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18th man as replacements for players suffering concussion

Chook Norris

First Grade
Messages
8,319
Club doctors fear success is bigger priority than safety

Canberra Raiders doctor Wilson Lo has confirmed there is simmering discontent within the NRL medical ranks, admitting some of his colleagues feel sidelined as some clubs put on-field success ahead of player welfare.
In the wake of a mass exodus of NRL doctors, Lo said supplements programs being introduced without doctors' knowledge and exploitation of concussion guidelines were two areas of concern.
Club doctors discussed a range of issues at a meeting in Sydney on grand final day, and plan to submit a proposal of recommendations to the NRL. A number of club doctors quit their posts at the end of the season, including high-profile Sydney Roosters medico John Orchard.
Lo stressed he was more than happy with the game-day processes and supplement program of the Raiders, which he described as one of the competition's most reserved.
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But he said the meeting highlighted the concerns of some colleagues of the threat of litigation as clubs increasingly tread a fine line to gain an on-field edge. ''Obviously there's been a lot of resignations this year, there's a general feeling a lot of people aren't happy with clubs because they're making decisions behind doctors' backs, whether it be concussion or supplements,'' Lo said.
''I'm happy because it's not my situation at our club, but I could see how it could easily happen at other clubs. There's a general feeling they're listening to the doctors less and less, and just feel the doctors are a necessary evil.''
The main change doctors want is the introduction of an 18th man for matches to replace a player who has suffered concussion.
They also want clearance for medicos to enter the field of play at any stage. At the moment, they need permission from the game-day ''orange shirt'', a club's designated medical official, to give them the green light.
Lo fears some orange shirts at other clubs aren't suitably qualified, and are being exploited by coaches to deliver messages to players.
He believes the no-tolerance policy for concussion introduced about three years ago isn't working, as clubs are more hesitant to take a concussed player off and lose him for the rest of the match.
Orchard had long campaigned for an 18th man, and Lo feels it would convince clubs to take a tougher stance. Under the initiative, a player would be examined thoroughly for 20 minutes, and if cleared of concussion would return to the field.
''The general feeling at some clubs is they're employing an orange shirt and putting him out there to deliver messages from coaches, which isn't their role,'' he said. ''To be an orange shirt you only have to be a level-two sports trainer, we want to propose they're a doctor, physio or paramedic.
''Another thing we agreed with is the doctor should be allowed to enter the field at any stage. In some other clubs they're really upset about it. The orange shirt is basically an ex-player or has an allegiance to the coach and not the player welfare.''
Lo acknowledged the potential for coaches to exploit the 18th man rule, but believes it is a necessary change. He said the doctors would be happy if the NRL were to employ independent doctors for potential concussion cases at games, to avoid any stigma of clubs putting players at risk.
''They're asking us to treat it more seriously and we all agree with that, but certainly some doctors feel sidelined because he's the only one who agrees with that notion,'' Lo said. ''They say the coach can exploit the rule, but if you're serious about concussion you just put up with it.''
The Raiders were incensed when their approach to concussion was questioned by the NRL after forward Joe Picker returned to the field late in Canberra's round eight win in Melbourne after copping an early head knock.
Lo, who also works with basketball's Canberra Capitals and part-time with AFL's GWS Giants, was unhappy his practices were put under the spotlight without the knowledge of the NRL's chief medical officer Ron Muratore.
''I brought him off and watched him for 50 minutes, even if you have the mildest concussion you have to get some type of symptoms coming up,'' Lo said.
''There wasn't one instant where the team pressured me saying he needs to go back on, the assistant coach actually questioned me if I was sure. They [NRL] sent a letter to the club asking me to provide what I did and that's fine, but they didn't even tell the chief medical officer. There was no pressure at all from the club, I was comfortable with my decision.''
Read more: http://www.smh.com.au/rugby-league/...than-safety-20131018-2vsd5.html#ixzz2i8pHKDre

thoughts?
 

muzby

Village Idiot
Staff member
Messages
45,959
It's a great idea, but like anything introduced some prick will find a way to rort it.

Players who have done an injury that would normally leave the team with 16 men to finish the game will claim concussion instead..

Eg. Someone who does their knee will suddenly be 'concussed' as well from when they hit the ground...
 

eozsmiles

Bench
Messages
3,392
I guess the 18th man makes it "easier" for the doctor in a concussion situation because there is less pressure to get the player back on to the field - not that the doctor should be influenced by such pressure, but they are footy doctors.

Basically, if a player is 50/50 the doc can scratch him and stay on the safe side, knowing that there is a fresh replacement available. I would actually like independent doctors for this task. I'm sure any doctor would rather tape up a 50/50 hammy than send a half concussed player back out there. Spinal and head injuries are in their own class compared to the strains and sprains. You can risk a hammy and the bad result might be a couple of weeks on ice and physio. Everything from the shoulders up must be treated with paramount care.
 

bottle

Coach
Messages
14,126
Will be rorted.
Less interchange not more is required to improve the game as a spectacle. However that approach is against the medical advice.
Let's not provide any more reasons to lessen the effect of attrition.
 

Dutchy

Immortal
Messages
33,887
It's a great idea, but like anything introduced some prick will find a way to rort it.

Players who have done an injury that would normally leave the team with 16 men to finish the game will claim concussion instead..

Eg. Someone who does their knee will suddenly be 'concussed' as well from when they hit the ground...

Independent doctor at each match.
 

Parra Glory

Juniors
Messages
113
I think it should be if a player has suffered concussion due to an illegal tackle (eg being put on report or sent off), then the team with the injured player can use their 18th man to replace him. However if the tackle is not deemed illegal, the substitution can't be made.
 

Puntastic

Juniors
Messages
993
As I understand it, players who are concussed may not to return to the field, but this is determined by the club doctor. Perhaps an independent 3rd party may be better suited to make this call.

Edit: what dutchy said

This article assumes that club doctors are not also driven by success and pressure from their employers - the same sort of problems that presumably lead to the same situation he complains about now.

As others have said, an 18th man is just as rortable a system.
 

Chook Norris

First Grade
Messages
8,319
Will be rorted.
Less interchange not more is required to improve the game as a spectacle. However that approach is against the medical advice.
Let's not provide any more reasons to lessen the effect of attrition.

Under the current approach teams are far too hesitant to take players off:

He believes the no-tolerance policy for concussion introduced about three years ago isn't working, as clubs are more hesitant to take a concussed player off and lose him for the rest of the match.

There is too severe a risk of long term head trauma. As Dutchy has said, perhaps we can have independent doctors
 

AlwaysGreen

Immortal
Messages
49,978
So what happens if two players get concussed? 19th man?

If you have an independent doctor at the game then the need for an extra replacement is moot. If the doctor says he can't go back on you are reduced to 16 men and its play on.
 
Messages
17,035
Every game should have an independent medical body who determines if a player can take to the field after a serious injury. If they did that and had an 18th man it would be a step in the right direction
 

AlwaysGreen

Immortal
Messages
49,978
Why have the 18th man? And having an independent doctor reviewing for injuries other than concussions is unnecessary. Part of the drama and toughness of league is seeing a player with an injury that would probably stop the average Joe from functioning take the field is inspiring and what the game is about.

A doctor will see a broken nose, decide that it might be a threat to his airway and rule him out of taking further part. Concussions yes, everything else no.
 

DeeJ

Bench
Messages
3,119
It should be an under 20's player to be 18th man. This reduces the chances of taking advantage of the rule as they will be fatigued and obviously not worthy of top 17.
 

CC_Roosters

First Grade
Messages
5,221
How about remove club doctors and the NRL assign 2 match doctors to each game. Take the decision out of the clubs hands who like in everything are short sighted and self interest dominates
 

DeeJ

Bench
Messages
3,119
How about remove club doctors and the NRL assign 2 match doctors to each game. Take the decision out of the clubs hands who like in everything are short sighted and self interest dominates

I'd say the outside doctor wouldn't know the players as well as team doctor. Could go wrong with misdiagnosis, etc.
 

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