Dr. Rod McLoughlin:

We see that the referee is the person with the authority. We say to our referees that even if there is a consultant neurosurgeon on the sideline, if they doubt that somebody is fit to play or suspect they have a concussion, they should be off. We do not want clinical discussions on a sideline. The other important thing we are doing is that we are saying it is the responsibility of all. We are educating players that if the player inside them is concussed, they have a responsibility for their safety because, as has been clearly shown during this meeting, no one can see everything and we need to keep this in mind. People also need to understand that we are educating them for their health, not for our health. That is a culture change, which takes time.
The association between concussion and CTE was mentioned. I cannot tell the committee the association. A recent article in the British Journal of Sports Medicinerefers to 158 cases worldwide. All we seem to know is that traumatic injury to the head may have a connection with CTE. We do not know that yet and, therefore, what we need to do to mitigate that is manage concussions well now in order that people do not suffer repetitive concussions.
Training was another issue raised. All our trainers are pre-hospital care trained. We give standard medical approach training to all our people. It is not that they are getting different training. This is what doctors have been trained in; it is pre-hospital level training.
The IRFU has a clear policy on supplements. No supplements should be taken by under 18s. If somebody has evidence to suggest that policy has been broken, they should tell us.
I refer to the issue of whether legislation is needed. Zurich talks about medical clearance. I would look for clarity and help on this. My understanding is medical clearance can only be given by a doctor whereas in America allied health care professionals who have been specifically trained in concussion management and assessment are used. That may be worth looking at. Do we have the ability to use trained physiotherapists or others similar to practice nurses who have expertise in a particular area?
The pocket SCAT is included in our handout. Let me be clear that I do not want people to become doctors. If this helps make the diagnosis, that is fine, but, as has been reiterated, if someone has any doubt, he or she should not even take out the pocket SCAT and just take the player off.One of the kick backs we get is fear on the part of referees about taking responsibility for a decision they may get wrong and where they stand legally. We would prefer if they put off lots of non-concussed players rather than the other way around.
I estimate 97% of the time I spend managing concussion, which is two to three days a week in terms of policy setting and overseeing it, relates to the amateur game. One of the cases mentioned was a result of failure to follow the guidelines. Everyone mentions education and I will not argue with that but implementation studies tell us that for education to be effective, it has to be proactive, user specific, instance specific and impact orientated. For example, we have a six minute video that all our referees must watch. It specifically tells them what they have to do on the pitch and in handover with specific sentences of guidance. It is specific to referees, specific to an incident and it impacts outcome because we are telling them what to do. It is the same with our coaching and, therefore, we are moving on from education to looking at how education has a greater impact. We are also beginning to look at whether we are having an impact. We will come back and tell the committee because we do not know.
We give guidance to all clubs on the terms of basic first aid content and so on and we have taken our safe rugby programme nationwide. That is getting down and into the clubs. We are very much trying to drive this within clubs. Two weeks ago we gave a talk to 60 schools coaches because we have proactively gone after people. We rang and e-mailed schools to get names. We are going out there because one can produce the material but it can sit there.