INJURY MANAGEMENT: PRESENTATION TO PORTFOLIO COMMITTEE

 

Clear distinction should be drawn between acute rugby injuries (those that occur during a match or a practice) and chronic injuries (which are longstanding ones that may present at any time). 

It is the group of acute catastrophic injuries, namely neck and head injuries that grab the news headlines and thereby cause great concern amongst both rugby persons and the general public alike since these injuries may result in permanent disabilities and death.

It is through this window, which represents a small percentage of all injuries sustained in rugby, that the safety of rugby as a sport is often judged and questioned.

 

It is the fiduciary duty of SA Rugby as custodians of this game to dispel this notion by creating the environment for all its players to ensure their safety, diminish the risk of injuries and make the game more enjoyable. We have always accepted that duty.

 

Since 1993 SA Rugby began taking stock of its Provinces and established that there was a serious lack of first aid support at most of the matches played at club level in particular.   Reasons cited for this included:

  • Cost of hiring first aiders
  • No trained first aiders in communities
  • Training of first aiders not affordable
  • Training courses conducting during the week when communities were at work

 

SARU through its Medical Department wrote a booklet highlighting the management of common rugby injuries, both life threatening and non-life threatening. With the aid of a sponsor we embarked on a series of one-day training courses for rugby clubs throughout SA until 2000 using this booklet as a guide.

More than 2000 persons were trained in basic first aid procedures including the management of acute spinal injuries

Areas included:

  • Eastern Cape
    • Queenstown
    • Fort Beaufort
    • East London
    • Port Elizabeth
    • Port Alfred
    • Uitenhage
    • Graaf Reinett
    • Cradock
    • Humansdorp
  • Gauteng
    • JHB
    • Soweto
  • Mpumalanga
    • Nelspruit
    • Witbank
  • KZN
    • Durban
    • Maritzburg
    • Kokstad
  • Kimberley
  • Welkom
  • Western Cape
    • Cape Town
    • Wellington
    • Robertson
    • Oudshoorn
    • Swellendam

 

In spite of this, 2001 was a very bad year in terms of a sudden increase in the number of catastrophic injuries especially amongst schoolboys.

Factors identified that contributed towards this unacceptable situation included:

  • Continued absence of adequate first aid at fields
  • Players who were recovering from injury were coerced or permitted to play
  • Players playing out of position

 

SARU increased it’s funding of the Chris Burger Petro Jackson Fund and in conjunction with the Fund launched the Power of Prevention Campaign, which consisted of:

·         Spine Line

·         Coaches Logbook which was developed in conjunction with the SA Rugby Coaching Department and which places the emphasis on correct coaching and safe techniques.

·         The Rugby Medic Club- (Training and certification of first aiders.)

 

Despite all these efforts and just when we thought that we were on top of things 2006 proved to be another “bad’ year in terms of the numbers of catastrophic injuries and the number of so called near misses. Injuries to high profile Springboks further worsened the publicity these injuries received.

 

Again factors were identified which could have led to these injuries:

·         Poor field side management by medically qualified personnel

·         Players who should not have been playing as a result of previous injury sustained and who had not fully recovered

·         Players continue to be played out of position

·         Social players

·         Poor coaching resulting in tackle phase and scrumming phase injuries

·         Foul play

·         Increased Competitiveness at schoolboy level resulting in

o        Playing players against medical advice

o        Encouragement of foul play

o        The use of drugs in sport

 

A high-powered Indaba attended by numerous stakeholders including SA Rugby gathered in August 2006 to attempt to develop a collective response to the current unacceptable number of catastrophic injuries in SA.

 

Out of this Indaba emerged certain key interventions upon which SA Rugby acted swiftly in the establishment of the SA Rugby Player Wellness and Performance Programme. SARU once again reaffirmed its commitment to all its players to ensure their safety, diminish the risk of injuries and make the game more enjoyable for them.  


 

Purpose of this programme is to create an infrastructure and capacity to assume responsibility for rugby players in terms of:

 

n       Injury prevention

n       Injury management

n       Rehabilitation

n       Education

n       Player Support

n       Wellness

n       Research

 

This programme is the responsibility of SARU and as such has to be managed in a professional, efficient manner in order to add value to the rugby community and the performance of teams and players across the spectrum

 

We believe that it a very comprehensive program that addresses all levels of play from grassroots (mass participation) to semi professional, professional and elite players. However the programme will obviously identify priorities, which at this point in time would have to encompass all of these stated areas of responsibility.

 

A Board consisting of both SA Rugby senior personnel and external stakeholders will oversee the Programme

 

Purpose of the Board would be: Oversight and governance, including

n       Strategy and direction

n       Performance measurement

n       Reporting on operational and financial performance to SA RUGBY

Other key elements of the programme will include:

 

  1. MEDICAL PANEL

 

Purpose:

 

q      Provide clinical oversight for the initiative

q      Approve all initiatives and programmes from a medical/clinical perspective

q      Veto rights on all initiatives and programmes

 

  1. PROGRAMME MANAGER / CO-ORDINATOR

 

Purpose:

·         Oversee general operations of the programme

·         Assume performance responsibility

·         Co-ordinate operations

·         Manage and measure performance of all subcommittees

·         Budget preparation

·         Financial performance

·         Reporting to Board

·         Make recommendations to programme changes and enhancements

·         Make recommendations to Medical Panel

·         Make recommendations to Board


 

3. HEALTH SERVICES

Areas of Responsibility:

n       Emergency Medical Services (EMS)

         EMS staffing levels and numbers

         Resource requirements

         Standards

         Protocols

         Designated receiving facilities and Disaster Management

 

n       Wellness

         Player and family trauma support

         Counselling – player and family

         Financial Wellness

         Legal Wellness

         Medical Advice

         Psychological Wellness (during injury)

         Wellness workshops

 

n       Medical / Clinical Issues

         Rehabilitation programmes

         Recommended Specialist list

         Fieldside regulations and standards

         Banned and controlled substance use and info

         Rule change recommendations

         Technique change recommendations

 

n       Coaching and Conditioning:

         Techniques to maximise performance:

         Avoid Injury

         Reduce incidence of injury

         Reduce severity of injury

         Reporting requirements

         Return to play timeframes

 

n       Match Officials / Referees:

         Implementation of recommendations

         On field implementation

         Injury prevention and avoidance

         Injury reporting

 

4.BENEFITS / VALUE ADDED SERVICES

 

Areas of Responsibility:

n       The co-ordination and evaluation of potential products to be included into the benefit design 

n       Consider the issue of offering value added services

n       Source products and benefits in the market as identified and approved in other divisions

n       Screen potential service providers and products for evaluation and inclusion into benefits


 

Examples of benefits / value added services:

n       Emergency Medical Assistance

n       Roadside Assistance

n       Home Assistance

n       Medical Aid / Insurance

n       Concierge Services

n       Security Services

n       Retirement Benefits

n       Disability / Death Benefits

 

  1. TRAINING AND EDUCATION

 

Purpose:

n       To take the programmes and information developed by other divisions and ensure that the information is collated and disseminated

n       Meet on training objectives and targets as set

 

Responsibilities:

n       Collation of information

n       Production of information and educational material

n       Creation of training and education programmes

n       Information availability via various media – website, call centre, pamphlets etc.

n       First Aid / First Responder training

n       Train within the sport structures those protocols developed

n       Roll out of training programmes around the country

n       Evaluate standards and effectiveness of training programmes

n       Develop and implement a “life after rugby” programme for players to prepare them for a career in commerce and industry once their playing days are over

 

  1. RESEARCH

 

Purpose:

n       Conduct research into all aspects of the game with the intention of gaining deeper and better understanding of topics and dynamics thereby effecting player safety and/or wellness and/or performance etc

 

Responsibilities:

n       Mechanisms of injury

n       Injury prevention and avoidance

n       Incidence of injury

n       Optimal coping and return-to-play strategies

n       Approval and endorsement of equipment and suppliers

n       Rehabilitation best practices

n       Warning signs

 

      7.   MARKETING/COMMUNICATIONS

 

Purpose:

 

n                   To market different aspects of the programmes to the market identified utilising the most appropriate media


 

Responsibilities:

 

n                   Awareness of programme

n                   Awareness of access number

n                   Utilisation maximisation strategy

n                   Sponsors identification and contracting

n                   Media relationships

n                   Advice in benefit/VAS design

n                   Create awareness for sponsors

n                   Create value

n                   Market segmentation – inside rugby structures, within the sport, public, government, department of sport etc

n                   Targeting strategies

 

8.CALL CENTRE

 

Purpose:

 

n       Main contact, facilitation and co-ordination point for all products and services as offered to players, coaches, refs, public, parents etc.

 

Responsibilities:

 

n       Management and co-ordination of acute phase of injury

n       Co-ordinate transportation of injured parties

n       Co-ordinate referral and admission to medical facilities

n       Co-ordinate access to advice and wellness programmes

n       Be a primary source of information on all aspects of the programme

n       Co-ordinate rehabilitation

 

9. DATA MANAGEMENT

 

n                   Capture, manage, manipulate and make available information as required by other divisions in the furtherance of the programme objectives

 

Responsibilities:

 

n                   Injury reporting platform and mechanism

n                   Electronic match report submission

n                   Database establishment

n                   Data integrity

n                   Data confidentiality and access

n                   Reporting at different levels – different info

n                   Reporting and analysis of data for Research Division

 

 

THE ROAD AHEAD

 

Much progress has been made since the August 2006 Indaba.

SA Rugby approved the programme in January 2007

  1. The proposed Members of the Board have since agreed to serve in this programme
  2. Spinal Cord Injury Research protocols have been agreed to and research has commenced. Until now, spinal cord injury information has been largely anecdotal and it is imperative that scientific research in this area be conducted. This will enhance the methodical approach that we as SA Rugby need to take to effectively curtail the number of spinal injuries.
  3. The persons serving as chairpersons of the various sectors have been identified and most them have agreed to serve
  4. The SA Rugby Medical Association consisting of all doctors serving the Provinces and clubs has endorsed the programme. They have also agreed to serve in whatever capacity

The main objectives of the Association include, but do not exclude others:

·         To create and maintain a scientific communication forum for South African rugby medical professionals,

·         To communicate with and advise SARU and relevant other organizations on strategies to prevent and manage injuries in SA rugby,

·         To assist in the development, implementation and operation of a comprehensive emergency and medical care structure for rugby at all levels in South Africa,

·         To liaise with the SA Rugby Research and Scientific Committee on research, injury prevention and management,

  1. The Medical panel has met and has identified for injury prevention
    1. Schools and clubs as priority areas
    2. Spinal and head areas as the primary area of concern
    3. Rural areas as a priority area
    4. Research focussing on spinal cord injuries
    5. Training of first aiders
    6. Coaches and referees

 

  1. Discussions with the Coaching Department have taken place
    1. Preventative Coaching and Safety sections have been included in the coaching education programme at all levels
    2. Vodacom Preventative Coaching seminars have recently been held in all 14 Provinces
    3. The newly developed Coaching Accreditation System will include a module on Safety/Preventative coaching as a prerequisite to be accredited at any level
    4. This prerequisite exists for referees but more stringent measures would have to be put in place to ensure that there is conformity by all regional referees associations
  2. Meeting with Chris Burger Petro Jackson Fund
    1. The Fund will continue with its Power of Prevention Campaign
    2. The Chairman of the Fund would serve on the Board
    3. The Fund would have input through its CEO wherever applicable
  3. Meeting with the Sharks-smart program presenters. This Injury prevention program has been operating very successfully in KZN. They have agreed to be part of this program
  4. We have met with the CEO of the SA Rugby Legends and we would be utilising their immense network in the rural areas of South Africa
  5. Both SASCOC Anti Doping Commission and the South African Institute for Drug Free Sport would be called upon to be part of this programme in eradicate doping at schools level in particular
  6. The existing Concussion Management Clinics in some of the major cities have been approached to become an integral part of the programme

 

It should be very clear that this programme is an all-inclusive program, which includes many stakeholders. Our jurisdiction may extend only to 14 Provincial Rugby Unions, Referees and Coaches but our responsibility for the safety of rugby players extends to all South Africans.

We do believe that we can be successful in providing peace of mind to all participants and their families in making this game safer.

We need to get into the schools and the Department of Education can provide us with the necessary assistance to do that.

There are many other aspects where we would obviously need assistance but that would be a topic for another occasion.

 

SA Rugby has often been described as a National Asset and it therefore behoves all South Africans to assist us in this very ambitious program. We certainly need your support.

 

 

DR. ISMAIL JAKOET

 

For: SA Rugby Union

 

20 FEBRUARY 2007