How could Francis be deemed fit to return?
Professor John Fairclough is staring at a video of the 20th minute collision at Twickenham last weekend which has since become the subject of universal outrage. How Wales prop Tom Francis and centre Owen Watkin wound up being medically cleared to resume as though nothing untoward had happened has alarmed expert opinion, not least that of an orthopaedic surgeon with a track record in traumatic injuries second to none.
Five days after the event, Prof. Fairclough is still at a loss to understand why the players, victims of an accidental clash of heads, could possibly have been deemed fit to return.
“After 11 seconds on the ground, Tom tries to get up and stumbles,’’ he says, analysing the tape. “After 14 seconds he is leaning against the post. After 24 seconds he is still doubled up in obvious distress. Owen is still on the ground after 21 seconds. We have two players who have obviously been concussed. It is so obvious by their dazed reaction as to render any test utterly superfluous.
“Both players were taken off for HIA’s (Head Injury Assessments). I am concerned that the HIA didn’t confirm what we all could see. So what does that say about the HIA? That it is incapable of diagnosing concussion. That is what it seems to be saying in this case.
“Watch the video and then ask yourself: Do you think Tom Francis was concussed? A man who was unable to stand for 28 seconds after the impact. Much the same can be applied to Owen Watkin.
“Tom’s is the most obvious case of concussion I have seen in rugby. At the very least it calls into question whether the HIA is fit for purpose.
“Ask yourself this: ‘Do you think it was reasonable for these men to continue playing in their dazed state?’ If neither was concussed then we may as well rewrite every book that’s ever been written on neurosurgery and neurology.’’
Prof. Fairclough wants to know why the HIA Protocol, as decreed by World Rugby with effect from January last year, was not followed at Twickenham. Stage 1 – Off-field HIA1 assessment states: “Players displaying obvious on-pitch signs of concussion are immediately and permanently removed from play and the completion of the off-field screening tool is not required.’’
Neither Francis nor Watkin was ‘permanently removed from play.’ Francis was off the field for nine minutes, returning in the 30th and he was still giving everything to the cause 25 minutes later before being subbed at his usual time.
Watkin’s absence was even shorter, his game-time longer. He was
“The failure to enforce World Rugby’s order is an egregious error”
back, suitably bandaged, after five minutes and remained at his post until the last ten minutes before being relieved by Jonathan Davies.
Professor Fairclough, whose distinguished c.v. includes long stints working with both the Wales national rugby and football squads, calls the failure to enforce World Rugby’s order ‘an egregious error.’
He and Professor Bill Ribbans, consultant trauma and orthopaedic surgeon from Northampton, have sent a letter of protest over the Francis-Watkin issue in their capacity as members of Progressive Rugby, a lobby group made up of ex-internationals, coaches, medics and teachers.
Dave Cobner, of Cardiff Met University, a Cornishman steeped in rugby, is another leading light in an organisation whose avowed aim is to work with World Rugby to create a safer environment for players at all levels. They are not part of the legal action brought by Rugby Law against the global governing body as well as the English and Welsh Unions on behalf of players suffering from early-onset dementia.
“We are concerned because we ask ourselves what the parents and kids are thinking when they see the outcome of a collision like the one at Twickenham,’’ Cobner says. “The message it says to them is: ‘So you can be knocked senseless for 30 seconds, get back on your feet and carry on playing.’ This is the wrong message. For every game played at elite level, there is now one player removed for a HIA.
“A boxer who has been knocked out is not allowed to train for 30 days. If he is knocked out again, he is suspended for at least 60 days and, in the event of a further knock-out, that suspension is increased to six months.”
In Rugby League the compulsory rest period for concussed players lasts for 11 days. In Union, it can be as short as five or six. The Wales team management will argue that because Francis and Watkin passed their HIA tests last week, each will be available for selection against France on Friday. Professor Fairclough takes a very different view.
“If Tom Francis plays against France, what the WRU are saying is that they consider the brain of a man who has been knocked out and unable to stand for 24 seconds has fully recovered. By extension, they are also saying that he is at no risk only 13 days later. I know of no medical evidence to support that.
“All we can say is that we know any tissue subjected to trauma takes time to heal. We are talking here about the brain. You can’t apply strength or conditioning to the brain.
“Francis couldn’t get to his feet at first because his brain wasn’t working. There has to be a better understanding that head injuries cannot be trivialised, least of all by players because they want to keep playing.
“We have to ensure that it is taken out of the players’ hands and put their safety first. You cannot use a test to say that it’s safe for that man to go back on when he is obviously concussed. Because you can’t see brain damage it doesn’t mean that the brain in question hasn’t been damaged. Anyone not sure about that only has to look at the video of last week’s match.’’
Another video worth a look shows Ireland’s Ryan Baird smashing a shoulder into the face of Italy’s Callesandro Fusco, an offence strikingly similar to that for which an Italian had been sent off. Incredibly, the Ireland lock wasn’t even cited.