Dr. Tony Holohan:

In response to Deputy McLellan's question on best international practice, the consensus statement on concussion in sport of 2012, known as the Zurich statement, describes the assessment and management of concussion, and most international observers would regard that as the statement of best practice. In terms of where we look to for examples of best practice, we are talking about countries as well as individual sporting organisations. Some sporting organisations, at both a national and international level, are better than others. There are particularly good examples of best practice in rugby in South Africa. In terms of public health initiatives on the wider issue of concussion in sport, Canada is an example of best practice. We are looking at all of those examples and have material on them to build into what we are trying to do here.
We are at the initial stages of our engagement with the sporting bodies. We would like to be in a situation in which we have a singular message. We are all agreed on the science behind the message but we must reach agreement on how it looks and feels and how to promote it. The Department of Education and Skills will be assisting us in the promulgation of the message to the school setting, which is very important because the question of children returning safely to learning is a big part of the management of concussion. We still have some work to do in this area. While a lot of good work has been done by individual sporting bodies, we are some way away from the point at which we have agreement on a singular mechanism and are actually putting it in place. It would be hard for me, therefore, to predict how quickly it will be done. There is no lack of willingness on our part or on the part of the Department of Transport, Tourism and Sport to engage, and that is also the case with the sporting bodies themselves.
Deputy McLellan also asked who is responsible for the player leaving the field. That is a complicated question and I will offer her my personal view, rather than a departmental one. I am very involved in coaching myself, and when one gets down to a certain level it is difficult because the level of official engagement varies in the sports in which large numbers of young children participate. There are generally referees for games - in GAA, for example, there are Go Games referees, but they are only trained to a certain level. One of the big challenges for all sporting organisations is to get the volunteers and mentors trained to a sufficient level so that they understand their obligations as trainers. Issues such as child protection come into the equation here. There must also be a singular view among parents, which can be challenging. We believe that having a singular communication mechanism, a tool or a leaflet, that has the same look and feel whether it comes through the school or through the GAA clubs, boxing clubs, rugby clubs and so forth, will help in terms of consistency and implementing the message.
In terms of training requirements, the coaching courses that most of the major sporting bodies run have content on concussion. However, getting people to participate in those courses is challenging and we must recognise that fact. It would be very easy for us to sit in criticism of the sporting organisations, but we know they are doing their best to overcome the difficulties involved in getting the message out to very large numbers of people.
We do not want to introduce any artificial requirement that might raise the standard from a participation point of view only to see people dropping out. We must remember that it is predominantly volunteers who get children out onto the playing fields at weekends and so forth. Were they to drop out, even in small numbers, that would have a profound impact on the number of children participating in sport. Indeed, if we reflect on the wider issue of children's participation in sport, that is something we as a Department are concerned about. We are particularly concerned about the level of participation in sport by girls in their teenage years and about their access to sporting and physical activity opportunities. We do not want to do anything that will interfere with that. We must promote awareness and so on while preserving a lot of what is already in place that is good. We do not want the volunteers to drop out either, because there is considerable evidence that volunteering yields significant physical, emotional and mental health benefits, irrespective of the actual activity.
Reference was made to a concussion database, but one of the challenges is that a lot of concussed individuals never formally present to our health services, so capturing the data is difficult. We have national data on those presenting and being admitted to hospital following concussion, but that is not representative of the total body of people who are being concussed. My information is that most of the good information available in places such as the US is generated through special surveys as opposed to routine reporting systems, which would be very difficult to put in place to capture a full picture on concussion.
Concussion clinics were referred to earlier and neurosurgery was also mentioned, both of which are important. However, concussion per seis not something we will deal with effectively through the provision of neurosurgical services. That is not where the gap lies.

Again, I am not suggesting that the Deputy is saying that. Neurosurgery is required for people who have significant brain trauma as a consequence of whatever mechanism. We must promote awareness among first responders who are going to be dealing with the vast majority of people, particularly children, who are concussed. They must understand what they have to do. The provision of extra neurosurgeons, with all due respect to them, will not help us significantly in terms of dealing with the public health impact of concussion.

Senator Burke asked about the task force. I understand the suggestion was made by the GAA and I had a very quick chat with Mr. Pat Ryan, the chairman of the player welfare committee, whom we know and work with. This is something that is very resonant with the kind of idea we already have going. There is a meeting of minds there. We are already involved in an exercise and can look to how we might structure it in a way that addresses the specific GAA suggestion. Our door is completely open in terms of working with our colleagues in the Department of Education and Skills and with sporting bodies to address these issues and we would be very happy to look at what the GAA is proposing. The idea we have already outlined to the committee this morning - the work we have put in train with the Department of Education and Skills with regard to its initiative - to develop a common information tool is an expression of our commitment to the way of working that the GAA was calling for this morning.

There was a question on the medical record book in other sports. I cannot provide the committee with an informed answer to that. It seems to me that many sports have a great deal to teach other sports. There appears to be an increasing awareness or understanding of the value of the cross-fertilisation of ideas between sporting bodies. Outside this arena, we see the use of yellow and red cards. Some sporting organisations have demonstrated an ability to learn from others. While there will be questions around the practicality of some of those things when one gets into the very large numbers of people, particularly children, in certain large-scale sports, we will do anything we can to facilitate and encourage cross-fertilisation of learning in the approaches to dealing with concussion and the implementation of the standard guidelines.

I hope I have not left any question out.