Dr. Tony Holohan:

I greatly appreciate the opportunity to speak to the committee this morning on the implications of concussion in sport from the perspective of the Department of Health. I am joined today by Dr. Miriam Owens, specialist in public health medicine, and Mr. Ronan Toomey, assistant principal officer, both of whom are working on the implementation of the Healthy Ireland project, which I will outline in a few moments.

First, I take the opportunity to commend you, Chairman, and your committee for raising the profile of this important issue which I have no doubt will make an important contribution to the awareness raising that must happen in relation to concussion. We have all seen some very public examples of concussion at major sporting events recently. We are also very aware that it is not just at major sporting events that the dangers of concussion arise. We know that there is always a risk of injury in every aspect of daily living. Normal day-to-day activities, whether in the school, while commuting, at home or in the workplace can result in injury. An injury such as concussion, wherever it occurs, presents particular challenges which we recognise need greater attention. Wherever incidents occur, during sport or otherwise, the Department of Health recognises that more can be done to respond in a manner that ensures the safety and health of the person experiencing concussion.

I understand that a number of medical experts presented considerable detail on concussion to the committee at last week’s hearing so I will not repeat it again but it is appropriate to recall a few particularly important points. First, it is important that we describe concussion as what it is in order to convince everybody of the severity of the problem. Concussion is mild traumatic brain injury. If those with responsibility for responding to incidents are convinced of this very real trauma to the brain, I think they will be more likely to respond in an appropriate manner. The symptoms of concussion may not be immediately apparent but may evolve over a longer period of time and it is important that somebody who may have experienced an incident is monitored to see how they are affected.

Concussion is not specific to any one activity and can occur anywhere. The management of concussion includes evaluation, removal from active participation, medical assessment of symptoms, and physical and cognitive rest until the acute symptoms resolve, followed by a gradual return to participation. The second important point to stress is that the risk of further complications is increased if an initial concussion is not properly diagnosed and treated. Members of the committee will be aware of Healthy Ireland, the framework approved by Government for improved health and well-being. The framework provides for new arrangements to promote effective co-operation between various sectors involved in protecting, promoting and improving the health and well-being of the population. The requirement to work together across sectors and across society is at the heart of what Healthy Ireland is about.

If the issues that influence the health and well-being of people are left to be dealt with by the health sector alone, we will fail to deal with them as we should and we will limit not only the health and well-being of our people, but also their ability to play a full and active part in the economy and in society at large. Healthy Ireland aims to provide a strong focus for modifying unhealthy lifestyle habits and, in particular, promoting awareness of the benefits of physical activity. These benefits are seen not just in physical and mental health, but also through participation and community involvement.

One of the priority actions under way is the development of a national physical activity plan, which will encourage greater levels of participation in physical activity. Mr. Ronan Toomey, who is present, co-chairs a group tasked with developing the plan with the Department of Transport, Tourism and Sport. It is a novel way of approaching something in which we have a shared interest and it is a very good piece of work which we look forward to being finalised in the near future. We all want more people to participate in sport and physical activity, but we want to encourage that in a way that keeps people safe and healthy and provides appropriate responses when an injury such as suspected concussion occurs. We must also ensure that we do not discourage anybody from participating in sport either directly or as a volunteer because of fears about sustaining injury or concerns about how to respond when in a position of authority or responsibility.

The health and well-being programme in the Department of Health, together with the Department of Education and Skills, recently began to explore the issue of concussion in school settings. The two Departments brought together a small group of relevant experts from key organisations to have an exploratory discussion about the implications of concussion and to identify current shortcomings in concussion awareness. Many of the experts have already contributed to the deliberations of the committee. A number of issues have been identified, many of which were also discussed by the committee last week - there is a need for a change of culture, particularly among coaches, players, officials and all others attending matches to remove a player suspected of having concussion from the field of play immediately and if concussion is suspected, a player should not be allowed to return to play until he or she has been properly assessed and medically cleared to return.

There is a lack of data on the incidence of concussion in this country. The need for cognitive rest is not fully appreciated and implemented. That has considerable implications for learning and engagement in school settings. There is a need for greater education and training of emergency medical personnel and general practitioners on the assessment and management of concussion. Without that, there is a danger of concerned parents and others being unable to access appropriate medical assessment and evaluation of possible concussion. It is vitally important that there is also education and awareness training for coaches, parents, teachers and all others involved in sport.

I acknowledge the work of a number of sporting organisations, Acquired Brain Injury Ireland and the faculty of sports and exercise medicine which have been very proactive in this area and have developed guidance on concussion, as they outlined to the committee, for participants, coaches, officials and others. The Department of Health believes there is an opportunity to build on this work and develop a uniform approach to understanding and educating people about concussion and creating a better awareness about injury prevention, risk reduction and response and treatment for concussion. While concussion is a complex issue, initially we intend to work with the Department of Education and Science and the group of experts from the key organisations to which I referred earlier, to raise awareness of the implications and responses necessary when dealing with suspected cases of concussion. We want to reflect best international practice, which is well set out, to ensure physical activities and sport can be undertaken in the knowledge that if an injury occurs it will be dealt with in a safe manner.

One way to progress the matter is the development and distribution of common information materials to reiterate that the management of concussion includes the elements I outlined. We hope the material will be widely distributed to everybody with responsibility for providing sports and physical activity opportunities. In our deliberations on concussion, we have recognised that we need to explore further what more needs to be done to ensure concussion is addressed in a safe manner. It is clear that the national governing bodies have a very important role in demonstrating an appropriate and adequate response to concussion when it occurs in public view. It is important for children and others involved in sport to see that what happens on television is in compliance with good practice and does not provide poor or bad example for them. It is through a greater public visibility of such actions that everyone can be aware and appreciate the dangers and consequences of concussion. Many instances of concussion are happening at events away from the public limelight and without medical or paramedical attention available. That clearly demonstrates a need for greater awareness among match officials, coaches, teachers, parents and players when concussion happens at minor events and in recreational settings and also the need for those routinely involved in such settings to have adequate training in the early management of injury.

While many organisations have developed excellent guidance materials for their individual sports - the committee has been made aware of them - there is an acceptance that there is not widespread adherence to guidelines. While in no way criticising the excellent progress made by a large number of organisations in recent years, a singular process will be beneficial in encouraging everyone to understand the true importance and implications of concussion, which as I outlined is a mild traumatic brain injury. Medical practitioners have the same duty of care when dealing with sporting or other injuries as they do in a formal clinical setting. That is important in terms of the visibility of events portrayed on television. In saying that, I also recognise that no medical or paramedical expertise will be present at the vast majority of occasions where people are participating in sporting and other recreational activities that take place every day of the week.

My colleagues in the Department will continue to liaise with the relevant experts to identify what we can do to develop a more effective and uniform approach to understanding and educating people about concussion through the singular mechanism we advocate and on which preparatory work has begun. I acknowledge the ongoing interest demonstrated in this issue and the evidence presented to the committee last week which clearly signifies the value and potential of the initiative on which we are about to embark. I would be happy to return in the future to provide an update to the committee if members so wish. I again acknowledge the commitment to this important public health issue shown by the committee and particularly by you, Chairman, in conducting these hearings.

I welcome the inclusion of player representatives at these committee hearings, as their experiences provide a valuable perspective. We look forward to the conclusions of the committee and to the continued ongoing engagement with relevant stakeholders.