IRFU Submission. Oireachtas Joint Committee on Health & Children. Concussion in Sport

Transcription

1 IRFU Submissin Oireachtas Jint Cmmittee n Health & Children Cncussin in Sprt Presented by Dr Rd McLughlin FFSEM (Ire & UK), MSc Sprts Med (Lnd), MRCGP IRFU Head f Medical Services Directr f Medicine Irish Institute f Sprt Medical Officer Olympic Cuncil f Ireland Thursday 9 th Octber 2014

2 INTRODUCTION The Irish Rugby Ftball Unin welcmes the Oireachtas Jint Cmmittee n Health and Children s invitatin t this meeting n cncussin and the pprtunity t address the cmmmitee. I am here in my capacity as Head f Medical Services with the Irish Rugby Ftball Unin. I am als Directr f Medicine at the Irish Institute f Sprt and Medical Officer at the Olympic Cuncil f Ireland, I have als been Medical Officer t Wicklw Intercunty Ftball GAA team and a member f the GAA s Medical Scientific and Welfare Cmmittee. Medical infrmatin abut cncussin in sprt has already been presented t this cmmittee, fr this reasn I will present hw the IRFU is managing cncussin in rugby in Ireland. Cncussin is a very imprtant issue which affects many sprts, including rugby, and recreatinal activities it is an issue the IRFU takes extremely seriusly. Cncussin educatin and management sits at the very tp f the IRFU s player welfare strategy aimed at educating, supprting and prtecting players at all levels f the game. Rugby perates a zer-tlerance stance twards playing with cncussin and the message t all is Stp Infrm Rest Return. Any player with clear r suspected cncussin shuld be remved frm the field f play and must nt return that day. The strategic visin intent f the IRFU is: That all players, caches, referees and medical persnnel invlved in rugby unin in Ireland understand the imprtance f cncussin, hw t recgnise cncussin and manage it, therefre enhancing player welfare. The unin is prviding leadership t change the culture within rugby. The culture that we aspire t, is ne in which - Cncussin is cnsidered a serius injury, actively mnitred fr, recgnised and practively managed with player safety the ultimate cnsideratin. We are wrking t achieve this visin and culture change by cncussin educatin, regulatin, preventin, management and research.

3 CONCUSSION EDUCATION Educatin is at the heart f driving awareness and cultural change and the IRFU s Stp Infrm Rest Return and Recgnise and Remve campaign features educatinal and guidance materials, a cncussin radshw and ur Standard Apprach t Field Emergencies in rugby (SAFE Rugby) curses. The IRFU is delivering its educatinal prgramme in the fllwing ways: Cncussin Radshws: Almst 2,000 peple have attended 54 cncussin rad shw talks natinwide, t prfessinal players and in the club and schl game. Standard Apprach t Field Emergencies in rugby (SAFE Rugby): Almst 900 participants have attended ne f 46 SAFE rugby curses. This is a ne day practical curse with ne instructr t every six participants. The IRFU has a netwrk f 28 instructrs natinwide, all with expertise in prehspital care. SAFE Rugby aims t prvide rugby specific, pitch side emergency care training and skills t medical and nn-medical individuals invlved in rugby. Curses at all levels include cncussin management prtcls, Basic Life Supprt/AED (defibrillatr) training and first aid management f sprt injuries. Pster and Wallet Card distributin: 30,000 cncussin educatin wallet cards and psters were distributed last seasn. These cards were delivered t every club and schl in July 2013 and January 2014 and the majr emergency departments in Ireland January IRFU Medical Website: The medical sectin f the IRFU website was redesigned with educatinal cntent n cncussin. We are at present develping child friendly material. Medical cmmunity: The IRFU's medical staff have presented educatinal talks t the Emergency Medicine Dctrs, The Faculty f Sprts & Exercise Medicine and The Irish Cllege f General Practitiners Summer Schl. Research tells us that educatin shuld be user- specific, cntext-specific, impact-riented and an interdisciplinary prcess. The IRFU is targeting schls, adlescent children, caches and referees with educatinal material specific t each grup t infrm them f their rle in cncussin management, with specific guidance fr each.

4 CONCUSSION REGULATION Rugby recgnises the assciatin between cncussin and CTE (Chrnic traumatic encephalpathy). Regulatin, which includes mandatry cmpnents, cupled with strng educatin is key t mitigating the risks. Cncussin management strategies have been supprted and reinfrced by the fllwing mandatry cmpnents: The IRFU intrduced mandatry time ut f the game fr thse with a suspected r cnfirmed cncussin at adult (21 days) and underage (23 days) level. All caches attending an IRFU caching curse must cmplete an nline cncussin educatinal mdule. Club and schl funding has been linked t cmpletin f cncussin educatin by caches. Referee reprting f all cncussin and suspected cases f cncussin in the Ulster Bank League. CONCUSSION PREVENTION The prmtin f crrect playing techniques, strng laws and strict refereeing (n hits abve the shulders, n tip tackles) and a medically supervised graduated return-t-play prtcl, that recgnises the imprtance f treating yuths mre cnservatively, is at the heart f ur apprach. Caches are being educated n prper tackle techniques and apprpriate training schedules, while referees are being educated n their rle in injury preventin and the dangers f ful play. CONCUSSION MANAGEMENT The IRFU perates a zer-tlerance stance twards playing with cncussin and the message is Stp Infrm Rest Return and Recgnise and Remve. Any player with any symptms f cncussin must be remved immediately and cannt return t play that day. Any player wh is even suspected f having a cncussin must be remved immediately and must nt return t play that day. Under IRB law 3.9 if the referee decides (with r withut the advice f a dctr r ther medically qualified persn) that a player is s injured that they shuld stp playing, the referee may rder that player t leave the playing area. The referee may als rder an injured player t leave the field t be medically assessed. Referees have been reminded f their pwers under this law and its use in suspected cncussin cases.

5 The IRFU is cntinually updating its cncussin management strategy in line with new develpments in this evlving area f sprts medicine. We are at all times guided by the Zurich Guidelines f 2012 and nging research. We have intrduced mandatry time ut f the game fr thse with a suspected r cnfirmed cncussin at adult (21 days) and underage (23 days) level. These times ut f the game have been fllwed by ther rugby unins. The IRFU Club Supprt Scheme which prvides financial supprt t clubs and schls has intrduced cncussin educatin by caches as criteria fr release f funding. Fr clubs t receive the participatin and caching grant, named caches must have cmpleted the IRB cncussin Management fr the General public mdule and be fully aware f the IRFU s Graduated Return t Play Plicy. The IRFU is als develping bespke adult educatin vides fr Irish caches. CONCUSSION RESEARCH Research drives IRFU s cncussin plicies. This reserch will infrm the IRFU abut hw effective its cncussin strategy has been and guide future develpments in cncussin management. The IRFU is currently supprting an epidemilgical study f schls rugby injuries (including cncussin) in Ulster Rugby. The Unin have develped an n-line reprting system t allw referees t advise us n any suspected r cnfirmed cncussins during a game. This enables us t audit the incidences and engage directly with the player t ensure return t play guidelines are bserved. The IRFU has als undertaken tw research studies n the prfessinal game in recent years and these studies have recently been published in internatinal peer reviewed medical jurnals as fllws: Cncussin knwledge and management practices amng caches and medical staff in Irish prfessinal rugby teams. Fraas MR, Cughlan GF, Hart EC, McCarthy C. Irish Jurnal f Medical Science Cncussin histry and reprting rates in elite Irish rugby unin players. Fraas MR, Cughlan GF, Hart EC, McCarthy C. Physical Therapy in Sprt The IRFU is at present lking at supprting cncussin research in the areas f cgnitive (mental) rehabilitatin, General Practitiner knwledge, injury bimechanics and knwledge and attitudes within the wmen's game. CONCLUSIONS AND RECOMENDATIONS The extent f sprts cncussin in Ireland is unknwn. The IRFU is at present supprting research t prvide sme answers t this questin.

6 The IRFU is leading the drive t change the culture within Irish Rugby with regards t cncussin and its management. The Unin has been practive in driving a cncussin awareness campaign, which has been underpinned by an initial brad based educatinal prgramme. This is nw mving t fcused educatin at multiple levels f the game and supprted by mandatry cmpnents. Recgnising the rle that General Practitiners, Emergency Medicine dctrs, Sprts Physicians and Physitherapists play in the recgnitin and management f cncussin and suspected cncussin, the IRFU has practively interacted with these bdies t supprt educatin f these imprtant grups. We all need t understand ur rle in managing this injury; the IRFU has stressed the rle and respnsibility f all by including particular emphasis n the rle f all players, caches and referees in its educatinal campaign and by highlighting the need t adhere t injury preventin strategies. We Recmmend the fllwing cnsideratins: 1. The develpment and distributin f cncussin educatin material thrughut the schls system. 2. The develpment f return t learn guidelines fr schls, similar t the return t sprt guidelines and educatin f teachers and parents n the imprtance f this part f management Cncussin educatin and training f all medical persnnel wh are invlved in managing this issue. This includes Sprts Dctrs, GPs, Emergency Medicine Dctrs and physitherapists in sprt. 5. Imprved access t specialist care e.g. neurlgists and the establishment f cncussin management clinics. 6. A cnsensus n minimum return t play timelines acrss all sprts natinally. IN CONCLUSION: The IRFU perates a zer-tlerance stance twards playing with cncussin and the message t all is Stp-Infrm-Rest-Return. The IRFU has been practive in its management f cncussin in rugby. and cntinues t evlve its strategic apprach t managing cncussin which is based n the mst up t date scientific evidence.

7 APPENDIX 1 IRFU Cncussin Strategic Plan 2013/2014 Player welfare is f paramunt imprtance t the Irish Rugby Ftball Unin (IRFU). The IRFU medical department is implementing a strategic plan t manage cncussin in Irish rugby. This plan utlines the visin, aims and implementatin f cncussin management in rugby unin in Ireland. Visin (intent): That all players, caches, referees and medical persnnel, invlved in rugby unin in Ireland, understand the imprtance f cncussin, hw t recgnise and manage it, therefre enhancing player welfare. What success lks like: That all players with cncussin, r suspected cncussin, are remved frm the field f play fr apprpriate management. Strategic Objectives (attentin t) 1. Leadership T change the attitude and culture within Irish rugby with regards t cncussin. Aim: The culture that we aspire t is ne in which; - Cncussin is cnsidered a serius injury, actively mnitred fr, Recgnised and practively managed with player safety the ultimate cnsideratin. 2. Educatin T educate players, caches, referees, parents, fficials and medical persnnel abut the fllwing: a. Health and perfrmance impact f cncussin. b. Hw t recgnize cncussin in players. c. On and ff-field management f cncussin r suspected cncussin. d. Return t play prtcl. Aim: That all parties understand the imprtance f cncussin, hw t recgnise cncussin and manage it, therefre enhancing player welfare.

8 3. Wrk in partnership - T wrk in cllabratin with the ther healthcare prfessinals wrking in the management f cncussin in Irish ruby unin (e.g. ICGP, Emergency medicine department) - T wrk with the prfessinal structures, IRUPA, branches, clubs, schls in the delivery f the cncussin strategy. - T wrk clsely with the Internatinal Rugby Bard s as t align ur strategy with the internatinal gverning bdy. Aim: That all bdies deliver an agreed message abut cncussin imprtance, recgnitin and management. 4. Cmmunicatin: Internal: T infrm IRFU and prvincial staff f initiatives related t cncussin being undertaken by the IRFU and prvinces t develp a cllective and cnsistent apprach. External: T infrm clubs, schls and media f the initiatives related t cncussin being undertaken by the IRFU and prvinces. Aim: That the agreed message is delivered in a user friendly frmat t all players, caches, referees, parents, medical persnnel and fficials invlved in Irish Rugby Unin. 5. Research/Audit: T cntribute t and undertake research in the area f cncussin in bth the amateur and prfessinal rugby game in Ireland. Aim: T mnitr the effectiveness f this strategy and aid develpment f best practice cncussin management. The IRFU fllws the Internatinal Rugby Bard (IRB) cncussin guidelines.

9 Rles, Respnsibilities & Authrity Rle Respnsibility Authrity Referee Cach Manager Mentr T remve any player wh, t his knwledge, has suspected cncussin frm the field f play and t ensure they d nt return t the same game. T ensure any player with suspected cncussin is remved frm field f play and des nt return until medically cleared r 3 weeks has passed. T nt select a player fr a game until medically cleared. T remve any player frm the field f play. Team selectin. Law / Gvernance t ensure same Player Dctr Club/Schl Branches IRFU T reprt t their parents / cach / medical persn any symptms suggestive f cncussin. T engage hnestly with medical staff. T nt return t play until medically cleared. T reprt t the referee / cach any signs in anther player suggestive f cncussin. T safely manage any player with cncussin r suspected cncussin. T abide by a referees decisin t remve a player frm the field f play. T ensure all players / caches / teachers and fficials are aware f the imprtance /management f cncussin. T enact the plicy n cncussin management as decided by the IRFU. T prvide leadership / plicy n cncussin management t the Branches. T ensure that the agreed rules and guidelines are adhered t. T reprt t the referee / cach a suspected cncussin. T make a diagnsis f cncussin. T declare a player medically fit t return t play after GTP prcess. The educatin / appintment f caches, teachers and fficials. T enfrce sanctins within the game as deemed apprpriate. T enfrce sanctins within the game as deemed apprpriate.

10 APPENDIX 2 IRFU Cncussin Strategy Plan 2014/15 Seasn The IRFU has during the 2013/14 seasn develped and delivered a significant strategy t address the issue f cncussin in rugby in Ireland. This strategy has included: - A very significant educatinal prgramme aimed at all cnstituents f the game including natinwide cncussin radshw talks, SAFE-Rugby, distributin f cncussin psters and wallet cards t every club, schl and emergency department in Ireland. - A cmmunicatin strategy including use f media (TV and radi), website, scial media (@IRFUSprtsMed), mailshts t all clubs and schls, In Tuch magazine and the internatinal match day prgramme. - Wrking in partnership with IRFU and prvincial staff, prfessinal medical staff, caches, referees, emergency medicine Dctrs, ICGP, IRUPA, clubs and schls. - Mandatry cmpnents Time ut f game and cach certificatin (IRB Cncussin mdule). As well as cntinuing t deliver the cncussin strategy, fr the 2014 / 2015 seasn the medical department has decided t specifically target key areas f strategy delivery as fllws: - Clarity f message - Early seasn fcus n awareness and educatin - Fcus n cach and referee educatin - Develpment and use f nline resurces - Audit f injuries - Player registratin frm - Enfrcement - Linking with ther bdies sprting / gvernmental

11 1. Clarity f message: T develp a succinct, memrable message as a guideline t all. STOP INFORM REST - RETURN. RECOGNISE AND REMOVE. IF IN DOUBT, SIT THEM OUT. 2. Early Seasn fcus: T specifically drive the abve message and educatin fr the perid frm mid August t end Octber Radshw talk (s). - Cncussin ambassadr. - Launch f message. - Cmmunicatin with clubs / branches. - Opening rund AIL games wallet card distributin. 3. Referee and cach fcus: T specifically target caches and referees in ur educatin drive. - Cach specific educatin sessin with fcus n identificatin, hand ver f care and return t play guidelines. AIL cach specific directives. - Referee specific educatin sessins with fcus n identificatin, remval frm field f play and hand ver f care. Presenting at natinal referees cnference in July 2014 Referee specific vide presentatin n-line. 4. Schls / child Fcus: T specifically target children and the schls rugby system in a child friendly way. - Child friendly nline educatinal mdule and brchure. - Target the educatin f schls and underage caches. Specific and phne call fllw up f schls re cncussin educatin. Schls specific educatinal sessins. 5. On line resurce: T develp an IRFU specific nline cncussin mdule that incrprates recgnitin f cncussin (visible clues and signs/symptms) and the IRFU return t play guidelines. A separate mdule t make the guidelines mre user and child friendly will als be develped.

12 6. Audit / research: T establish an audit / research n the incidence and management f cncussin within ne area f the game in Ireland. 7. Player registratin: Fr players wh sign a club/schl registratin frm, the additin t this frm f the fllwing: I cnfirm that I have read the IRFU A guide t cncussin in Rugby Unin (available n the website and that I agree t fllw the guidelines. 8. Enfrcement: a). Cnditin f entering a cmpetitin: - Team cach has read IRFU A guide t cncussin in Rugby Unin and agrees t fllw the guidelines. - Cach has t cmplete nline mdule n cncussin. - Cach agrees t reprt all suspected cncussins - n-line reprting system. b). In AIL games the referees reprts game, club, name f any player remved with suspected cncussin t IRFU Medical department which maintains a central register. 9. Linking with ther bdies: Fcus n physitherapists in rugby. Cntinued interactins with: 1) Emergency Medicine Dctrs, 2) ICGP 3) FSEM. 4) Dept f Educatin.

13 APPENDIX 3 STRATEGIC PLAN IMPLEMENTATION TO DATE 1. LEADERSHIP: - The Cncussin histry and reprting rates in Elite Irish Rugby Unin players research paper cntributes t identifying and understanding the present culture with regards t cncussin within the IRFU. - The IRFU is leading by: - Intrductin f minimum mandatry perids ut f rugby in the amateur game pst cncussin r suspected cncussin (where a dctr has nt assessed) f 23 days fr the under 20yrs and 21 days fr the adult amateur player (exceeding IRB guidelines in this area). - Prductin f a cncussin guide recgnized fr its value. - Use f vide analysis at Aviva fr the assessment f ptential cncussive injuries. The IRFU recgnizes the need fr different criteria fr the amateur game fr the fllwing reasns: (i). The lack f baseline assessment (available in the prfessinal game). (ii). The limited access t medical staff at time f injury in amateur game. (iii). The limited access t medical staff and t neurcgnitive testing (rutinely used in the prfessinal game) fr the management f the incident and the graded return t play in the amateur game. (iv). The limited access t specialist medical pinins in the amateur game where apprpriate. (iv). The greater lack f awareness f the significance f cncussin within the amateur game. (vi). The amateur game includes children and adlescents, the grup mst at risk pst cncussive injury. 2. EDUCATION: Standard Apprach t Field Emergencies in Rugby (SAFE-RUGBY) SAFE Rugby is the IRFU natinal rugby specific first aid prgramme. It was launched in May 2013 with the appintment f the IRFU First Aid and Injury Preventin Crdinatr. T date ver 850 medical and nn-medical persnnel frm clubs and schls have attended 54 curses. All IRFU and prvincial full-time n field staff have nw received SAFE-Rugby training. There are three different levels f the curse: Level 1 (nn-medical persnnel i.e. caches, parents, fficials, players) Level 2 (club/schl medical persnnel)

14 Level 3 (natinal and prvincial medical persnnel) These practically based curses include training in cncussin, basic life supprt (BLS), autmated external devices (AED), fracture management, and match day preparatin. All attendees must cmplete the Internatinal Rugby Bard (IRB) nline cncussin educatin mdule prir t attending the curse. Curses are schedule t take place between nw and the end f the seasn. As f December 2013, all caches undertaking IRFU Caching Curses must cmplete the IRB Online Cncussin Mdule as part f their certificatin. Pster and Wallet Card distributin: 30,000 IRFU Guide t Cncussin wallet cards utlining the diagnsis, management and return t play prtcls is t be distributed t all prfessinal players and all clubs and schls in early The design and prductin f A Guide t Cncussin in Rugby Unin in wallet card, A4 and nline frmats. The design and prductin f a cncussin awareness pster. Cncussin educatin psters and wallet cards were delivered t every club, schl in July 2013 and January 2014 and emergency department in Ireland January Wallets cards were distributed at Clntarf V Barbarians and Ireland V France U19s matches. IRFU Website A dedicated sectin n Cncussin is available n the IRFU medical website; Items available t dwnlad include the fllwing educatinal material; Pcket Cncussin Recgnitin Tl, the IRFU Cncussin Awareness pster, IRFU Guide t Cncussin wallet card, the Zurich Cnsensus Statement n Cncussin. The IRB cncussin guidelines and ther infrmatin n cncussin are available fr dwnlad n the IRFU Medical Website and n the IRB website (linked n IRFU website) Cncussin Radshw 41 cncussin rad shw talks have been delivered natinwide t the club and schl game t ver 1500 peple in all fur prvinces, as well as t the natinal U20, U19, U18 Clubs and U18 Schls Teams. 5 talks have been delivered t the referee assciatins in the fur prvinces and the Natinal Referees Assciatins. 5 talks entitled Cncussin its yur call were delivered by an expert neurlgist t all 250 prfessinal senir and academy players and caching staff in each f the fur prvincial teams and the natinal senir team. 2 Talks were delivered by IRFU medical staff t age grade and wmen s players.

15 5 educatin sessins were cnducted with the Irish Emergency Medicine Training Assciatin, Emergency Medicine cnsultants, the Irish Cllege f General Practitiners and the Faculty f Sprt & Exercise Medicine. 3. WORKING IN PARTNERSHIP: Irish Cllege f General Practitiners (ICGP) A frmal apprach has been made by the IRFU t the training cmmittee f the ICPG fr the IRFU t undertake a number f evening lectures with the ICGP t educate their members n cncussin. A presentatin was made at the ICGP Summer Schl, the main educatinal meeting f the cllege each year. Emergency Department Staff The IRFU is currently engaged with Accident and Emergency staff t undertake training with their members t educatin them n cncussin. We have presented t 50 A&E cnsultants (sme f whm wh are trainers f A&E dctrs) n cncussin. We have presented t the Irish Emergency Medicine Training Assciatin. Caches (Rugby/Fitness) and Referees The mandatry cmpletin f IRB nline mdule as part f certificatin fr caches (rugby/fitness). The develpment f a referee specific cncussin educatinal vide and referees and als the mandatry viewing f the Referee Department safety vide. The delivery f cncussin educatin prgrammes where pssible e.g. lectures at natinal/prvincial meetings etc. IRB Use f IRB infrmatin and mdules fr disseminatin and als nging cntact with IRB Cncussin Subgrup. Other bdies: The IRFU is wrking in partnership with the fllwing bdies: Other Natinal rugby unin medical departments (Scttish Rugby Unin, Rugby Ftball Unin, Welsh RU, Australian Rugby Unin). Prfessinal players unin (IRUPA) The prvincial branches, clubs and schl

16 4. COMMUNICATION: Internal Meeting f IRFU staff frm all departments related t the area f cncussin and utline f cncussin infrmatin and educatin initiatives t these staff fr disseminatin t their wn and prvincial staff and feedback n these. Strategy has been presented t the IRFU management cmmittee, the prvincial CEOs and IRFU directrs. External A cmmunicatin strategy t prmte cncussin awareness and the IRFU guide t cncussin was undertaken including the use f media: Natinal and lcal TV Natinal and lcal radi The natinal print media The IRFU website Scial media including the medical department Twitter handle (@IRFUSprtsMed) with fllwers Mailshts t all clubs and schls In Tuch magazine Internatinal match day prgrammes In December 2013 there was a media launch f strategy and in September 2014 a practical educatinal mrning n the Head Injury Assessment prtcl was run fr the sprts media 5. CONFERENCES / RESEARCH: Cnferences The IRFU has held a bi-annual sprts medicine cnference and this will be next held in April The tpic f cncussin is central t this meeting, and internatinal and natinal level experts deliver presentatins n cncussin. The IRFU supprted the Eurpean Brain Injury and Sprt Cnference in the AVIVA Stadium in December, Research The IRFU is currently supprt an epidemilgical study f schls rugby injuries in Ulster Rugby including cncussin. The IRFU has als undertaken tw research studies n the prfessinal game in recent years and these studies have recently been published in internatinal peer reviewed medical jurnals: Cncussin knwledge and management practices amng caches and medical staff in Irish prfessinal rugby teams. Fraas MR, Cughlan GF, Hart EC, McCarthy C. Irish Jurnal f Medical Science. 2014

17 Cncussin histry and reprting rates in elite Irish rugby unin players. Fraas MR, Cughlan GF, Hart EC, McCarthy C. Physical Therapy in Sprt PROFESSIONAL GAME: All f ur medics and physitherapists wrking with prvincial, age-grade and wmen's teams fllw the current IRB prtcls and have undergne SAFE-Rugby Level 2 r 3 training. All prfessinal players undertake ImPACT neurcgnitive testing at baseline and fllwing a suspected cncussin. Vide Analysis intrduced during the 2013 Nvember series games, the Natinal senir team utilize live vide analysis f players with suspected cncussin as part f the IRB Head Injury Assessment (HIA). This facility enhances the identificatin f cncussin related incidents in the game assisting the medical team. It is planned t rll ut this initiative t the prvincial teams fllwing this trial. Match-Day Dctrs - All IRFU match day dctrs must undertake the IRB Match Day Dctr nline mdule. 7. MANDATORY COMPONENTS: The IRFU intrduced mandatry time ut f the game fr thse with a suspected r cnfirmed cncussin at adult (21 days) and underage (23 days) level. As f January 2014, all caches undertaking an IRFU caching curse must cmplete the IRB nline cncussin educatin mdule in rder t receive their certificatin. IRFU Club Supprt Scheme: Criteria fr release f funding t Clubs and schls are nw dependent n cmpletin by caches f cncussin educatin. (Pint iv Cncussin Awareness: fr clubs t receive the participatin and caching grant, named caches must have cmpleted the IRB cncussin Management fr the General public and be fully aware f the IRFU Graduated Return t rugby Plicy).

18 Cmpnents fr Specific Grups: The IRFU undertk the fllwing with each f these grups in the 2013/14 seasn: Medical Dctrs: SAFE Rugby Level 2 and 3 Educatin sessins with the Irish Emergency Medicine Training Assciatin, the Irish Cllege f General Practitiners, the Emergency Medicine Cnsultants and the Faculty f Sprts & Exercise Medicine Cncussin educatin psters and wallet cards sent t emergency departments natinwide IRFU medical website resurce Caches: SAFE Rugby Level 1 Cncussin rad shw talks Cncussin educatin psters and wallet cards IRFU medical website resurce Mandatry IRB nline cncussin mdule certificatin prir t caching curse certificatin Referees: SAFE Rugby Level 1 Referees circulated re enfrcement f rule 3.9 which gives them the pwer t remve any player frm play fr cncerns abut their health. Cncussin presentatins t Branch Referee Assciatins and Natinal Referee Panel with specific emphasis n the rle f the referee. Cncussin educatin psters and wallet cards IRFU medical website resurce Players: SAFE Rugby Level 1 Cncussin rad shw talks amateur and prfessinal players Cncussin educatin psters and wallet cards IRFU medical website resurce Mandatry time ut f game perids fr amateur players Schls and Clubs: Funding nw linked t cmpletin f cncussin educatin by caches. Distributin f SAFE Rugby and Cncussin awareness psters and wallet cards t all rugby schls and clubs n tw ccasins last seasn. Practive ffering f Cncussin talks and SAFE rugby curses t schls.

19 APPENDIX 4 Dr Rd McLughlin (Shrt Bigraphy) MB, DCH, DObs, Dip Pall Med, MRCGP, MSc (Sprt Med), FFSEM (Ire & UK). Dr McLughlin Graduated frm UCD 1984 and cmpleted a General Practice training in He then cmpleted a fulltime ne year University curse in Sprt & Exercise medicine at the Lndn Hspital. On returning t Ireland in 1991 he set up practice as a Sprts and Exercise Medicine Physician at O Neills Sprts Medicine nw based at Dublin City University and University Cllege Dublin. He is n the Specialist Register f Sprts and Exercise medicine. At present he is Head f Medical Services at the IRFU, Directr f Medicine at the Institute and Medical Officer Olympic Cuncil f Ireland. He was Medical Officer fr the Beijing and Lndn Olympics. Dr McLughlin lectures n the Diplma and BSc curses in Sprts Management, at University Cllege Dublin and is a member and past chair f the Accreditatin Cmmittee f the Faculty f Sprts and Exercise Medicine, RCSI and RCPI. He is an examiner n the Intercllegiate Diplma in Sprts and Exercise Medicine in the UK. In the past he has been Medical Officer t Wicklw Intercunty Gaelic Ftball and Mnkstwn Rugby Club. He has been President f the Irish Sprts Medicine Assciatin, bard member and Treasurer f the Faculty f Sprts and Exercise Medicine, RCSI and RCPI and a member f the GAA medical & scientific cmmittee.

20 APPENDIX 5 - POSTER

21 APPENDIX 6 FOLDED WALLET CARD

22