Knock out

First topic message reminder :

Despite some great performances and a very welcome win what will stick in my mind is George North. He d already had 1 concussion check and took another hefty blow to the noggin and stayed on. How and why it was allowed is beyond me. Its too serious a pointtobe ignored. Does the tmo need to be involved more here?

Have I been a resolutely black & white guy on this?

I don't think so.  

Fristly, I'm one of the first to state that the Welsh boys on the sidelines shouldn't be accused of doing things for cruel reasons, like keeping a vulnerable player on the field because he was considered too good a player to take off.

I said talk like that isn't helpful as you would never try to class backroom staff as being so cruelly calculating.  

I fully believe that there was a mix up in the ranks and that the backroom boys and docs didn't see that final fall by North.

I DID say though that a number of the players (from either side) MUST have seen it.  I did say some of those who MUST have seen it should have been man enough to step away from their rugby duties and bring the collapse to the attention of the ref, who obviosly didn't see it either.

That's no black and white - "Wales are wrong, wrong, wrong".  It's saying an inability to see the event should have been corrected by players who might have seen him fall - again, from either side (Welsh or English)

And I said it was the second hit that North should have been taken off for (had it been seen) because nobody - nobody - needs a qualified doctor to tell them what they saw was anything less than a knock out.

That knock-out was then much more dangerous because it was his second incident and hinted that the first incident hadn't been fully recovered from at all.

It was a dangerous moment - and, in an ideal world without any errors or oversights, he should have been taken off.

Now, my last point is, as always, a story designed to prove non-bias in my views - something we all have to be oh so conscious of these days, it seems.

So I go back to last year again and the England/Ireland game, and Sexton in the second half.  I was giving out stink after that game that an obviously concussed Sexton was allowed play on through the second half, and all the signs were virtually ignored not just by the sideline people but by the commentators who never spoke about how groggy and out of it he looked, and even by most of the fans on either side who seemed to take days before they started asking why Sexton was making so many 'bad' decisions in the second half.  But if you go back to the game you can see it and you can see Irish players go to him with concerned looks but still he stayed on.

He was gone and should have been off - and that's what I stated over and over back then.

So it's not simply "kick the Welsh when they're down and vulnerable" - it's question the people who constantly deny what their eyes are seeing right before them.  North was out of it for most of that second half.  People can talk about protocalls all they like, he was quite visibly out of it.

That's the only thing I've been b&w on - North wasn't up to being on and shouldn't have been.

MrsP wrote:Well actually it is not up to me to prove he was KO'd.

You said he "patently wasn't".

To remove him from the pitch all that is required is "Suspected loss of consciousness."

Now I know very well why I suspect he had lost consciousness. But you are certain that he did not. Can you explain how you are certain he wasn't KO'd?

So you make the statement that he was KOd, I then answer that he patently wasn't, so you then ask me to prove my theory, and finally I say you prove your point first, as YOU made the first statement you show it and then I'll counter, as in the Initial exchange.

North looked out cold following the clash with Hibbard. The Welsh medics state that had they seen the footage they would have concluded this.

So please, for the love of god, anyone who believes he was not knocked out please state why you believe that.

Very fair Fly. Does anyone dispute the second incident resulted in him being knocked out? Clear as day. Personally don't think he looked or was knocked out by Attwood.

SecretFly wrote:Have I been a resolutely black & white guy on this?

I don't think so.  

Fristly, I'm one of the first to state that the Welsh boys on the sidelines shouldn't be accused of doing things for cruel reasons, like keeping a vulnerable player on the field because he was considered too good a player to take off.

I said talk like that isn't helpful as you would never try to class backroom staff as being so cruelly calculating.  

I fully believe that there was a mix up in the ranks and that the backroom boys and docs didn't see that final fall by North.

I DID say though that a number of the players (from either side) MUST have seen it.  I did say some of those who MUST have seen it should have been man enough to step away from their rugby duties and bring the collapse to the attention of the ref, who obviosly didn't see it either.

That's no black and white - "Wales are wrong, wrong, wrong".  It's saying an inability to see the event should have been corrected by players who might have seen him fall - again, from either side (Welsh or English)

And I said it was the second hit that North should have been taken off for (had it been seen) because nobody - nobody - needs a qualified doctor to tell them what they saw was anything less than a knock out.

That knock-out was then much more dangerous because it was his second incident and hinted that the first incident hadn't been fully recovered from at all.

It was a dangerous moment - and, in an ideal world without any errors or oversights, he should have been taken off.

Now, my last point is, as always, a story designed to prove non-bias in my views - something we all have to be oh so conscious of these days, it seems.

So I go back to last year again and the England/Ireland game, and Sexton in the second half.  I was giving out stink after that game that an obviously concussed Sexton was allowed play on through the second half, and all the signs were virtually ignored not just by the sideline people but by the commentators who never spoke about how groggy and out of it he looked, and even by most of the fans on either side who seemed to take days before they started asking why Sexton was making so many 'bad' decisions in the second half.  But if you go back to the game you can see it and you can see Irish players go to him with concerned looks but still he stayed on.

He was gone and should have been off - and that's what I stated over and over back then.

So it's not simply "kick the Welsh when they're down and vulnerable" - it's question the people who constantly deny what their eyes are seeing right before them.  North was out of it for most of that second half.  People can talk about protocalls all they like, he was quite visibly out of it.

That's the only thing I've been b&w on - North wasn't up to being on and shouldn't have been.

Fly I was having a go at you over your flippant Dr Burrell, as for the Sexton case sorry didn't see it and as I've said on here many times, I very rarely read or get involved in topics that does not have a welsh interest, and for the umpteenth time I have NO problem with North going off after the 2nd incident and the one player who was in a position to see that he was unconscious was the English player possibly May

LT,

Wayne and I are talking about the first incident when he was kicked in the head.

Wayne.

There is no need for me to prove that North suffered LOC to justify him being removed from the game.

The protocols say that a player who has Suspected LOC must be removed from the game and not allowed to return.

And, the irony of being called infantile by a poster who has also called me an idiot seems to have been lost on you.

MrsP wrote:LT,

Wayne and I are talking about the first incident when he was kicked in the head.

Wayne.

There is no need for me to prove that North suffered LOC to justify him being removed from the game.

The protocols say that a player who has Suspected LOC must be removed from the game and not allowed to return.

And, the irony of being called infantile by a poster who has also called me an idiot seems to have been lost on you.

Mrs P we are not going to agree on this, I don't believe he was knocked out, you do, and even though there are no screens in the Welsh Medical Teams Booth, there is no reason to not believe within the Stadium where the Independent Doctors were situated and examined him that there could have been.

If the independent medics had access to the video then I would have hoped they would have insisted that North was removed from the game after the second incident!

I do not need to think he was KO'd, just suspect it to be right that he should have been removed.

Disagreeing is fine. Calling posters names is not.

Maybe he was just having a rest.

WELL-PAST-IT wrote:Well said Doc, can't disagree with a thing you have said.

Your hearts, wouldn't be the body parts you cut off would they?

hearts are too soft and gushy to cut off consistently. However, if one does get one, fried with a little Chianti?????

Worth pointing out after all these shenanigans that the WRU's concussion and general injury management is going to improve. Assuming the redoubtable Mr North is fine, the net result is, hopefully, a better future for Welsh players. Hope the other Unions are paying attention.

The SRU medics have had access to live monitors during games for several years, and I can't think of any instances when they have been anything but sensible and cautious whenever players have had head knocks.

Indeed in last year's game against Wales Kelly Brown had a head knock early on and wasn't allowed to come back on.

It helps that we have Dr James Robson, and there's a reason he is always picked to head up the Lions medical team (excuse the pun)!

doctor_grey wrote:

WELL-PAST-IT wrote:Well said Doc, can't disagree with a thing you have said.

Your hearts, wouldn't be the body parts you cut off would they?

hearts are too soft and gushy to cut off consistently.  However, if one does get one, fried with a little Chianti?????

Maybe filled with herbal stuffing, with sautéed kidneys and braised liver. An offal mixed grill.

Cowshot wrote:Worth pointing out after all these shenanigans that the WRU's concussion and general injury management is going to improve. Assuming the redoubtable Mr North is fine, the net result is, hopefully, a better future for Welsh players. Hope the other Unions are paying attention.

A good point - while nothing can now be done to improve the care that GN had last Friday (and I think it is almost universally agreed that he should have been removed after the 2nd incident), the main question is how did the medical team miss him being KO'd, and so how do they prevent something similar happening in future.

Obviously a coupfewkey questions:
1 - was the pitch side concussion assessment (as carried out on GN after the Attwood incident) fit for purpose, or should GN have been prevented from returning (and given the subsequent KO, there has to be some doubt here)
2 - If the result of the assessment was marginal, will the Docs be more assertive in refusing to let a player return even if the player insists they are OK?
3 - How to minimise the likelihood of the medical team not seeing an incident like the 2nd knock and loss of consciousness.

Unlike some, I have no issue with the TMO being allowed to highlight such issues, and bringing them to the attention of the referee. To be honest, it's not the sort of incident that happens often, so I don't see a 'thin end of the wedge' in this. After all, the RFU and IRB have been saying for several years that player welfare is paramount, and the changes to laws such as the scrum engage and 'tip tackling' have had this as the motivation. Head injuries are potentially amongst the most serious that can happen in rugby, so care is needed, especially as we have all seen concussed players who clearly don't know where they are try to stay on the field.

dummy_half wrote:
1 - was the pitch side concussion assessment (as carried out on GN after the Attwood incident) fit for purpose, or should GN have been prevented from returning (and given the subsequent KO, there has to be some doubt here)

I have read a few articles about the assessments that seem to give two very good reasons as to why the assessments are not fit for purpose.

1) Mental degradation following a knock to the head is usually delayed by more than the 5 minutes they have available to do the assessment.
2) The key element of the Pitch Side Concussion Assessment is a cognitive test. The base line for this test is set by all players pre-season and it is alleged that players, either deliberately or inadvertently, can set this mark lower than their potential. Should performance in this cognitive test be matched during the PCSA then the player can return.

LondonTiger wrote:

dummy_half wrote:
1 - was the pitch side concussion assessment (as carried out on GN after the Attwood incident) fit for purpose, or should GN have been prevented from returning (and given the subsequent KO, there has to be some doubt here)

I have read a few articles about the assessments that seem to give two very good reasons as to why the assessments are not fit for purpose.

1) Mental degradation following a knock to the head is usually delayed by more than the 5 minutes they have available to do the assessment.
2) The key element of the Pitch Side Concussion Assessment is a cognitive test. The base line for this test is set by all players pre-season and it is alleged that players, either deliberately or inadvertently, can set this mark lower than their potential. Should performance in this cognitive test be matched during the PCSA then the player can return.

Good points, mate.  The in-game assessments can never be a perfect diagnostic tool.  The main reason, in my opinion, is that it is an injury we cannot see, and can only evaluate behaviourally.  

No pitch side assessments for any suspected injury is 100% perfect, though in many cases we get it right.   As a bone guy or RAMC field surgeon, I need to see, feel, manipulate, touch, smell an injury in order to diagnose.  In other words, some combination of the  physical, tangible, sensory.  Head trauma is carefully hidden beneath the skull and is completely different from a diagnostic point of view.  And that means completely different skill sets.  

Another way to look at it that we all know is bruising and swelling can take hours or days to completely develop.  This is frequently easy to see, easy to diagnose, easy to treat.  Since, in simplistic terms, concussion is bruising of the brain inside the skull, it cannot be seen, touched, or manipulated.  Outside of hospital, it can only be diagnosed behaviourally.  And since bruising can develop over time, a person might not appear symptomatic after the immediate aftermath has subsided.  

This is what makes this so damn difficult to assess.  And why we need to be very cautious.

This site is a great deal richer because of the contributions of the good doc.

Can Jonathan Davies ever take criticism of anything welsh related? It has nothing to do with "jumping on the bandwagon" or an anti-welsh sentiment, it is to do with player welfare and the welsh medical staff got this one wrong. Is he really trying to suggest George North may not have been knocked out? He rag dolled to the ground!

Rory_Gallagher wrote:Can Jonathan Davies ever take criticism of anything welsh related? It has nothing to do with "jumping on the bandwagon" or an anti-welsh sentiment, it is to do with player welfare and the welsh medical staff got this one wrong. Is he really trying to suggest George North may not have been knocked out? He rag dolled to the ground!

I was a little disappointed by his comments. When it's comes down to players life's I don't think a players nationalities Matters to anyone.

lostinwales wrote:This site is a great deal richer because of the contributions of the good doc.

Thanks for the comments, mate. I am fundamentally a meathead of the highest (lowest?) order. But am happy to share when I can.

Another retirement due to repeated concussions.

http://www.bbc.co.uk/sport/0/rugby-union/31508482

Scarily, the team Doctor at Cardiff Blues recommended retirement on the fact that Rory's close family noticed behaviour changes after his most recent concussion. 

I hope Rory finds his way in life now that rugby's behind him. 

I had the pleasure of playing on the same team as him in a sevens tournament a couple of years ago, and he was a hugely impressive player. He never quite got made it as a regular at the Blues, but his tackling and ball carrying was always superb. 

All the best to him.