Radical new proposals including law changes and possible punishments for team doctors are being drawn up in a bid to halt a shocking 900 per cent increase in reported concussions ahead of this year’s World Cup. High-profile incidents suffered by players during the current Six Nations — including Wales wing George North, England full-back Mike Brown and Ireland flanker Sean O’Brien — have reignited concerns over the extent of concussion in professional rugby and how the potentially fatal injury is handled. A recent RFU audit revealed reported rates of concussion were 59 per cent higher during the 2013-14 Aviva Premiership season than the previous year, with 10.5 concussions occurring every 1,000 player hours. Full-back Mike Brown suffered a heavy blow to the head in England's victory over Italy . But figures seen by The Mail on Sunday show the rate of reported concussions for the current Six Nations stand at 25 per 1,000 player hours after three rounds — more than double the RFU’s figure and almost 10 times the number reported a decade ago. ‘It’s a massively high number and it’s causing significant concern across the sport,’ said one insider at the governing body, World Rugby. ‘Something needs to be done because the World Cup is coming up and the eyes of the world will be on rugby. Concussion is unquestionably the biggest issue facing the sport.’ Significant strides have been made by the sport’s governing bodies in recent times, with a compulsory education programme introduced in the Aviva Premiership at the start of this season and a gradual introduction of pitch-side video technology for medics to access. Brown was ruled out of Ireland game after failing stage three of the return to play concussion protocol – a process all players must undergo after suffering head injuries . World Rugby bosses, aware of potentially damaging long-term effects of multiple concussions to players and desperate to avoid potentially crippling legal action seen in the NFL, have also instituted an extensive education programme. And they are in the processes of drawing up a legally binding document to ensure strict player welfare guidelines are adhered to at the World Cup. But there are fears the current measures do not go far enough and The Mail on Sunday understands World Rugby chiefs have agreed the introduction of further medical protocols ahead of the World Cup which include: . Wales admitted George North should have been removed from play after being knocked unconscious . Rugby union has been on high alert since the NFL agreed to pay out close to a billion dollars to more than 4,000 former gridiron stars with neurodegenerative conditions linked to multiple concussions and the latest figures will do little to ease concern. This week, World Rugby’s head of medicine Dr Martin Raftery presented to the world governing body’s executive committee when the proposal to draw up a worldwide group of players, coaches, referees, doctors and medics with a remit to look at law changes to reduce concussion rates was ratified. ‘We are now starting to understand the magnitude of the problem,’ said Dr Raftery. ‘If we had started the prevention programmes five years ago, we would have been saying, “We need to get it down from five [concussions per 1,000 hours]. Now we know it’s going to be at least 10.5 if not more and I think we’ll see another increase. We are getting far better compliance around concussion but we don’t believe we have finished this process. We’ve reached a baseline but we are not going to allow people to drop the ball in this area. If there’s an issue it will be referred to a disciplinary tribunal and we’ll investigate it.’ There was widespread criticism of the Wales medical team for failing to spot two incidents in which North appeared to be knocked unconscious but was allowed to play on. A World Rugby concussion panel — comprising Dr Raftery and some of the world’s leading brain injury experts — accepted the Welsh medical team’s explanation that they were unsighted for both incidents, although questions remain as to why no one among the team’s backroom staff, some with access to BBC broadcast footage, alerted the medics. ‘The Welsh didn’t have to co-operate but they were extremely co-operative,’ said Raftery. ‘They were also extremely embarrassed about what happened.’ Concerns also persist that so-called ‘independent’ match-day doctors in the Six Nations are often employees of the home union and therefore highly unlikely to challenge or even over-rule a team doctor if they believe a serious breach in protocol has occurred. ‘They will have to be fully independent match-day doctors at the World Cup,’ said Raftery. ‘Every other match day appointment is independent so why not doctors? Imagine if England were playing Australia and the match-day doctor was English and decided that Israel Folau should come off with 20 minutes left even if the Wallaby team doctors said he was fine. There would be absolute outcry. We have to avoid that scenario. ‘The match day doctor has the ability to over-rule team doctors but I’d hope they would look to work together.’ Exeter Chiefs have announced a new research programme to investigate effects of concussion on their players, while Saracens are also trialling micro-chip technology to assess the extent of forces their players are being exposed to.
Reported concussions for current Six Nations are more than double the rate for the the 2013-14 Aviva Premiership season . High-profile incidents suffered by players during the current Six Nations have reignited concerns . George North, Mike Brown and Sean O'Brien all suffered concussion . sanctioning and possible suspension of team doctors found to have breached concussion protocols through an ‘untoward incident review panel’
independent pitch-side doctors and neurologists with no affiliation to either team’s union with the right to over-rule team doctors . baseline cognitive testing for every participating player and compulsory medical screening . identification of high-risk players with a history of concussions . assembly of a sport-wide group looking at law changes to reduce concussion rates . real-time television replays available for all pitch-side medics to assess head injuries .