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Please excuse my cross-pollination of topics between the mastheads for which I write, Roarers, but I touched on something yesterday for ESPNscrum that I really think warrants deeper discussion.
It all relates to the curious and simultaneously worrying occurrence in the Blues-Brumbies game on Saturday evening, where in the 75th minute, Brumbies outside centre Tevita Kuridrani got his head in the wrong position in attempting to bring down Blues fullback Charles Piutau.
Play was stopped soon after, with the Brumbies getting no advantage from the Piutau’s knock-on – which came from the tackle after Kuridrani’s attempt, a tackle where Christian Lealiifano coincidentally also had his head in the wrong position. It may have even been Lealiifano’s head that forced the ball loose.
Kuridrani had stayed down in the meantime, and the Brumbies trainers, including Dr Angus Bathgate, came to his assistance almost immediately.
The concern for a head injury was evident to all, and indeed Dr Bathgate began to help Kuridrani from the field, where you would imagine a Pitch Side Concussion Assessment would’ve been conducted, even though there was less than five minutes left in the game.
Kuridrani and the trainers got about half way to the sideline when time was called back on, at which point Kuridrani looks to have decided that he was fine, and despite some initial resistance from Dr Bathgate, Kuridrani was allowed to take his place back in the defensive line.
I was really impressed at this point, at first anyway, when referee Lourens van der Merwe held up play to run over and check whether the player truly was fit to continue.
However, the conversation took a rather disturbing twist:
Van der Merwe: “Are you happy for 13 [Kuridrani] to be on the field? I’m not going to take responsibility for him. Are you happy with that?”
Bathgate: (nodding) “Yeah, he passed the test there, so…”
Van der Merwe: “Are you sure? You don’t want to send him for a concussion test?”
Bathgate: “No, I think he’s OK. We’ll keep an eye on him for the next two minutes.”
Van der Merwe: “Alright, sure.”
And play continued. Kuridrani played out the remaining four and a half minutes of play with no evident discomfort, and indeed made a couple more tackles, one of which stopped Blues winger Frank Halai after a half break.
Kuridrani could be seen pointing at Blues attackers and organising Brumbies defensive alignments. He certainly looked ‘OK’ in the remaining period of play, and there have been no reported after effects.
Three days on, word from the Brumbies is that he’s completely clear of all concern.
Here’s my take on this from yesterday’s Scrum Five:
“There’s all sorts of alarm bells in this for me. For starters, the whole point of the PSCA is to ensure players can be assessed properly, well away from the temptation of the game, and the laws allow teams a free temporary substitution to do so.
“The test is in place because player safety is paramount, and also so that teams aren’t disadvantaged by having to use one of their seven replacements.
“I’m not for a minute suggesting that Dr Bathgate acted anything but professionally, and likewise I obviously don’t know what “the test” on field comprised, but surely in this situation, when the referee had recognised the state of the player enough to audibly attempt to absolve himself of responsibility for the player’s welfare, the duty of care should extend beyond asking the medics if they want to conduct the PSCA, but to actually ensure they do? Head injuries are not trivial, and the situation of a game should not dictate how they are handled.”
The Super Rugby ‘Game Deliverables’ overview, in which the introduction of the PCSA was explained, says the test is there “For players suspected of having a bad head knock and could be concussed”.
There’s no hard and fast rule on when it should be applied, though, and perhaps this is something that needs to be looked at further.
It seemed unusual at the time, but referee van der Merve did the right thing, and acted well within the PSCA Procedures as laid out within the Super Rugby Tournament Manual (Section 4.3):
1. Who can request a PSCA?
The Referee, the Match Day Doctor or the Team Doctor are allowed to request PSCA. An opposition Team Doctor is not allowed to request a PSCA on an opposing player.
Van der Merwe’s attempts to absolve responsibility shouldn’t wash though, and if he was concerned enough to try and disown any ongoing problems then perhaps what he should have done is more forcefully request that the Brumbies did actually take Kuridrani off and conduct the PSCA properly.
Just to be clear, my concern is not with this case in particular, but rather the possibility in the future that genuine concussion injuries will be similarly given the ‘wait and see’ approach if a game is in the balance. Even more so if the head injury has been suffered by a key player.
My concern is that while the PSCA is there to protect the players and indeed the clubs from themselves and to bring some degree of universal assessment into the treatment of head injuries, I wonder whether the guidelines might not go far enough.
Should the procedures not just allow referees to request a PSCA be conducted in cases where the concern is quite evident, but to actually direct a team doctor or the MDD to do so?
There is so much more research being done on the effects of concussion and brain injury in numerous sports around the world – and particularly related to the NFL in the States – that surely we’ve reached a point where any head knock should be assessed properly.
Head injuries are not trivial matters. Player welfare is not something that should vary depending on the game situation, and where possible concussion is concerned it is much better to lean too far on the conservative side. Let’s not allow unnecessary risks to be taken.
I’ll be interested to hear your thoughts in this one. Even with the guidelines in place, there’s obviously still some grey areas in how suspected head injuries are treated.