A concussion without a thorough concussion test

[bomberclifford]

That he clearly had concussion.

... and only North fans could see this?

 

[Sterge]

The question here isn’t really about whether Simpkin was concussed, but why no further testing was done which could have helped determine how serious the level of impact was.

It seems like you are assuming they just went 'oh well he failed let's leave him' They can rule him out concussed and then still provide further treatment, all the test is for is to diagnose the concussion to begin with.

 

[The Warlord]

... and only North fans could see this?

Given it was the first time I can think of him leaving the ground for concussion, yes.

Jy cracks in as hard as anyone going, and is a tough little nugget.

You know your own players, and I'd never seen him look like that.

 

[The Warlord]

Worth recalling we once got fined over a concussion issue when we sent Lachie Hansen back on after he passed a test.

 

[The Warlord]

Why wasn't he taken straight off?

He was pushing trainers away and they got him off as soon as they could.

 

[John Who]

It seems like you are assuming they just went 'oh well he failed let's leave him' They can rule him out concussed and then still provide further treatment, all the test is for is to diagnose the concussion to begin with.

I think showing some comparisons would make my point a bit more clearer.
Exhibit A (Sloane concussion)


Exhibit B (Will Hamill concussion)


I'm only showing 2 examples above because I watched these games when it had happened, and on both occasions, Sloane and Hamill could walk and talk and was brought into the changerooms for a thorough assessment. You can argue that both these examples were worse appearing than the Simpkin knock, from the vision of impact, the length of time they remained lying on the ground, and behavioural changes after the knock. Yet, both were assessed further, and not done at the bench.

 

[Adelaide Hawk]

He got hit on the head, by a player who had chosen to bump, and was clearly affected by the hit.

I thought that was the rule, or has it been changed? It was made abundantly clear a couple of years ago that if you attempt to bump and get a player high, then you're in trouble.

 

[seanoff]

“He failed at first step. End of test” - this is not consistent with players being assisted to the changerooms. Are you suggesting that players sent to the changerooms for 20 minutes aren’t severe enough, so need further testing to qualify “concussion”?

20 mins is the set time for a hia. they don’t test you for 20 mins.

I think showing some comparisons would make my point a bit more clearer.
Exhibit A (Sloane concussion)


Exhibit B (Will Hamill concussion)


I'm only showing 2 examples above because I watched these games when it had happened, and on both occasions, Sloane and Hamill could walk and talk and was brought into the changerooms for a thorough assessment. You can argue that both these examples were worse appearing than the Simpkin knock, from the vision of impact, the length of time they remained lying on the ground, and behavioural changes after the knock. Yet, both were assessed further, and not done at the bench.

sloane when he got up was combative. That’s a huge red flag. the guidelines if you don’t have a doctor is to transport straight to hospital when a player does that. They didn’t test Sloane either btw. They took him into the fridge in Darwin to watch him

hamill was in a bad way. they didn’t test him. They took him down to the rooms to lay him down And watch.

 

[John Who]

20 mins is the set time for a hia. they don’t test you for 20 mins.


sloane when he got up was combative. That’s a huge red flag. the guidelines if you don’t have a doctor is to transport straight to hospital when a player does that. They didn’t test Sloane either btw. They took him into the fridge in Darwin to watch him

hamill was in a bad way. they didn’t test him. They took him down to the rooms to lay him down And watch.

I’m quite intrigued how you know what happened with Sloane and Hamill in the rooms? And what made you seem to think there was no doctor at hand to test him?

I’m not really arguing with you btw, and I know 20 minutes in the rooms isn’t 20 minutes of testing, but merely 20 minutes time off minimum while there is testing done.

I purposefully picked the Sloane incident because any medico and a child could probably see Sloane wasn’t “with it”, even though he could jog off the ground looking comfortable. If it was as simple as the argument “he failed at first step”, then why wasn’t Sloane monitored and assessed at the bench, and like all the other ones similar to the Sloane incidents?

 

[1970crow]

I think showing some comparisons would make my point a bit more clearer.
Exhibit A (Sloane concussion)


Exhibit B (Will Hamill concussion)


I'm only showing 2 examples above because I watched these games when it had happened, and on both occasions, Sloane and Hamill could walk and talk and was brought into the changerooms for a thorough assessment. You can argue that both these examples were worse appearing than the Simpkin knock, from the vision of impact, the length of time they remained lying on the ground, and behavioural changes after the knock. Yet, both were assessed further, and not done at the bench.

What difference does it make. They had enough visual evidence to rule him out of the game. Further assessment and care occurs later and is unrelated to the risk analysis and procedures relating to determining if he can get back on the park in that game.

 

[John Who]

What difference does it make. They had enough visual evidence to rule him out of the game. Further assessment and care occurs later and is unrelated to the risk analysis and procedures relating to determining if he can get back on the park in that game.

Is it really wrong of me to ask why a concussion test was done on a bench, when in recent years, it’s been done in the changerooms?

I don’t mind a quick assessment anywhere as long as it’s on protocol and ongoing assessments are done. Just on this example it’s an anomaly location, and thus why I’m asking the question why the anomaly.

I’d argue though testing in the rooms is a more beneficial location as there is less noise and distraction, and perhaps can benefit both the assessor as well as the player to rest their brain better after a hit.

 

[D-N-R]

Is it really wrong of me to ask why a concussion test was done on a bench, when in recent years, it’s been done in the changerooms?

I don’t mind a quick assessment anywhere as long as it’s on protocol and ongoing assessments are done. Just on this example it’s an anomaly location, and thus why I’m asking the question why the anomaly.

I’d argue though testing in the rooms is a more beneficial location as there is less noise and distraction, and perhaps can benefit both the assessor as well as the player to rest their brain better after a hit.

The test can be done quickly. Even looking at a replay can tell a medico if someone is concussed or not. The 'test' is to check if they can go back on. If they have already decided they can't go back on, they don't need to do the test.
Then they wait, and make sure nothing further happens. If a player is sitting on the bench, they can be observed. It also means the medicos are available if someone else is injured, rather than down in the changerroms.
Also, this would be dependent on how bad they think the concussion is. You can have a mild concussion or a severe concussion.

 

[flamethrower]

Is it really wrong of me to ask why a concussion test was done on a bench, when in recent years, it’s been done in the changerooms?

I don’t mind a quick assessment anywhere as long as it’s on protocol and ongoing assessments are done. Just on this example it’s an anomaly location, and thus why I’m asking the question why the anomaly.

I’d argue though testing in the rooms is a more beneficial location as there is less noise and distraction, and perhaps can benefit both the assessor as well as the player to rest their brain better after a hit.

A thorough concussion test would only be done in the rooms if the symptoms were mild or inconclusive.

For the North player to be ruled out of the game immediately, his symptoms must have been at the severe end or quite obvious to a qualified professional (not knowing where he was, talking "gibberish", complaining of blurred or double vision etc).

In either case, the player is always tested further after the initial examination for the severity of the concussion, method of ongoing treatment, and monitoring of recovery.

 

[seanoff]

I’m quite intrigued how you know what happened with Sloane and Hamill in the rooms? And what made you seem to think there was no doctor at hand to test him?

I’m not really arguing with you btw, and I know 20 minutes in the rooms isn’t 20 minutes of testing, but merely 20 minutes time off minimum while there is testing done.

I purposefully picked the Sloane incident because any medico and a child could probably see Sloane wasn’t “with it”, even though he could jog off the ground looking comfortable. If it was as simple as the argument “he failed at first step”, then why wasn’t Sloane monitored and assessed at the bench, and like all the other ones similar to the Sloane incidents?

given I was sitting about 5 seats form the Adelaide bench I know exactly what happened. They took him in and then the doc popped straight out. Someone stayed with him. But it wasn’t the doc

In Darwin there are air conditioned rooms directly behind the benches. He went in there. It’s not exactly hidden.

hamill wasn’t tested. He was clearly badly concussed. They may have tested him for spinal injuries but not concussion. Maybe done a gcs score at intervals just to check on him.

And I said if a doctor wasn’t available for Sloane it’s a take to hospital situation for below AFL level

 

[master bate]

Guidelines are just guidelines, they don't replace clinical judgement.

Simpkin doesn't need the full test because they've decided he clearly was concussed. He doesn't need to go the rooms for more thorough medical examination because otherwise his symptoms are mild and they can monitor him on the bench. He is simultaneously both too sick and too healthy to go to the rooms, which is fine.

There's a point to be made about concussion first aid and immediate low stimulus treatment in a quiet room but there's not a lot of evidence for that.

 

[John Who]

Ok guys, I’ve deliberately hold back on some thoughts as I was waiting to see how Simpkin went during the course of this week and whether he’d play this weekend - he is playing.

So here’s what I think went on using all available data, and from a working perspective of having involved in concussions:
- I believe Simpkin’s knock was somewhere between a “dazed” incident to a “mild concussion”.
- “dazed” incident is a short temporary episode of mild confusion/disorientation, and then quickly returning back to full brain function.
- people here making assumption “he failed first test”, when in fact I’m thinking he may not have obviously failed any test at all whilst on the bench.
- the above would then make sense for the medicos to then assess the video footage, and then using a clinical judgment that it would be safer if Simpkin was rested for the rest of the match, and perhaps ongoing observations when applicable.
- I think the above point would be the best approach, because if further testing was done, Simpkin may well pass the full concussion test in the changerooms, and then the medicos would feel obligated to let Simpkin back out on the field; which would be against their instincts of a borderline/mild concussion.

- Simpkin was able to run, talk, smile, looking very comfortable sitting on the bench. Then you take into account no further mention of delayed concussion symptoms during this entire week, and the fact he’s playing the following round without the need for a rest; suggests the initial hit he was somewhere between being dazed or mildly concussed.