Dr. Sean Moffatt:

I thank members for their important questions on and interest in concussion. I will take up on three key areas, the first of which is the concussion substitute. There is an awareness within the association of the medical resources. In many of the under age and club games, no doctor is on site. Consequently, the GAA has tried to have the same uniform message for both elite and club players. As we have been coming from a low base since 2007, it is very much based on education, whereby if one recognises a sign or symptom of concussion, the message is "if in doubt, take them out". As for players getting the best medical attention and safe return to play, the key consideration has been discussed but in considering the guidance of players, we did not want a situation in which they may be left in a vulnerable position whereby they remain on the field and sustain a second injury, hence the issue of the second impact.

In respect of specialists and with my general practitioner and sports physician hat on, I agree there is a general lack of neurologists and further to that, there is a lack of neurologists with an interest in sports concussion. As a team doctor and a GP, I am very much reliant on favours, personal connections and using the private health sector to get the opinion for players, particularly for those who have sustained their second and third concussion or, as we have highlighted, the concussion with modifiers. Each concussion is unique, a lot of concussions are not the same and for a lot of them, particularly for the second or third concussion, one will need specialist opinion. This is an area of public health to which we must give consideration. If we are to bring into place concussion policies, we will need those specialists to be in place in order to not leave players in limbo.

The third area on which I will focus is the SCAT 3 tool. All health care professionals, including doctors and physios, have been aware of the tool, the first medical part of which is recognition of the injury and a medical examination, namely, the Glasgow coma scale, as well as making sure there are no other injuries. The second part for doctors is a tool to assess symptoms, to outline return to play and to allow players to be serially monitored. I believe all players, coaches and schools should have access to the pocket concussion recognition tool, which is a more miniature version of it that is easily readable. It will give players, coaches and managers the tools to detect it and to be confident in this regard. It highlights that the key message is, "if in doubt, sit them out and get medical attention". That is where the SCAT 3 is a useful tool but it remains a clinical diagnosis for team doctors like me and it can be difficult. At times during the game, we do not have the benefit of video analysis or what spectators and television audiences would have. It is a clinical diagnosis and we have emphasised very much today our role in respect of education of the playing population.