Oireachtas Joint and Select Committees
Wednesday, 29 April 2026
Joint Oireachtas Committee on Arts, Media, Communications, Culture and Sport
Long-term Effects of Repetitive Head Injuries in Retired Athletes: Discussion
2:00 am
Alan Kelly (Tipperary North, Labour)
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Apologies have been received from Deputies Brennan and Gibney.
Today's meeting has been convened to consider the topic of the long-term effects of repetitive head injuries in retired athletes. I welcome from Trinity College Dublin Professor Colin Doherty, consultant in clinical medicine, and Professor Matthew Campbell from the Smurfit Institute of Genetics. I also welcome Mr. Andrew Dunne, chartered physiotherapist and retired professional rugby player.
The format of this meeting is such that I will invite the witnesses to deliver an opening statement, which will be limited to five minutes. The statements will be followed by questions from members of the committee. The committee may publish the opening statements and presentations on its website.
Before we move to today's discussion, I would like to clarify some limitations in relation to parliamentary privilege and the practice of the Houses as regards references witnesses may make to other persons in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege in respect of the presentations they make to this committee. This means that they have an absolute defence against any defamation action for anything they say at the meeting. However, they are expected not to abuse this privilege, and it is my duty as Chair to ensure that this privilege is not abused. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.
I invite Professor Doherty to deliver his opening statement.
Professor Colin Doherty:
I thank the committee for the invitation to appear before it today. We are here as a scientist, a clinician and a former professional athlete, united by a shared concern regarding brain health in sport and a shared belief that this now requires co-ordinated national attention in a proactive and positive manner. Collectively, we will be able to address questions surrounding the clinical and scientific manifestations of head trauma in sports. Additionally, our colleague Mr. Dunne will speak of the lived experience of a career in sports, its importance and benefit to society and his views on making sports safer.
We will begin by acknowledging something fundamental, which is that sport is an essential part of Irish life. It supports physical and mental health, builds communities and shapes identity. Participation in sport is overwhelmingly a good thing and should be encouraged across the lifespan. Our purpose here is not to diminish sport but to ensure that it continues to thrive safely for future generations. However, alongside these benefits, there is now a body of scientific and clinical evidence that we can no longer ignore. Recurrent head injury in sport, including both concussion and the much more frequent subconcussive impacts that do not cause immediate symptoms, is associated with long-term risks to brain health risks.
Recent research from Trinity College Dublin and St. James's Hospital has provided some of the clearest insights to date into what may be happening in the brains of athletes exposed to repetitive head impacts. Using advanced imaging techniques, we have identified that a significant proportion of retired athletes show persistent disruption of the blood-brain barrier, a critical protective system that normally regulates what enters and leaves the brain. In some individuals, this barrier remains compromised for years, and in some cases even decades, after they have stopped playing sport.
This is not a transient injury. It appears to represent a chronic condition. We have also shown that the degree of this disruption correlates with measurable cognitive decline, particularly in memory function. Importantly, these long-term changes do not appear to be explained simply by the number of diagnosed concussions an athlete has sustained. Rather, they are more closely associated with the cumulative exposure to repetitive head impacts over time. The everyday collisions that are often considered routine in many sports may, in aggregate, be driving long-term brain injury.
This shifts the focus of the conversation. While concussion management remains critically important, it is no longer sufficient on its own. We must address the broader issue of repetitive sub-concussive exposure. Clinically, we are seeing the consequences of this more clearly. Some former athletes present with symptoms consistent with what is termed traumatic encephalopathy syndrome, including cognitive impairment, mood disturbance and behavioural changes. There have also been well-documented cases, some involving Irish athletes, who have died with full-blown dementia known as chronic traumatic encephalopathy, CTE. Our recent research work that has been published in an international scientific journal and demonstrates for the first time emerging evidence of ongoing brain inflammation long after retirement, suggesting that these injuries may trigger a long-lasting biological process that continues well beyond an athlete’s playing career.
At the same time, we must acknowledge uncertainty. Not every athlete exposed to these risks develops long-term problems. There are likely individual differences in susceptibility, including genetic and environmental factors. However, just like with smoking and lung cancer, uncertainty about who is most at risk does not diminish the reality of the risk itself. It strengthens the case for systematic research and monitoring. From the perspective of lived experience, there is also a cultural dimension to this issue. Modern sport, particularly at elite levels, increasingly celebrates physical intensity and collision. This is often framed positively as resilience and commitment, but it also risks normalising repeated head impacts in a way that may not be compatible with long-term brain health.
We have faced similar challenges before as a society. Road safety is a useful example. In the 1970s, Ireland experienced very high levels of road traffic fatalities. Over time, through a co-ordinated public health response involving legislation, enforcement, education and engineering, those numbers were dramatically reduced. This did not involve banning cars; this involved making driving safer. We believe a similar approach is now required for brain health in sport. At present, there are significant gaps. We do not have a comprehensive national system to track head injuries or cumulative exposure across different sports and levels of participation. Concussion protocols vary between sporting bodies, and sub-concussive impacts are largely unmeasured and unregulated.
This leads us to a central point. This issue should no longer be viewed solely as a matter for individual sporting organisations. In fact, it is unfair to put this burden on these organisations to deal with alone. It should be recognised as a public health issue requiring co-ordinated national leadership. We would, therefore, ask the committee to consider a number of key actions: first, the establishment of a national multi-stakeholder clinical and policy group to develop consistent, evidence-based guidance across all sports; second, a publicly funded national concussion centre for expert advice and guidance to be continually delivered and updated; third, the development of a surveillance system or register to monitor concussion and head impacts over time; fourth, a focus on prevention, particularly in youth sport and training environments where exposure can potentially be reduced without compromising the integrity of the game; and finally, sustained investment in research to better understand risk, identify vulnerable individuals and develop effective interventions.
We are not proposing to remove risk entirely from sport. That would be neither possible nor desirable. However, we are proposing that unnecessary and unmeasured risk should be reduced. Ireland is well placed to lead in this area. We have the scientific expertise, clinical infrastructure and sporting culture to develop a model that balances the benefits of sport with the protection of brain health. The evidence has reached a point where inaction is no longer neutral. It carries its own risks. We have an opportunity now to act in a measured, proportionate and forward-looking way. Our goal is simple: to ensure that sport in Ireland remains not only a source of immense pride and enjoyment but is also a safe and sustainable part of life for generations to come.
Alan Kelly (Tipperary North, Labour)
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I thank Professor Doherty very much. We will now have questions from members of the committee who will have five minutes each. We are starting with Senator Ní Chuilinn.
Evanne Ní Chuilinn (Fine Gael)
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I thank the witnesses for being here today. That was a very substantial opening statement. For clarity, did Professor Doherty say the recent research was this year or last year?
Professor Matthew Campbell:
I can speak to that. The research was published approximately three to four weeks ago. It is a culmination of probably about four years' worth of work where we focused really heavily on cohorts of retired athletes who engaged in collision and combat sports. The vast majority were rugby players. There were 47 athletes altogether; 33 were rugby players and the rest were a mixture of Gaelic games and soccer players. The majority were rugby players, however.
Evanne Ní Chuilinn (Fine Gael)
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Were they all men?
Professor Matthew Campbell:
Predominantly men, yes. We had one female in our cohort, but it was predominantly men. That is a bias that we have. We have to put our hands up and say that is a bias in our research, although not necessarily of our own making. It is probably a manifestation of the fact that a lot of the elite level female sports that involve collision and combat really only became professional in more recent years, so we do not have females of a certain age who would actually fit the bill for our research. That will come, however, and that is a spotlight of our future research.
Evanne Ní Chuilinn (Fine Gael)
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One of the issues that is important to point out from the beginning is that the witnesses are calling for the monitoring and documenting of concussion and head injuries and so forth not to be the sole responsibility of sporting bodies. That would be a big change because, as they know, rugby will have its head injury assessment, HIA, and its return to play protocols but then other sports would have different models for that. Can they explain to us, as laypeople outside of the clinical environment, why it is important for sports bodies not to have that control?
Professor Colin Doherty:
I will start with that and maybe Professor Campbell can chime in. First, the level of expertise in relation to neurological exposure, acute neurological injury and rehabilitation just does not exist in the sporting bodies. There is a question of how we export or demonstrate or help to expose the clubs to the expertise they need.
It is also true that on the level of the incentives for generating interest in the sport, I am very aware that some of these proposals we are making seem to be putting a brake on the development and expansion of the sport. I understand that worry. What I am saying to them is that this is coming. The question of people's concern at grassroots level, such as parents, etc., is building momentum and the sporting bodies are not ready for that yet. It could be forced on the sporting bodies rather than be part of the solution. When I say to them that they should not have the responsibility for monitoring, they do need to take the responsibility for monitoring. What we are saying is that it is guidance driven from within the public health infrastructure, involving all the stakeholders, to tell them what to do and how to do it. That is what we are saying. We are not saying we are taking over the monitoring.
Evanne Ní Chuilinn (Fine Gael)
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Do any countries have that model in place already or a public health response to head injuries in sport?
Professor Colin Doherty:
There are two countries to which we would look. One is Scotland on the general co-operation of all of the sporting bodies. It is a similar size in demographic terms and it is culturally similar to us and interested in sport. They have this "If in doubt, sit them out" protocol, which all the sports signed up to, by the way, including badminton. Everybody signs up to this. They do not have a big monitoring programme beside that, so it remains to be seen how effective that will be for long-term outcomes. Somewhere like Canada, however, which is a kind of a federal system, has amazing co-operation across the federalised areas in Canada. They have an app on which every child who suffers an injury is recorded and it is shared across the system. Canada would be a very good place at which to look. They are the two. I do not know if there are other jurisdictions in Europe.
Evanne Ní Chuilinn (Fine Gael)
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They are the two main ones. I might just move on because I am conscious of time running out.
Evanne Ní Chuilinn (Fine Gael)
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It is important to say that as a committee, we cannot just decide to set up a policy group or committee. We can advise or maybe suggest to the Department and Minister to have a look at this. I would like Mr. Dunne's point of view. Rugby was described by Professor Doherty in The Irish Times a few days ago as the "glorified gladiatorial contest" that it has become. Could he give us an insight into how reticent players are, no matter what age they are, to come off the field of play after a head injury?
Mr. Andrew Dunne:
I can certainly speak to my life experience as a player 25 years ago when, culturally, it was less acceptable to come off the field. However, that is because there was less awareness and less research. To paraphrase Professor Doherty, there was a culture of gladiatorial combat in the sport. Over time, however, with the monitoring was introduced, it might not have been ideal or perfect, but awareness began to raise around the incidence of chronic or acute issues like CTE in the sport. The class action in the NFL helped raise awareness among sports players and among coaching and management.
Right now, that has made a huge level of progress. There is almost a complete reversal around that attitude and approach to coming off the field. It is accepted by peers among players and coaches, even against their own competitive will to win a game, for example. We have countless examples of that at top-level sport where important players who are influencing games are coming off the field for head injury assessments, HIAs, and being kept off the field. It is widely accepted now.
Evanne Ní Chuilinn (Fine Gael)
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I have a lot more questions but I will wait for the next round.
Joanna Byrne (Louth, Sinn Fein)
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I thank the witnesses for coming in. In years gone by, we would have heard terms like "punch-drunk". We all watched Muhammad Ali after his diagnosis with Parkinson's at a very early age. I think he was in his early 40s. At the time, there was some debate on whether that was caused by his sporting career. As time progressed, we learned more about CTE. Every country at this stage has a documentary about one of their own sporting heroes who played a contact sport and suffered in some way after retirement. It is a very important conversation.
Am I correct that the research linking blood-brain barrier, BBB, to CTE, Alzheimer's and dementia is a first?
Professor Matthew Campbell:
Certainly in the context of the living athlete we suspect as having CTE, it is the first time we have ever got in-life diagnosis. Professor Doherty and I were the first to report internationally that CTE, post mortem, has a blood-brain barrier deficit. Basically, the blood vessels in the brain become leaky and allow blood-borne material into the brain, causing inflammation. We took post mortem tissue, made that discovery and then asked if there were clinical tools available so we could study the integrity of blood vessels in the living brain to assist with the diagnosis of CTE. That is why it is so important-----
Joanna Byrne (Louth, Sinn Fein)
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It is exciting, yes.
Joanna Byrne (Louth, Sinn Fein)
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How significant do the witnesses think that find is, potentially, for future medical treatment and stuff like that now that there is actual research that backs that up?
Professor Matthew Campbell:
It is massive. The way we diagnose chronic traumatic encephalopathy in-life is a thing called traumatic encephalopathy syndrome. There are three main criteria. People have to have a history of repetitive head trauma, a low cognitive score and then they also have to have no other form of dementia. This is potentially a fourth way of adding to those diagnostic criteria so it is absolutely massive that we can do this. What can we do to address it? There are drugs on the market that could restore the integrity of blood vessels to treat this. We are really of the view that this is not a deterministic diagnosis. Just because people are diagnosed with CTE does not mean they are going to go on to develop full-blown dementia. There are potential drugs on the market that could be repurposed and there are, potentially, drugs in development that could be applied here as well.
Joanna Byrne (Louth, Sinn Fein)
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It is to potentially stop something like this progressing to an advance stage before it goes too far. That is massive.
Joanna Byrne (Louth, Sinn Fein)
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I presume it is but I will ask the witnesses the question: in regard to interest and input from the medical profession at this stage, is it engaged in this research and its findings?
Professor Colin Doherty:
At the interface of concussion, the biggest group is probably the emergency room doctors. About 11,000 people every year who are playing sport arrive at the emergency room to be assessed by a doctor. What they get is a computerised axial tomography, CAT, scan, which is a normal computed tomography, CT, scan. It has to be normal in order to get it diagnosed as concussion. If there is nothing on the scan, there is really nowhere for them to go after it, which speaks to one of our points about the need for a centre of expertise.
Necessarily, because of the way the professional game is gone, there are experts within the private health system. There are concussion treatment areas in at the UPMC Sports Surgery Clinic in Santry, etc., but there is not one in the public system. There is not one that is dedicated to managing people from all backgrounds and every part of the country. We need to put that expertise together. The doctors are interested but there needs to be investment there.
Internationally, we are talking to a guy from the Fred Hutchinson Cancer Center tomorrow. He contacted us and said he was really interested in what we are doing. This speaks to the way drugs develop.
Joanna Byrne (Louth, Sinn Fein)
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Of course.
Joanna Byrne (Louth, Sinn Fein)
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That is billiant. This hearing is specifically focused on repetitive head injuries but is there a similar holistic approach to other diseases that potentially affect other parts of the body that could be followed, or a template that could be used? Do the witnesses see any? It is probably not their area.
Professor Colin Doherty:
Anybody who has played a game here that has involved a collision has seen people hobbling around with joint disorders, etc. My first thought is, "God, look at their joints. Think of what is happening to their brain." We do need a co-ordinated approach to health after retirement and to prevention of collision in sport itself. We will be working together. I would be absolutely happy to have people from all areas.
The brain health thing is just my area. To give the Deputy an example of how this is perceived, if someone gets a bloody nose in a game, everybody says, "Oh yeah, he just has a bloody nose. That is all he has". That is obviously a head injury. It is usually ignored because they see the injury.
Joanna Byrne (Louth, Sinn Fein)
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If it stops bleeding, it stops.
Alan Kelly (Tipperary North, Labour)
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Mr. Dunne can come in in a second. I call Senator Comyn. I apologise; I should have called her last because she is on a swap with Senator Mullen.
Alison Comyn (Fianna Fail)
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That is no problem. Gabhaim buíochas leis an gCathaoirleach and I thank the witnesses for coming in. As the mum of a rugby and jiu-jitsu player, I know exactly how important it is that we have the discussion and see how we can progress it further.
I want to touch on something my colleague Senator Ní Chuilinn said on the perceived lack of women in this research. It was mentioned it was because they are not that long at an elite or professional level. In the opening statement, it was mentioned that "everyday collisions that are often considered routine in many sports may, in aggregate, be driving long-term brain injury". Young girls might be playing from the ages of eight, nine or ten so that repetitive nature could include long-term brain injury. When can further research be conducted that can take in women?
Professor Matthew Campbell:
I refer to the acute scenario, by recruiting current athletes. We did study back in 2018 where we recruited current rugby players and we did the same types of brain scans that are able to detect potential damage and CTE. We saw a similar signal in current athletes directly after playing a game or in preseason compared to post-season brain scans. We have yet to do that in the female context and that is what we need to do as well. We want to do that study in rugby players and mixed martial arts, MMA, fighters. That is on the horizon.
What we know about the female brain in the context of concussion is that it is more susceptible to concussion, for reasons we do not fully understand. Women and more susceptible to experiencing concussion than men. We need to figure that out. That is an untapped thing we need to focus on. In all likelihood, we may see down the line instances of CTE predominantly in women compared to men. In other forms of dementia like Alzheimer's disease, we know it is a predominantly female disease. It is a former of dementia as much as CTE is a form of dementia. Again, we still do not have good, clear evidence as to why that is the case.
These are all things we need to do and we think this idea of a national concussion centre and a national narrative around this will pull in all the parts of society.
Alison Comyn (Fianna Fail)
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Absolutely, and it is quite worrying to hear that women are more susceptible to concussion. I take it that is in all sports as well.
In their opening statement, the witnesses also mentioned that there should be a focus on prevention. I am a big fan of prevention being better than cure. Can they expand on this a little bit? How are they talking about prevention and what form will it take?
Professor Matthew Campbell:
I will let Professor Doherty come in on this as well. The starting point is getting cohesion across the board on how clubs and different sports understand what a concussion is and how we deal with it. At the moment, it is very siloed in that every sporting organisation has its own way of understanding what concussion is and what it is not.
I will give the Senator an example. In rugby, when somebody has a concussion, the message is "recognise and remove". In GAA, it is "if in doubt, sit them out" but also assess for possible concussion and, after that, assess for possible concussion and then remove. Then, in hockey it is "suspect and remove". In the Football Association of Ireland, FAI, it is "suspect and remove". In the 21st century, with the amount of data and clinical indications we have, it is ridiculous that we cannot sit down in a room and get all of the sporting bodies to agree on what a concussion is and how it is managed. Concussion in rugby is the exact same as a concussion in GAA, jiu-jitsu and boxing. How we do it is so disparate. That is the first part of how we will address this: get all the codes together to focus on one message and one message only, and then education for the grassroots but also for professional sports as well.
Alison Comyn (Fianna Fail)
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When I quoted that "everyday collisions that are often considered routine in many sports may, in aggregate, be... long-term brain injury", we have to look at the ages of athletes as well.
Peter O'Mahony, Johnny Sexton, Rory Best, Tadhg Furlong and even Bundee Aki are all well into their 30s. It is their experience and longevity that made them such elite players. Are we having a conversation then about longevity? They may have been training since they were five years of age. Is it the build-up of injuries that may be causing long-term damage? I am not suggesting that any of those individuals is suffering that. Professor Doherty knows exactly what I mean. Are we talking about a retirement age at any stage?
Professor Colin Doherty:
I might take that question. If we go to the other big prevention point, I think we could potentially even extend people's retirement age, which is really about the dose reduction. We all know that the NFL has a big problem with CTE, but there are 70 players on each team. Does Senator Comyn know what I mean? The amount of exposure an individual player gets in any one game or any one season is relatively modest compared with a lot of what our players are going through. Players can be doing full contact during practice and playing every game - we know that there are players who are critical to team success - but hopefully that is changing and people understand that players need to be rested. I would love to see these players have extended careers, but reducing the dose is the absolutely biggest thing. If we look at elite teams, we have data which suggests that somewhere between seven and 12 sub-concussive blows are happening per elite game. That is not true in the amateur game, but we know we have this data from the BMJ. That amounts to thousands of exposures in the career of a professional player. Why not just say "Right, you're playing every second game. You're not doing any contact during practice." Suddenly, we are taking the doses down by a third, two thirds or even higher than that. The retirement date is not as important as reducing the dose of impact during someone's career. That is key.
Alison Comyn (Fianna Fail)
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I am not sure where we would stand in the Six Nations if we only play them every second game, but that is a discussion for another day.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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The witnesses are very welcome. I thank them for taking the time to come in to us. Like most people in this room, I fully support sport. If there are risks involved, however, then parents and volunteers across all sporting codes deserve honesty. Parents are watching today's meeting. Could the witnesses reassure parents that children involved in sport in Ireland are fully protected from cumulative brain injury? Can they give that assurance to parents watching?
Mr. Andrew Dunne:
I am 46. I played sport every day, including physically impactful sports, from about the age of eight until the age of about 33, and then coached sport afterwards. I did have a number of concussions in a professional rugby career. The number involved was four, from recall. I have no long-term exposure to the disease. I have no chronic long-term effects. Twenty-five years ago, I had acute momentary impacts that were managed as best they could have been with the knowledge that was available at that stage.
In terms of young children playing sports, the benefits far outweigh the negatives. I would move very strongly to reassure parents that sporting involvement, including sports that involve collision, are safe for the majority of people. It is vitally important that we address it with stakeholders across multiple sports with a public health message. The Deputy's colleague asked if there are examples of rehabilitation programmes in different areas in chronic health that are publicly funded. I think immediately of cardiac rehabilitation programmes, which are multidisciplinary, lifestyle related and reduce the secondary complications of heart disease.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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Is it possible to sustain cumulative brain injury without ever being diagnosed with concussion?
Professor Colin Doherty:
In our paper, the most worrying group for me clinically was that we saw evidence of some early leakage in this barrier system that Professor Campbell studies, in people without symptoms. That obviously is a worry. It is one thing to have symptoms and to find that there is a brain abnormality and you can correlate the two. Inevitably, these things must start very slowly. Eventually, people start to complain of symptoms. We do see evidence. There is a group of people with some damage – leakage and inflammation of the brain - who have not had any symptoms. They are a worrying group, and they need more study and more research.
Mr. Dunne is a good example, which is why it is so important that he is here. We all know that a full career in contact sport can have huge benefits socially, psychologically and, in his case, from a career point of view as a physiotherapist. He does not feel that he has had any damage. We know this is not inevitable for everybody, but that does not mean there is no risk.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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Would the GAA, the FAI or the IRFU have an idea of how many of their former players or members are suffering from neurological decline? Is that formally tracked?
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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Is it just a case of play as hard as you can for as long as you can and when you are done, you are done?
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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Yes, I am not singling out any sport.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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These things emerge later in life.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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I have a huge concern about the gap between elite and grassroots sport. I have been involved in both. The care and supports the elite side gets is incredible in terms of the protocols. Some of the doctors that have been involved with the teams I have been involved with have been absolutely exemplary, much to the annoyance of a lot of coaches, etc. I have a huge concern about sport at the grassroots level where people do not have the skill set, capacity or finances to provide the level of care that is available at elite level. That is a huge worry for me across all different sporting codes. I am very confident that if someone suffers a concussion at the national level the right protocol will be adhered to, but that is a huge amount of pressure and responsibility to put on volunteers in an ordinary rural club of any code in Kilkenny where I am from.
Professor Matthew Campbell:
I could address that. It is just by having formal education processes for any volunteer who wants to get involved in coaching kids in sports at the amateur level. We just educate them on how to deal with concussion. We are not saying that they have to learn how to manage a concussion on the sideline. It is just education about identification.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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There is a huge body of work in terms of education. My local soccer club could have 25 or 30 different teams involved in it. We might always get one or two to do it but, realistically, we would need a mentor from every single team to go through that education piece.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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That would be really helpful. People go on first aid courses but if there was a concussion course nationally it would be a huge first in terms of making sure that those involved at the grassroots level are protected. I am not so concerned about the national league because that is there. Whether it is grassroots rugby, soccer or GAA, that is something that could be rolled out quite quickly. I will support Professor Campbell in whatever way I can.
Professor Colin Doherty:
When I am talking about this to big groups I always say that concussion is not the slow-motion things we are seeing on the TV in three dimensions. Concussions happen on field five where little Johnny gets knocked out flat and everybody goes "What happened?" and nobody saw anything and then the kid does not want to leave so they say "I'm fine", "I'm grand". That is 99% of the concussion. It is not what we are seeing on television. It is an important point.
Peter Cleere (Carlow-Kilkenny, Fianna Fail)
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I thank the witnesses.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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The final point is interesting. I had a question as to whether there is concussion involved if somebody is knocked out. I played many sports, and I was only knocked out once. That was in hurling. I broke my nose four times in different sports, so I have had my fair share of head injuries. At the time, everybody had a different attitude. I played on with most of those injuries, apart from when I was knocked out and I was just put on the sideline. There was no treatment. There is pressure. The world has moved on since I played as a young fellow, but there is still pressure on players to play on with an injury, not just a head injury, because there are not enough players or all of the subs have been used up and the injured player has to stay on. We have to be mindful of that, especially if it is a small club.
There are a range of sports. Everybody picks one or two, like rugby, but boxing is one of the main ones for head injuries. If we want to measure head injuries that sport probably gets the most of them. Boxing has taken more care in recent years but how much more can be done by sports like boxing or football – soccer - where you are specifically using your head? In boxing you try to avoid getting hit on the head but in soccer you are heading the ball the whole time. In rugby you do not use your head, it just happens to get banged around a bit. It is the same in Gaelic football and hurling.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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When I started to play hurling, there were no helmets. You were a wuss if you wore a helmet. Now, nobody would dream of playing without a helmet. The same applies to gum shields. There are other such protections that should be in many sports. What are those sports? Can we identify what needs to happen now, maybe on the basis that it will take years to change?
Mr. Andrew Dunne:
An obvious thing I have seen in my transition from being a player 25 years ago to being a coach to being a healthcare professional is that exposure to sub-concussive events has almost been eliminated in week-to-week training in rugby. There is a cap on the number of physical contact sessions that can be delivered by a coach. The number was unlimited 25 years ago. The adage that you should train hard and play easy was folly because people were getting battered during the week. That thinking has been completely eradicated. This is a clear and clean example of a reduction in sub-concussive events in a sport.
The various sports associations ought not to be left with the responsibility alone, because this would result in a less than co-ordinated approach. Public health buy-in, with a coherent approach on the part of multiple sports organisations, would help greatly in this area.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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In football, heading the ball is key. If you are good at heading the ball, you will be picked up by many clubs. In the absence of contact, however, you will not learn how to do it. It is a special skill. Football is international, so it would be naive to believe that we could change things by taking action here, such as banning heading of the ball. Hurling and Gaelic football are largely confined to the island, yet we saw how long it took for the rules of play to change. How do we address sports that are very much international in nature, including boxing?
Professor Colin Doherty:
I have a couple of things to say about that. Helmets and head protection are a good example. When people ask me whether wearing more head protection in all the relevant sports would reduce injury, I say if only we knew of a sport in which players wore crash helmets and did not have a problem with CTE. The NFL has a massive problem with CTE, yet it uses the best helmets. Billions are poured into helmet technology. Helmets change behaviour. If you wanted to make the NFL safer tomorrow, you would take their helmets away. They would not use their heads as weapons. That sounds counterintuitive, but it would be a different game. People would start protecting their heads.
There are dead ends here. Sometimes people think there are obvious solutions, such as head protection. I tell parents not to let their children wear scrum caps. A 17-year-old wearing a scrum cap thinks they are protected by the soft padding. What happens is that they change their behaviour, go lower and become a little braver because they think their head is protected. I suggest that they not use scrum caps and ask that they be allowed to protect their heads naturally.
To go back to our point, we need a multi-sport approach. Mr. Dunne has ideas, I have ideas and Professor Campbell has ideas. There are loads of ideas and nobody has a monopoly on what the best one is. Let us come together as a group, take 18 months or whatever it takes to come up with guidance we can all sign up to and have some way to monitor the success of implementation and the health of players so we know the guidance has worked. The problem with the Scottish model is that although everybody is signed up, there is no monitoring of outcomes. We do not know if the approach is right. We suspect it is. There are many potential ideas to deal with what the Deputy referred to. How do we deal with a game like boxing, where the object is to hit people in the head? What do you do in this regard?
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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The object is to knock the opponent out.
Rónán Mullen (Independent)
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I am reminded of what George Orwell said, which is that international sport is war minus the shooting. I have been concussed only once, and that was when I fell off my bicycle. I am not much for contact sports. I may be more of a pacifist by physique. I am struck by what was said, because Senator Ní Chuillinn told me that, in some contexts, children under 14 are not allowed to head the ball in soccer, for example. I was thinking of "Dinny" Allen, the great Cork dual player, who at one stage had a goal disallowed when he headed the ball because it was regarded as a tactic of foreign games. The referee was not going to have that.
I was very interested in the talk about the positive benefits of contact sports. What Professor Doherty has been talking about today is very laudable. He is seeking a co-ordinated approach and the adoption of a public health attitude. That is all good but it would really come under the heading of harm reduction. Will there be a time when people look back and ask whether parents were mad to let their children play such and such a sport under such and such rules?
My question for each of the witnesses is as follows: is there a sport as currently played that he would discourage a child in his care from taking part in? I certainly come across parents who tell me they are glad their son is not playing rugby. Obviously, the witnesses are doing what is achievable within the short term, and it is great that they are all here today, but taking the longer view, is there a goal we practically dare not speak about, namely not playing certain sports as currently constituted? Would they discourage a child in their care from playing any particular sports at the moment?
Alan Kelly (Tipperary North, Labour)
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Such as?
Rónán Mullen (Independent)
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Have Mr. Dunne’s colleagues a similar view?
Professor Colin Doherty:
People who sometimes look to me because of my interest in this and my expertise do not need to ask me. There is already a trend. The Senator said he meets people with reservations. What I am saying to those in the sport is that it is going to be a sport people will no longer play as the scientific data and public comment build up. People do not have to ask me for my view. When I talk about this, I refer to my son, who is 6 ft 6 in. He played in the second row for a Dublin schools team. I had no influence on him. I could not stop him because he wanted to play. The answer is that there is a solution in respect of making the sport safer. Let us not just ask what Colin Doherty thinks or what should be banned now; let us just get it done. Let us make sport safer so we do not even have to ask these questions.
In 1918, Teddy Roosevelt banned college football for a year because 25 players had died the previous year. He brought all those concerned to the White House and they sat around to discuss the matter. It was the start of the player welfare movement and the player welfare organisation grew from this. It was so positive. The following year, the game was safer.
Pausing a game is a big thing to ask for. We can do this in parallel. We can work with each other, with the sports bodies and the public health department. Let us just get it done. I feel like I have been banging this drum for a decade.
Professor Matthew Campbell:
I think so. I have had the experience of going into mixed martial arts gyms and boxing gyms to recruit athletes. I have seen the massive benefit of those sports for the individuals engaged in them. They engage out of choice because they want to be engaged in them.
To echo what Professor Doherty and Mr. Dunne said, it is pretty obvious that sports that involve direct head contact are not good for your long-term health. Can we take one or two hits to the head? Yes, we can. Can we take ten of them? Yes, we can. The data – I am a scientist – is pointing us to dose effect. The length of the career and the repetitive nature of the head trauma, independent of the sport, are the problem. In this regard, there are two issues that we need to highlight. The first is concussion. On the management of concussion, all the codes have different rules. The second is long-term health. In this regard, are there means of mitigation?
Rónán Mullen (Independent)
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We will be down a few Olympic medals.
Alan Kelly (Tipperary North, Labour)
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Good questions. I call Senator Ahearn.
Garret Ahearn (Fine Gael)
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I thank the Chair. I will try to put good questions, too. Most people talk about rugby, obviously, and the NFL. The NFL has done quite a lot in the past ten years regarding practice sessions. For example, you can never tackle the quarterback.
In all NFL games now, head-to-head contact is a foul. Have we seen any improvement in terms of the number of concussions and the long-term effect or is it still too early in the NFL and in rugby? We have obviously seen that rugby has become an awful lot better in terms of recognising concussion and taking players off of the field immediately. Have we seen any beneficial impact from that? They are the two sports that are named the most in terms of long-term side effects from hard collisions.
I was at the Waterford versus Tipperary match at the weekend and there was a collision between a Waterford player and a Tipperary player. I think Bryan O'Mara was involved. I was in the stand and I could hear it. They were both running at an incredible pace and ran straight into each other. Both of them ended up on the floor and took at least 30 seconds to get up. There was a bit of water splashed on their faces, they drank a bit of water and off they went again. There was a very different response. If that had been rugby, even though rugby gets a lot of negativity, they both would have been taken off and would not have come back on. On the long-term impact, we know many people have had serious repercussions but has that reduced or is still too early to say?
Professor Colin Doherty:
It is too early because some of the protocols put in, such as the dose reduction and the reduction in contact during training as seen in rugby, are too new to say. One factor against the improvement has been the equal and incredible development of the speed and power of the athletes, if the committee knows what I mean. These are very different games to the ones we were watching 20 years ago. If look at the GAA, these guys are professionals in every sense of the word except they do not get paid a salary for playing. That is a worry. This is why we need an ongoing process because things change and we need to be agile to the changes. The speed and power of players has mitigated some of the things we have rightly done. I worry about the NFL because it is an incredibly fast sport. You wonder whether-----
Garret Ahearn (Fine Gael)
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I know Professor Doherty said if the game had no helmets, it would be a very different game. I know where he is coming from on that because there would no deliberate head-to-head contact. Even though it is against the rules in NFL, it still happens. You could have a defensive back run head first straight into a wide receiver and take him out completely. It deliberately would not happen if there were no helmets but it would accidentally happen, at times.
Garret Ahearn (Fine Gael)
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I totally agree but an accidental head-to-head hit with no helmet would have very serious repercussions, so I am not sure getting rid of helmets would help. It would change the dynamic but accidental head-to-head contact would be very serious.
Garret Ahearn (Fine Gael)
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Are the professors getting positive feedback from all sporting organisations in terms of having a one-size-fits-all view on concussion and collisions? Deputy Ó Snodaigh was speaking about how anyone under the age of 14 cannot head the ball in soccer. Yet, there are under 14s doing boxing and hitting each other. That is a totally contradictory in terms of the health of young kids.
Professor Matthew Campbell:
Getting the different codes to talk to each other is about managing concussion. It is not about getting rid of concussion. We will never get rid of concussions but it is about how you manage it. Why does one organisation have a different rule set on how you deal acutely with concussion than another? It should not be different because a concussion in boxing is the same as a concussion in GAA. We are not saying we will eliminate head contact altogether, we are just asking how do we manage it? At the moment, it is all disparate. Kids play different sports. My kids play soccer as well as hurling and football. You can get concussed on the GAA pitch and go and play the next day in soccer.
Garret Ahearn (Fine Gael)
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How do you handle it? It was said earlier that someone who gets a bloody nose is dealt with as if it is a bloody nose. I was laughing when it was said because my little six year old plays under-sevens for Ardfinnan. He threw a ball - supposedly accidentally - at an opponent and the little kid's nose started bleeding. The obvious reaction to that from everyone who is a volunteer there is let us wipe his nose, tell him he is grand and that is fine. What is the professors' suggestion? From a parent's perspective, I can imagine if it is said it is a concussion and they need to go to hospital, that is just not realistic at an under-sevens training. What are the professors saying there in terms of some incidents being treated very lightly when there could actually be a brain-----
Professor Colin Doherty:
All I am asking for is the recognition that it is a blow to the head. He did not just get a blow to the nose. His nose is bleeding because he got a blow to the head. That needs to be configured as a blow to the head. Is he concussed from that blow? He might not necessarily be but it might be configured in terms of the cumulative hits he is taking.
Garret Ahearn (Fine Gael)
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What should be the protocol in that situation? In an ideal world, what does Professor Doherty think a club should do?
Professor Colin Doherty:
Their parents are there. You might be lucky and somebody might be a GP or something or might be a physiotherapist. Normal, day-to-day grassroots players do not have professionals at the sidelines. How would you train the coach to understand the nature of that? You do not want these people going to the emergency room, unless they do not stop bleeding. On the head injury itself, all I am saying is we should recognise that as a blow to the head. It might have no impact and this might be the only blow they get in the whole season. They are only six or seven. It is a complete accident. We are not trying to get rid of all risks. We are not trying to get rid of accidental blows or get rid of any level of concussion. The danger of us not all talking together in one room to come up with this guidance is that somebody will draw conclusions and judgements. They will say, "I saw your man at the Oireachtas committee saying that every kid with a bloody nose has suffered a head injury."
Garret Ahearn (Fine Gael)
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That is the worry.
Alan Kelly (Tipperary North, Labour)
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They were really good questions, Senator.
Garret Ahearn (Fine Gael)
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I thank the Cathaoirleach. I got Tipperary in as well.
Alan Kelly (Tipperary North, Labour)
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I have some questions myself. On the five recommendations made at the end, I more or less agree with them all. I think they all have to be put into one because they all kind of overlap. Leinster are playing Toulon this weekend, and I remember Mr. Dunne playing rugby, by the way. When Leinster are playing Toulon and somebody gets a head injury, they have the protocol and they take them off. It will not be like Brian O'Driscoll against the All Blacks in 2012 where he wandered around the place for ages before they eventually took him off.
Portroe are playing Burgess in junior B this Friday night. Portroe and Burgess have a huge rivalry. I am from Portroe and Burgess is the next club. We have not played one another like this in years. It is just the way it worked out because we have slid down and they have stayed at the same level. John Moloney and Tony Greegan, who are both neighbours of mine, are the managers in both clubs. If somebody gets a head injury in Leinster versus Toulon, we know what will happen. In Portroe versus Burgess in junior B hurling, that is a totally different scenario. In fairness to the managers, they are not medically qualified. Will there be somebody there who is medically qualified? What is the protocol for taking somebody off? Will both teams have a substitute? These are the practical things.
My daughter received a head injury last Friday night in a soccer match. She plays nearly every sport and she is nearly 16. Obviously, she was taken off. We monitored her, she did not to go an emergency department or anything. She turned out to be fine but we said she was not playing sport for at least a week, if not ten days, and we would monitor her. We checked her that night and the following day and all of that.
I am 100% supportive of the ethos what the professors are trying to achieve here, such as standardisation as regards defining concussion, research and the whole issue of creating a similar protocol across sports because there are different rules as regards taking people off, etc. The examples in Scotland and New Zealand were cited. The issue for me is the consistency of approach as regards the different levels of sport. What do we do? It is not practical to say in every scenario, you will end up in an emergency department. You can imagine what the HSE would say to us about that. I was in emergency departments loads of times with broken fingers and so on. I remember being knocked out playing rugby for Nenagh. The padding went the wrong way around and I hit my head off the post trying to score a try. It was the only time I have been knocked out. I do not remember it, obviously.
How do we reach an equilibrium in terms of a standard as regards concussion, a definition, group research and registering concussions when they happen across all codes?
What standards do we have to introduce or maintain at the different levels of sport? Senator Ahearn referred to his young lad throwing the ball at the under-eights, I am thinking of my nearly 16-year-old daughter, there is the junior B team and then there is the Leinster-Toulon match. Those are four different standards. How do we create some form of structure around that?
Professor Colin Doherty:
I will tell the Chair something that might surprise him. I think that if we get this right, we will massively reduce the number of visits to accident and emergency. Most kids go to accident and emergency because there is an insurance policy, and they are told they had better go to the accident and emergency unit to get checked out. The people on the sidelines do not have basic information. It is possible to have very basic information available. I do not think it should be published as guidance. We need to have a training programme. We can absolutely do this in Trinity. We can put a training programme together and have the coaches in for a day. We can tell them what happens and show them the four or five things that are red flags that need a doctor to assess in accident and emergency. If that happened, we would have half the number of accident and emergency visits. If we want to take pressure off accident and emergency units, and I want to do that too, that is one way to do it.
Alan Kelly (Tipperary North, Labour)
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Who would do the assessment on the sideline?
Alan Kelly (Tipperary North, Labour)
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What sort of certificate? There might only be four people on the sideline.
Alan Kelly (Tipperary North, Labour)
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Is it that at the under-eights or under-16s match, one person has to be medically trained?
Alan Kelly (Tipperary North, Labour)
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What sort of training? That is the question.
Professor Colin Doherty:
I would say that you can train people in concussion recognition and dose reduction in a day-long course. Here is why I know this would work. I went to Blessington to meet one of my PhD students, who had heard me talk about concussion. She is very involved in the GAA. In Blessington, all of the codes work closely together, and she organised a meeting, with the three presidents of the FAI, IRFU and GAA clubs all in the room. I gave them a 90-minute talk and at the end, they said they needed all of their coaches to hear that talk. That was the decision.
Alan Kelly (Tipperary North, Labour)
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Is Professor Doherty saying we should roll out a programme across all sports in Ireland where there is training so that at every event, at least one person is trained on this issue?
Professor Colin Doherty:
Unless the mothers of Ireland are told that, they are going to ask for it. It is coming. It does not matter what Colin Doherty says in this space. The games will die. All of these games will suffer unless we can reassure people that someone there is trained, has a certificate and knows basic concussion management. The issue of what that course consists of will need to be put together. Mr. Dunne might want to speak from a physiotherapy point of view on whether we can get coaches trained in concussion recognition. I think we can.
Alan Kelly (Tipperary North, Labour)
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If we are going to do it, it would have to be standardised. Otherwise, some sports would do it and others would not. That could not happen.
Evanne Ní Chuilinn (Fine Gael)
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Most sports have coaching badges. Even if someone is just coaching the under-sixes in a GAA club, they have to do a level one foundation course. Are the witnesses suggesting that, as part of that course, there would be a module or set of slides where people would have to answer questions at the end of the course? Would that be at all academy level coaching across the various sports that are affected by recurrent head injuries? We obviously will not be looking at rowing. I am surprised by the mention of badminton because not much damage will be done by a shuttlecock. Are the witnesses saying that for the FAI, the GAA and the IRFU - the big ones where people can take a hit - even the juvenile coaches would do this as a badge on top of their coaching course? Is that the model they are looking at? If it is not widespread and standardised, there is too much work in it. I can hear the federations saying: “Here we go. More admin. The medics are in, giving out about sport.” I know that is not what the witnesses are doing but I think this would need to be very simple.
Professor Matthew Campbell:
It could be done very quickly. People do not need to be medically trained to do a course in basic life support or CPR. It is the exact same principle. This would take a little longer because there is probably more involved. Professor Doherty and I could sit down and make a presentation for one hour, and the person answers questions and literally gets a certificate at the end of that. It would be about the signs and symptoms of concussion. I have asked parents what they would do if their child was concussed and started vomiting on the sideline. They said they would get a bucket, or something like that. You get them to accident and emergency. That is a sign for you to move your child to accident and emergency. Dizziness and things like that are symptoms but there has to be a combination of the signs and symptoms to get that red flag. There are rules and guidelines in place for how to manage this that anyone can upskill themselves on.
Professor Colin Doherty:
There is a tension regarding the practicalities mentioned by the Senator. I have a slide where I show what the brain is actually like. It is like a peeled tomato. This is a very delicate organ. I am only asking what every mother in the country should be asking, which is: can we have somebody who has some sense of what to do if a child gets a blow to the head, whether they have symptoms or not? By the way, can we all just agree on this? It is not Colin Doherty or Matthew Campbell saying this. Let us get agreement from everybody. Is it going to be a bit of a culture shock? I think we need a bit of a culture shock. We need to say that we are now taking this seriously.
Evanne Ní Chuilinn (Fine Gael)
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From a practical point of view, and from the point of view of the committee and the Oireachtas, who do the witnesses want to drive this messaging? Is it the Minister for Health? Have they engaged with her? Is it the Minister of State with responsibility for the sports side of things? The witnesses are clinicians. Where do they think this sits, in particular, the responsibility for delivering the message? If they want it to be a public health message, where do they want it to come from?
Professor Colin Doherty:
We might all have a separate answer to that. I will talk from the clinical side. I think this is a public health issue. In. By the way, no one disagrees with this. There were discussions before Covid that they needed to take a public health response to concussion. They have agreed with that but it just has not really advanced.
Evanne Ní Chuilinn (Fine Gael)
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Who is “they”?
Professor Colin Doherty:
The Department of Health. Under the last CMO, before Covid, there was an initiative to try to get a public health response to concussion. That is the first point. If I was asked what I would want from this committee, we need help with getting all the codes to agree that they would be part of this. We also need a more cohesive single message about how to manage concussion, with maybe a single website, a single place that everyone agrees to, and stamped with all the codes across the top, saying “This is how we all agree concussion should be managed.” That is what I would like this group to do. I agree that we definitely need help and we need to have public health involved. I am not a public health doctor but I have learned a lot about public health in terms of the messaging around this. We need public health doctors and specialists involved.
Alan Kelly (Tipperary North, Labour)
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I did not know that.
Alison Comyn (Fianna Fail)
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I welcome any kind of action. We seem to have homed in, in the final stages, on the grassroots, juveniles and so on. That is clearly where we have a bit of a problem. It would need to be standardised. Every club, no matter where, has a child welfare officer. If we are going to be targeting anything, it is probably a standardised course or message that goes through them and has to be drip-fed down to every single parent who is going to stand on the sideline.
Professor Doherty targeted a rugby mum, and I am sure there are dads who care as much. Deputy Ó Snodaigh used a word that I have heard a million time, "wuss". People say, "Don't be a wuss, don't be a baby, wipe your nose, you’ll be grand, get up, you'll be fine and off you go." There is an attitude. I am not sure how we are going to get rid of that attitude because that is where things can hide. The second time my young fellow broke his nose, he did not tell me because he did not want to be taken off. That is him, that is the coaches, that is everybody. It is the tough boy element to it, and I am sure it goes through to the girls as well. How do we combat that? How can we include that message with the really serious medical side to it?
Professor Colin Doherty:
I am sure we all have a view on that. If we think about some of the things that have happened in youth sport in the past two decades, one is that nobody smokes. If we think about it, an athlete smoking is the single worst thing they could possibly do. That has completely changed from my era as a schoolboy playing sport - the linkage of smoking to health. We need to get over this. It is our responsibility. These are young, developing brains. We cannot leave them with the responsibility to make these choices. That is why I am happy that we are concentrating on youth sports, and the really practical stuff that the committee is talking about.
This is a duty of care issue for me. These guys were getting paid a lot of money to go out on the rugby pitch and run into 200 lb walls. I am not really going up against that. If the professional game changes over time, that is fine. However, the coach on the sideline of an under-18 game is the person responsible for the health of those kids. To some extent the parents are secondary because they are allowing them to play. When we get it right in our heads that we are responsible for these decisions, then we just have to work hard on the whole wuss argument and all that stuff, like we did with smoking. We are doing a little bit of work on alcohol as well; it is not as big as what happened with smoking. All our young athletes now take their diet seriously because they know how important it is.
Alison Comyn (Fianna Fail)
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There must be no mixed messages. Parents, coaches and clubs all need to sing from the same hymn sheet so that we know there is a protocol to follow. Does this report suggest any age when contact sport should start? Should there be an element of tag rugby or hurling before contact starts?
Professor Matthew Campbell:
I do not think the data is there but as the bodies start getting bigger and the collisions get greater, we could probably guesstimate that it would be around about 15 or 16 years of age for boys and girls. Their bodies are getting bigger then and the collisions get stronger. I would guesstimate that it would probably be from the age of 15 onwards. Below that, the collisions are not as intense on a repetitive basis.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It is an interesting debate and I do not think we can wait forever. One of the reasons I used the word "wuss" is it is the kind of word they use and it is often that they need to-----
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Man up would be another one. My daughter decided last October to play rugby. She has played Gaelic football, camogie and soccer. She plays four sports at quite a high level. She broke her nose in January and was not allowed to play. If she was playing soccer, she would have been allowed to play wearing a mask. She is not allowed play rugby wearing a mask even though it is properly fitted and all that she was saying she was under pressure in the club to go back playing. There was nothing wrong with her nose. It was not out of shape and had not been dislocated but she got a bang on it and she had to stay out for the full time. There is no harm in that. However, the pressure was on from the other players. How do we deal with that pressure? For rugby if there are only 15 players and no subs but one player cannot play, all of a sudden, the outcome for that club was it did not top the league that year because according to her she was missing for those few weeks.
Are there any figures for hurling? Before helmets came in there were quite a lot of head injuries in comparison with today. She was playing camogie last night and got two clatters on the head but just kept playing because it did not bother her. Somebody needs to keep an eye on somebody who is taking hits on the head but she will not remember that next week. She is in her 20s and is not a child; I have no control over her. Is there any record kept of injuries when there is a change of safety protocol?
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It just means that if we are proposing a change in protocol, we can suggest looking at what happened in hurling and in other sports when we brought in a safety protocol.
Professor Matthew Campbell:
The south-west of Ireland used to have the highest rate of ocular injuries in sport because of the amount of hurling that was played there. The introduction of the mandatory wearing of helmets with visors on them has almost completely eliminated ocular injuries and face lacerations. That is why those helmets were brought in, not for concussion. Helmets do not stop the concussion in any regard. Someone can get a concussion without a direct hit to the head. There is really clear and brilliant evidence that with the introduction of helmets into hurling, as a public health measure, the difference is like night and day.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I presume the same would be true of mouthguards in Gaelic football.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I think shin guards should be mandatory in hurling as well. She is the only one; she has worn shin guards since she started playing at eight and she is still wearing them.
Alan Kelly (Tipperary North, Labour)
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I will not comment on that.
Rónán Mullen (Independent)
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Professor Doherty used a very interesting phrase earlier, "duty of care". When we think of duty of care, we think of where there is a breach of duty of care. When there is causation between the injury and the breach of duty of care, there is negligence. In terms of playing hardball on this, there is, of course, a defence of consent, volenti non fit injuria, to the willing there can be no injury. However, that is common law and law can change. Do any of the witnesses think legislation around liability is part of the future here?
Professor Colin Doherty:
What does the Senator mean by liability? I am not a lawyer. If I said to him somebody got an injury in a football game where a coach was in charge of the team, they ended up going to hospital and had substantial injuries from that, could they now be sued based on common law? Is that the Senator's question?
Rónán Mullen (Independent)
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No. What I am really wondering is whether there are dangers that can be at best minimised but cannot be completely eliminated. Does that leave an unsatisfactory situation? If sporting bodies which organise games that carry inherent dangers were more exposed to liability as a result of injury suffered, would that change the landscape in terms of the rules of those games, in terms of the way they are played and in terms of the more dangerous aspects of them?
Rónán Mullen (Independent)
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Looking at the international horizon, are there trends? Are there particular champions? Sometimes change happens. I mentioned liability. The witnesses are all excellent champions but in terms of particular people emerging who are known, who have concerns, who devote a considerable amount of their time and prestige to promoting the need for change, do the witnesses see that happening at home or abroad? Can they point us to any trends internationally showing that change is coming and we might as well be at the forefront of it?
Professor Colin Doherty:
Nationally we are sponsored and supported very heavily by Professor Mick Molloy a retired rheumatologist from Cork. He was an Irish rugby international and Lions player. He was the international team doctor for 15 years. He has an advocacy group of all retired players from the era that we remember back in the 70s and 80s and they are very much on this page. They all believe that the sport is stronger and faster, and needs some kind of approach to brain health. It is very important that Andy Dunne is here. They are absolutely committed to the good things that sport brings to the game. I do not know of anybody in our group who says this should be banned.
Internationally, I have a few contacts in the UK. Sam Peters, whose book Concussed: Sport's Uncomfortable Truth won the sports award, is very much on this page, as is David Walsh a journalist with The Sunday Times. In the North, Willie Stewart, who is a neuropathologist, can be credited with bringing in the "if in doubt sit them out" idea. We are all in contact with each other and we can certainly be a force to be reckoned with. This advisory group should be inviting international expertise to be part of it. We could absolutely be world leaders in this. We have the capability and infrastructure to do it.
Alan Kelly (Tipperary North, Labour)
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It is very interesting that the witnesses have said all along that this is about mitigation rather than about trying to stop it. Following on from what Senator Mullen said, that is not the case with all sports. Do the witnesses believe that boxing and martial arts should be banned?
Alan Kelly (Tipperary North, Labour)
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How is it possible to mitigate a kick to the head?
Alan Kelly (Tipperary North, Labour)
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How do you mitigate driving your elbow into somebody's eye socket?
Alan Kelly (Tipperary North, Labour)
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I just do not know how you can mitigate an elbow to the head as part of the rules.
Professor Matthew Campbell:
That is part of where we started off where there is an acute scenario and the long-term effect, which are quite different. Regarding an acute scenario, a hit to the head is managed and dealt with acutely and managed as a concussion. The repetitive sub-concussive nature - the cumulative forces - involve a different argument and a different thing that needs to be addressed. One can mitigate for both of them. With the acute things, one can mitigate by decreasing the length of time someone goes again so if you take an elbow to the head, you have to take your time before you go again.
Professor Colin Doherty:
I would just make it safer. An elbow to the eye should not be allowed. If the sport wants to exist, we should take these things, which are legal, and make them illegal in the sport. I am talking about the legal environment - the rules of the sport. It is about making all the things we do safer. Amateur boxing is a good example. They removed the head protection in amateur boxing. One of the reasons for that was that they knew it did not really make a difference. The head stuff does not make a difference. The reason amateur boxing is better than professional boxing is that in amateur boxing, a boxer gets points for body hits so it is not all about the knock out. In professional boxing, it is about the knock out so it is all about the head hit. There are ways we can make all of these sports safer and that is all we are asking for.
Alan Kelly (Tipperary North, Labour)
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The witnesses' information has been shared. If they were going to tier the response, type of response or no response from different sporting codes, how would they tier them? Do some sports listen more to the witnesses as opposed to others that just want the witnesses to go away?
Alan Kelly (Tipperary North, Labour)
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I am giving the witnesses a chance to tell us which sports are being good and which are not.
Professor Colin Doherty:
I have not been approached either way. Nobody has said, "Hands off, you're bad for our sport" but nor have they said "Let's work together". It is a bit like saying, "The codes are responsible for fixing this. You lot go away and fix it". They have done a lot. They have done everything they could to fix it but now there are some public health things, particularly at the grassroots. We talk about how much they give to the professionals who come off with a blow to the head and how much care and attention these professionals get, such as scans and physiotherapists, but this is not happening at the grassroots. We need to move into the space where we are taking responsibility along with them for making it safer. That is all we are asking for.
Alan Kelly (Tipperary North, Labour)
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We are legislators but, as a committee, we are not part of the Executive. We do not have the power to direct but we can make recommendations. What do the witnesses hope this committee can recommend? Our process would be to do up something, agree it, send it to the Minister and Government and say we believe the following should be done. I have not read the witnesses' document but what would they recommend we do?
Alan Kelly (Tipperary North, Labour)
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I am asking all three witnesses.
Alan Kelly (Tipperary North, Labour)
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That is no problem. We will definitely do that.
Professor Colin Doherty:
-----and that a dual approach is taken. Our second recommendation is that the influence of the members of this committee, all of whom are interested in sport, would help us bring the codes together. There has to be some formal mechanism for that. It is not just about inviting us in.
Alan Kelly (Tipperary North, Labour)
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Trust me; it will not be.
Alan Kelly (Tipperary North, Labour)
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My God.
Alan Kelly (Tipperary North, Labour)
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I know that whatever happens, they will end up in the public house afterwards together anyway.
Professor Matthew Campbell:
I am with Professor Doherty. We need multi-stakeholder involvement to get all the codes together to manage this acutely but also to recognise that there are long-term implications that we need to address. We also need cross-departmental engagement as well. It is critical.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Is this something that Sport Ireland should be taking on?
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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At the end of the day, it has a greater say than-----
Alan Kelly (Tipperary North, Labour)
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I agree. We will write to the Joint Committee on Health and to Sport Ireland about this. We will make our own recommendation, based on what we heard here today and send it to the Minister. It was a very interesting, necessary and worthwhile discussion. We will now go into private session.