Home Rugby The Gain Line: Florian Fritz & The Duty of Care

The Gain Line: Florian Fritz & The Duty of Care

In a damning article, Brendan Kelly slams the IRB and demands that the issue of concussion in rugby be dealt with appropriately before it is too late.

On Friday night Racing Metro 92 travelled to Stade Toulousain for the barrages round of the Top14. Earlier in the season it looked fairly unlikely that the Parisians would reach this stage but their fortunes have changed since former Irish outside half Ronan O’Gara took charge of collisions and defence.

Cards on the table I tuned in mainly as procrastination for my upcoming Obstetrics final, but I’m very glad that I did. I thoroughly enjoyed watching Jonny Sexton kick his side to a rare 21-16 away victory, in the process earning his adopted team the right to face Toulon in the semis. The result however was overshadowed by an incident in the 19th minute.

Florian Fritz, the Toulouse second centre, carried the ball into contact and was met by Bernard le Roux. The second man in was, of all people, Springbok Francois van der Merwe. As Fritz was being brought to ground the South African’s knee collided with the side of his head. It was a shuddering impact. As soon as Fritz failed to place the ball back it was apparent something was wrong.

Racing and Toulouse players alike immediately called for help. A normal, human reaction to seeing fellow competitor prostrate on the floor. Adrenaline still pumping through his veins blood poured from the gash in Fritz’ forehead. Medics rushed around the fallen player, but remarkably he pushed them off. Fritz rose first onto all fours and then to his feet. Miniscule hapless looking doctors impotently waved towels in the direction of the Frenchman. Fritz swotted them away like flies. His gaze was distant, his movements primal as he attempted to walk off the pitch. A few steps later Fritz stumbled and fell.

Guy Noves the Toulouse coach looked distraught pitchside. Strange considering how Gael Fickou was such an appropriate replacement. As Fritz struggled off the pitch his manager was remonstrating with him. Noves was concerned not about the veteran’s welfare but rather about whether he would be able to return to the game. Watching this, even with my basic level of medical training, I was immediately concerned for Fritz. The impact was worryingly close to the pterion (a thin part of the skull that overlies the middle meningeal artery). Injuries to this area can cause a bleed in the brain that begins with a lucid interval followed by an often fatal rise in intracranial pressure. This of course was unlikely, but Fritz was clearly not right.

The National Institute of Clinical Excellence define concussion as:

“The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiological and/or anatomical disruption of connections between some nerve cells in the brain may occur. Often used by the public to refer to a brief loss of consciousness.”

By this, or any other definition Fritz was concussed.

Rugby is a physical game and injuries are expected; what happened 15 minutes later however was not. Noves was seen down in the changing rooms roaring at the medics, Fritz was being called back into the game. Where was the normal, human reaction to a player who could not stand on his own two feet only minutes earlier?

Twitter blew up.

Alex Corbisiero was among the most vocal critics, but he was far from alone.

Knowing about his history and interest in concussion I asked Bernard Jackman for his opinion. The Grenoble coach and former Leinster hooker was forced to retire from the game early due to repeated concussions. He said that allowing Fritz to return was one of the craziest incidents he had ever seen. He was right.

The IRB has recently introduced the ‘Brain Bin’ to their concussion guidelines. These have been publicly lambasted by experts, such as the former IRFU official Dr/ Barry O’Driscoll. He went as far as to resign his position in protest. The fact is that the new guidelines are not evidence based. No one can reliably outrule a concussion in 10 minutes; it has never been shown to be possible. It begs the question, who decides if the injured player is fit to return to the field of play? Who is the final guardian of player welfare? Much of the online discussion revolved around rule 3.9:

If the referee decides – with or without the advice of a doctor or other medically qualified person – that a player is so injured that the player should stop playing, the referee may order that player to leave the playing area. The referee may also order an injured player to leave the field in order to be medically examined.

While I wholeheartedly agree with this rule in principle, it is not fair to expect the referees to make a call on the medical well being of the players. To paraphrase @AdamMeakins, The Sports Physio, doctors don’t award tries and referees don’t make diagnoses. Once a doctor sees a player on the field, that player is his patient. Doctors have a duty of care to their patients, and compared to this, the game becomes irrelevant.

This is a real issue for rugby. As a sport we need to tackle this issue head on and learn lessons from other sports. The NFL have learned the hard way with the deaths of players like Dave Duerson and Junior Seau whohave died by suicide; tragically ending their lives by means that would preserve their brains so that they could be studied at autopsy.

Another stark example is the trembling figure of the man who was once “the greatest of all time” Muhammad Ali. But sadly we do not have to look so far afield to know how devastating concussion can be.

Fourteen-year-old Ben Robinson lost his life on the rugby pitch after being treated for three separate head injuries in Northern Ireland. Lucas Neville suffered permanent disability while playing for St Michael’s Secondary School just days after a previous head injury. From this came the prerogative that, after a head injury, players must not play or train for 24 days. This ensures 3 weeks without competition.

What good is it though when at the highest level coaches still want to play concussed players, doctors submit to pressure and forgo their duty of care and referees are expected to diagnose neurological conditions? Why are we not learning from the mistakes of others? Once a concussion is suspected the player needs to be removed to the game, it is as simple as that.

Rugby fans everywhere, myself included, mock soccer fans for the simulation and lack of respect for referees that plagues their game. This is our sport’s major issue, and it’s about time we stood up to it. I only hope that Florian Fritz comes through his injury safely and that it won’t take more loss of life to change things.

Brendan Kelly, Pundit Arena.

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