in the past prior to us developing the knowledge we have today about concussion. Players being vocal is perhaps the quickest and most effective way of breaking this down.

As an indicator of how productive these educational measures have been in the past two to three years, we can refer back to an IRFU survey carried out in the 2011-2012 season. Of those players who said they suffered from concussion and remained on the field, 95% did so because they did not think concussion was a serious issue. Only two years later after the work carried out by the IRFU, we conducted our own survey which revealed that 80% of the players were now concerned about concussion – a statistical turnaround that was no doubt based on increased awareness campaigns in the sport both globally and domestically.

Moving on to other stakeholders in the sport, it is important to emphasise the importance of team coaches and management in this. Under no circumstances should these people have any influence over the decision of whether to remove a player from the field or not. The game has addressed this by not only educating coaches about the dangers of head injury mistreatment but also by linking it to performance. Leading medical experts in rugby are constantly preaching to coaches that a team's best player concussed is not as effective as a lesser player who is not concussed. They have supported this statement by highlighting video evidence of even mildly concussed players who show an inability to perform the more fundamental skills such as running the right support lines in attack or aligning in defence. The management of coaches is another crucial area in this cultural progression.

The role of the referee in the responsible treatment of head injuries should also not be understated. Often the referee is in a better position than anyone to see the impact of a collision at close range - sometimes even better than the use of video technology, which may not pick everything up. As Dr. McLoughlin mentioned, IRB regulation 3.9 gives the referee the power to remove players from the field of play. Referees should not be afraid to exercise this right for fear of the repercussions that removing an influential player might have. Quite simply, the health of the individual must take priority in all cases.

The IRB educates elite medical staff around the rugby world in various ways. In November of each year, it hosts its annual medical forum and medical advisors from all international teams are invited to Dublin to listen to leading practitioners present. I have personally attended this conference the past two years and have found it to be a very informative and interactive environment. The IRB Player welfare website, which is dedicated strictly to player welfare, has a very clearly laid out "Learn Online" concussion management tool in which medically trained visitors to the site can enter the interactive learning modules at various stages. There are modules for doctors, match day medical staff and elite match day medical staff. There is also a module available for the general public to access.

I will speak very briefly about the management of concussion in professional rugby. I will not speak for too long as Dr. McLoughlin has addressed this area, as did Dr. Falvey last week on behalf of the IRFU. Rugby is at all times guided by the Zurich guidelines of 2012, which we believe to be best practice in this area. Under the guidance of IRB Chief Medical Officer, Dr. Martin Raftery, the IRB has managed a working party over the past two years dedicated to pitch side concussion assessment, which is now referred to as head injury assessment. We as a players' association internationally have had a seat on that throughout. The fact that rugby has come out and recognised the association between concussion and chronic traumatic encephalopathy, CTE, is a positive step. While a conclusive link may not be formed at this point in time, the fact that an association or potential association has been recognised in the US is positive in bringing a focus to this matter.

As players, we also acknowledge that the game is adopting a strong preventative policy.

Rugby has shown itself to be a world leader in the promotion of correct playing techniques, as well as the implementation of laws that ensure that dangerous play - such as high tackles and tip tackles - is outlawed from the game as best possible. We compliment the IRB and the IRFU for giving this greater focus they have placed on this matter in recent years.

At professional level in Ireland, the IRFU complies with all guidelines set out by the IRB and takes a very serious approach to the management of concussion, particularly in the past few years. The IRFU has implemented an instantaneous video review system at all home international matches, which allows their medical advisors to assess the mechanics of the injury at that point in time and thus hopefully better understand the severity of that particular concussion on the spot. This puts them in a leading position throughout Europe in this regard and is a strong step forward from a player-welfare perspective.

The role of the players association in respect of all of this could be described as being twofold - first, understanding and influencing players and, second, interacting with the governing bodies of the sport. In the context of understanding players, our role is to represent them in a number of capacities. No matter how we represent them, we take on the role of being the key influence on many occasions. We are able to influence and shape opinion on the general approach to particular matters. With respect to managing head injuries, we educate our players in understanding their role in society and the degree to which they are revered as role models by a generation of youngsters. Players need to understand how closely their actions are being watched and, for this reason, they should not be seen publicly to be having any influence over medical staff in trying to remain on the field of play. They need to demonstrate, through both words and actions, that the entire decision is in the hands of the medical advisers. In order to understand our players better, last year we completed a survey of our membership specifically in the area of concussion. In the past month we have issued our more extensive biennial survey to players which questions them on all aspects of their employment. Concussion is obviously an important part of this survey in the context of the questions asked. We are awaiting the results of the survey, which will be processed by an independent body over the next month.

Our interaction with the governing bodies is sometimes conducted by me or by other members of the staff of IRUPA. On other occasions it is conducted through industry leaders. We employ Dr. Niall Hogan as our medical representative of the players and he acts as a conduit between ourselves and medical experts in the game such Dr. McLoughlin. At international level we as a collective international player body and, as stated earlier, we are involved in the IRB working parties. We have also been involved in concussion education videos with the IRB as part of the "Recognise and Remove" programme. Overall, our role in interacting with the governing bodies of the game is critical to both parties. The players need to be well informed and represented by their associations in this process and equally the governing bodies of the sport need to understand player attitudes and how they view this all important area.

As representatives of the players, we welcome being invited to forums such as this in order to discuss the important player welfare issue of concussion. We also welcome any studies and research which might lead to further advances in this particular area.