GAA will not introduce blood sub for cases of suspected concussion

The GAA has stopped short of introducing a blood-sub type rule for players with suspected concussion for fear it might be abused. A rule demanding a concussed player be stood down for a set number of days has also been resisted.

Instead the GAA has agreed new a 12-page concussion guideline document, with an extra emphasis on proper diagnosis and education: it is part of the updated report of the Medical, Scientific and Welfare committee which has also identified that concussion accounts for less than one per cent of the injuries sustained by intercounty players.

While recommending that any player with suspected concussion be immediately removed from the field, and not return to play on the same day, the actual decision rests solely with the team doctor – who must also give medical clearance before the player is allowed return to play, and after a rest period of at least 24 hours.

However the committee didn’t favour the tabling of any motion whereby under rule the player may be temporarily replaced, similar to a blood substitution, while being diagnosed for concussion, particularly when all five substitutions have already been made. This was the situation in the All-Ireland football final where Dublin’s Rory O’Carroll played out the last 10 minutes while quite visibly concussed, at which stage Dublin had already made five substitutions, one of which was to replace Jonny Cooper, who had also been concussed.

“We did give consideration to that but having looked at the level of concussion injury, having taken advice from experts, we believe the guidelines are sufficient, and a very good template for managing concussion,” said Ger Ryan, chairman of the GAA’s Medical, Scientific and Welfare committee. “Obviously we will review, like any new guidelines, how effective they are and if they are doing the job we expect them to do.”

'Develop the culture'
O'Carroll's concussion in the All-Ireland final followed several other high-profile incidents in this year's championship – with Donegal manager Jim McGuinness claiming that four of his players had been concussed in just three games. Yet affording teams the chance to temporary replace players suspected of concussion was open to potential abuse, according the Dessie Farrell, chief executive of the Gaelic Players Association.

“I know it’s not as evident as a blood sub, where blood is drawn,” said Farrell, “and the argument will be, well, could it be used to just replace a player, whenever? I think what we need to do first of all is develop the culture that everyone understands what concussion is about, and that a blow to the head must be taken really, really seriously. ”

It also emerged after Dublin’s All-Ireland final win that Cooper had wanted to play on, despite being concussed. Yet the committee is satisfied that team doctors are still best positioned to make such calls.

“The absolute view of the committee is that the player’s welfare is of paramount importance at all times,” said Ryan. “You can’t put the player at risk and I don’t believe any team doctor or manager would willingly do so. We’re not suggesting the player be the best judge of it. We’re suggesting that it’s a clinical diagnosis by the doctor. And concussion is most likely to occur in the most intense games, and all of those teams have experienced doctors, and their clinical ability, coupled with the guidelines, should lead us to overall a successful management in concussions.”

Yet it might not always be in the team’s best interest for their own doctor to declare a player concussed – particularly if all five substitutes were used – although the committee didn’t explore the option on an independent doctor or assessor: “It’s not so much that it wouldn’t work,” added Ryan. “We didn’t see it being necessary at this point. All of the team doctors are experienced, well able to do the diagnosis, and the best people to liaise with their team managers.”

Stood down
Ryan's committee may also revisit the possibility of a rule demanding a concussed player be stood down for a set number of days.

While the committee report reveals less than one percent of all intercounty injuries are classified as concussion – 0.8 per cent in football, and 0.5 per cent in hurling – that mightn’t necessarily capture the extent of the problem. “We did a piece of research on it ourselves, just internally within the players association, and the indication is that a lot more players have experienced concussion at various stages throughout their career,” said Farrell. “I would have thought it unusual for a player of say a 10 year career not to have sustained a concussion at some point.”

In the meantime, the committee report, which has now monitored 2,525 intercounty players since 2006 (45 football teams and 32 in hurling) has revealed that two out of every three players will get injured at least once in a season (see panel).