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Trust PA Spinal Injury EYES UP - what's that all about?

If you don't have time to read the whole subject, just scroll down to POSITIVE PROGRESS WORLD RUGBY & view the link,

plus the links at the bottom of the page to see; why & how UK Rugby should be dealing with this injury issue.

 

INTRODUCTION & BACKGROUND

a) This information has been compiled by me as Director of Trust PA Spinal Injury Charity which was set up in memory of our youngest son Paul-André (known as P-A). He was tragically injured during a rugby tackle, where he sustained a high level C1/C2 spinal cord injury (SCI) that instantly paralysed him from the chin down, unable to even breathe for himself. He survived many traumas and inappropriate treatment over the coming six months of good and poor NHS care, when he eventually died unexpectedly and unnecessarily from a pulmonary embolism aged just 26 years. The work of Prof. Geoffrey Raisman FRC UCL Institute Neurology had inspired him to fight for his life and recovery.  PA wanted to be part of the scientific/clinical route towards SCI repair becoming available, he offered to take part in the clinical trials. Sadly that did not transpire and in PA’s memory, Trust PA Spinal Injury Charity is now raising funds to support the route to the ultimate repair of SCI to help other injured paralysed men, women and children. More recently Prof. Raisman set up the first Spinal Repair Unit based in the Dept. of Neurology at UCL which is currently working to perfect a non invasive repair technique for SCI Paralysis (See latest info: http://www.trustpa.com/SCI-Research.php). 

 

b) At the Coroner`s Court a request was made  by the Coroner to obtain any video evidence of the rugby game/tackle incident, during which Paul-André’s was injured. This was to establish the cause and reveal any occurrence of foul play. While in hospital Paul-André had said that "during the incident someone either kneed or kicked me in the head".

A spectator’s copy video footage was available, which showed that no foul play was evident.

Subsequently for years I could not understand, how such a devastating injury could have possibly occurred, - from what the video revealed & what I had seen in many games & similar tackles.

Via the internet some five/six years later I discovered a training video called Heads Up, that had been produced by the USA/NATA – The National Athletic Trainers Association -https://www.youtube.com/watch?v=KkBAiK7WEFA

Suddenly I understood what caused PA's spinal cord injury (SCI) & how it could be easily stopped for others.

In USA football the spinal paralysis injuries had escalaed annually to double figures so they wanted to discover why & how to stop it happening. 

SEE BELOW how Trust PA EYES UP developed & why UK Rugby must provide adequate training & video information to inform every player & coach as has happened in the USA.

 

c) NB: UK Rugby Union & American football are different games agreed BUT both games involve the same player collisions, tackles & contacts - but the FACT is sadly with the same injuries resulting!

This information had been specifically researched and designed by medical orthopedic experts to instruct all American Football Coaches and players to enable every player to protect themselves from sustaining a serious spinal cord injury (SCI). The US Football Authorities had noted that the rate of SCI’s was growing at an alarming rate so engaged eminent Orthopaedic Specialists to investigate many video recordings of many game situations where players had sustained a serious SCI. This enabled them to understand what actually happened to cause this life changing outcome and sometimes even resulted in player deaths. American Football is a contact sport just like rugby, the main difference being the use of protective body armour & helmets, which also brings their own unique risks and problems.

The outcome from this research revealed some vitally important information.

d) The spinal column is a strong structure when in the erect upright position, protected by the vertebral discs that act as shock absorbers between the bony segments - vertebrae of the spinal column. The whole structure is supported by the musculature surrounding and supporting the spinal column. Dropping one’s head weakens this structure so consider a situation, where a 14 stone rugby player, running with the ball drops his head and makes contact (with the top/front of his head) with another stationary player . The player’s head stops but his body mass will continue with full body weight inertia. In between is the weakened neck/cervical spine that takes the impact of a minimum travelling 14 stone. This either displaces or crushes the player’s cervical vertebrae, thus damaging the very delicate information highway we know as the spinal cord, which runs down the centre of the whole structure. Once this cord is damaged (pinched, crushed or cut) spinal shock occurs which interrupts the body messaging system between the brain and the extremities below the site of injury – resulting in partial or full paralysis.

e) I suddenly became fully aware of what had happened to my son P-A during that fatal tackle!

No-one had kneed or kicked him as he had throught while in hospital after the injury. The video footage showed that, the opposing player running through with the ball had turned to take the impact of P-A’s low tackle. During the incident the player’s hip struck P-A’s forehead as he came in low and off balance to take the tackle. The combined 26stone approx. impact almost instantly, virtually ended a wonderful young life at just 26yrs.

Over the years we have read or heard of so many other young people, including schoolboys seriously injured in this life changing way.

f) Subsequently this gave me the urgency to share this important information with all Rugby Authorities and Educational/establishments, initially in the UK but then worldwide. I  now realised that some inexpensive basic training instruction can avert a hugely expensive, life changing event which happens to a victim in the UK every 8 hours of every day - with an average age of just 19years.  [NB: 48% of injuries result from vehicle accidents 52% work/leisure/sport/military accidents - 78% of injuries happen to males of all ages].

My key aim was to save lives but also to reduce the trauma to the wider cohort of parents and families but also to help avert the huge cost implication for the struggling NHS and UK Society at large by the loss of a useful contributor to the working, income generating community.

The factual evidence to indicate the magnitude of this cost relates to Paul-André’s six month rehabilitation time in Salisbury NHS Trust that exceeded £1m., while 100% failing both Paul-André his family, friends and colleagues.

NB: FACT Men, women and children paralysed by SCI are normally in hospital/recovery from two months to two years dependant on the injury nature, level and severity. The potential problems that can occur include; health issues; chest infections, eating difficulties, pressure sores, disrefexia plus other care & recovery problems. These problems all impact on the patient’s ability and either positively or negatively influence their attitude towards their own recovery chances and process.  Replicate this across the SCI society, with the cost of home/car modifications and adaptions, carers, loss of dexterity or worse, the loss of earning potential, the huge complexity with insurance claims involving implications, solicitors and the court process etc. it all becomes a huge hidden hole in the UK's societies financial pockets. 

g) There are far too many related issues involved with my son’s accident & the resulting outcomes to fully illustrate all the implications for this piece. One can however, start to understand the serious situation that exists for every player at every level of rugby as a sport. What is unacceptable is that sporting and other authorities continually fail in their Legal Duty of Care and the UN Convention on the Rights of the Child to put in place, universal appropriate Trust PA "EYES UP" training measures along with the vital message of why it is important - (as has been done in USA Football) to lower the injury frequency for everyone playing rugby, especially children and young players in the UK.

h) My prime frustration with the current situation, results from the time wasting complacent, apathy and a lack of a “Can Do” approach to such a serious problem, that I have endured since P-A's injury and finding both the cause of this life changing injury & the very simple inexpensive solution. Why would anyone balk against promptly adopting this to - save childrens (players) lives?

I have made approaches to the Rugby Authorities; WRU, RFU, SR and IRB, Welsh Education Authorities and Welsh Government.

We (Self/wife and eldest son) have also been featured in two TV Programmes raising the issues regarding serious injuries in rugby during this time. These include: The Pain Game - BBC TV 2010 and Hacio S4C (Welsh with subtitles) where evidence was shared by qualified consultants, academics, clinicians and injury specialists in: concussion, brain injury and SCI etc.

i) The information that I found via the Web from USA NATA Heads Up video evidence, along with P-A’s injury video (which illustrates the same injury cause  in UK Rugby) was shared at the IRB International Medical Rugby Injury Conference in London in November 2010 by Dr Roger Evans Medical Advisor to the WRU at that time, with a view to promoting the Heads Up technique towards advising all players of the serious dangers of tackling head down.  As a result of this exposure a nominal pictorial change was made in the IRB Rugby Ready booklet to include 2 x pictures, one showing head down with a cross and other showing the head up and tick, plus a short comment to illustrate keeping the head up. Although this was a positive move forward it failed to make the key impact statement, that dropping the head (a natural tendency of players to protect the face) left a player open to a potential SCI and paralysis or just simply - vulnerable to serious neck or back injuries! 

I illustrated the fact in meetings that cigarette package advertising includes the clear message; “Smoking Kills” to ensure that there is no misunderstanding - so why not similarly make the message very clear regarding a serious potential injury outcome?    By teaching; Trust PA "EYES UP to see where the danger is" along with the message that dropping the head is dangerous and leaves the player vulnerable to a serious neck or back injury, paralysis and even death! Using EYES UP  method of play, rugby players can then protect themselves from serious neck & back injuries & paralysis while understanding WHY!

A key hangup excuse shared by many Senior Rugby people in authority is that the info is not relevant to UK Rugby but derived from a different game - USA Football so is therefore irrelevant.

Such irritating stupidity I have often contested by sharing that the universally used safety equipment adopted for Motor Rallying and Formula 1 Racing – all driver wear neck braces which has been adopted from the USA American Nascar racing! If a safety system works anywhere, is effective in reducing or stopping injury, saves young lives, who worries where it originated! - Just Do It!

4. The NATA Heads Up Video message becomes  Trust PA EYES UP

j) Further work by Dr Michael England Medical Director for The RFU (the only contact to seriously take any real action) has carried out research using the Heads Up information that I/we supplied him. It included copies of P-A’s accident video information, plus other data from his hospital records etc. to help perfect and improve the technique. Dr England discovered by watching trial rugby games with young players, plus post game analysis discussions that the Heads Up message needed modification. What transpired was our modified EYES UP message – “Always play rugby - EYES UP to see where the danger’s coming from" this will enabling players to avoid serious neck & back injuries and SCI paralysis even death.

EYES UP was a personal message that I had shared with Paul-André (& Dr Mike England) when he was a young player – but sadly P-A had not had the benefit of being properly trained through his school or club coaches - to keep "EYES UP" during his early rugby training career to make EYES UP method - second nature in his game. Unfortunately children listen to coaches nmore than non-expert but caring Dad's!

Adopting this technique enables players to see danger as it develops, along with not dropping the head (to weaken the spinal structure) thus avoiding potential injuries more effectively. To enable this to be understood universally, I requested the production of video footage showing the EYES UP rugby technique. The idea being to specifically illustrate the EYES UP Technique using well respected celebrity/international rugby player/icons to inspire young impressionable players to adopt this improved safe-play method.

I am still pressing for this to be introduced, also that the information must eventually be shared universally to every school, club, coach, trainer, teacher and player.

k) To try and move things forward, an approach was made to the Welsh Government Education Department to share the importance of EYES UP training for schoolboy rugby. The aim being to enable every young player to protect themselves from potential SCI paralysis. Learning the lessons from day one, would help to protect them throughout their playing life. Initially this was met with interest but the WGED instructed me to consult the WRU yet again. The explanation was; that the WRU was the Rugby Authority in Wales, not the Welsh Government or Education Department and so we would have to consult the WRU to give their backing and support to enable the Welsh Government Education Department to act and broadcast the information across all schools in Wales.

At various meetings with the WRU it was repeated by representatives that they were already supporting the school rugby system and would continue to provide, what they considered to be appropriate training support, as and when required.  - This indicates the obvious discrepancy between the Health Authorities and Sporting Bodies, who continually pass the buck regarding their responsibility to act or adopt this simple training change for the benafit of all players.

l) To try and positively influence the WRU to act appropriately I also showed them the range of available USA Football Association video’s which became available to US trainers and players after and as a result of the initial Heads Up video. The benefit of the later USA Football Videos shows how the American Trainers have taken on board the Heads Up technique initiative, adapted it into their player training schedules by producing a range of appropriate detailed training video material to instruct coaches/trainers/educators and players right across the USA in the new method. These videos are the equivalent to what I was requesting the WRU & IRB to produce for UK Rugby (& World Rugby). 

These can be viewed for info as listed below in - Reference Information #  below. 

5. Reason for Sharing this Evidence

The main reason for explaining this situation is to indicate the continual poor attitude received from different Authorities and their approach to making change. The attitude is either to pass the buck or fend off responsibility for no action by saying; it cannot be done or we are doing something similar or we train players appropriately - all to negate real action. The message shared is invariably one of compassionate understanding of the problems involved, while very concerned about the injury potential, often indicating that yes - EYES UP is probably a good idea. However, the contact (always very senior people) are never sufficiently concerned or motivated to actually commit resource to initiate appropriate training or training materials to deliver an uniform message to ALL parties who need to be alerted to the dangers. I even approached the Children's Commissioner Wales for her support in my quest but ended up on my own again due to a lack of proactive support or real proactive action.  

POSITIVE PROGRESS - WORLD RUGBY /IRB Website -

There is one reference that I can find which indicates recognition of the issue but I spent some time finding it

To View just: CLICK HERE

My concern is; whether the full training message is being given to coaches & players, that (although this is the correct statement) it needs the added:

# EYES UP " to see where the danger is coming from" - (PLUS) IMPORTANT  - All players and coaches must appreciate, that NOT using safe EYES UP "to see where the danger is coming from" - method of play, by dropping the head when tackling, weakens the spinal structure, which leaves a player vulnerable to serious neck and back injury, paralysis and even death.

 

OTHER RELATED ISSUES 

There are many other serious implications involved in this subject and too many to list here, just two to highlight how sporting injury is expensive while injury recording is vitally necessary:

b) The level of player insurance cover for victims of seriously debilitating injury.

At the moment anyone with a high level C1/C2 SCI will need a very high level of income to cater for their new injured needs. For a high level injury victim like P-A would have needed a minimum one carer 24/7, home modifications, special bed facility, ventilator, wheelchair etc. (an estimate for my son 15 years ago - was an income of £16k-£20K per month).

Rugby player injury insurance needs to be set at a minimum of £3+ million for accidental injury cover/per player a mandatory requirement to protect all players via all Rugby Clubs & authorities.

Just consider for a moment any young person with a job and family to support, who suddenly becomes SCI and paralysed, without the appropriate financial Insurance cover, the bill falls to the state. This implication plus all the associated pain and suffering can be averted by the inexpensive appropriate introduction of universal EYES UP rugby training. 

c) Until very recently a SCI is recorded by the UK/NHS under the heading Disability, which is inadequate for future intervention or repair. Things are changing to now record the detail and nature of the SCI which will help future clinicians identify specific patient/injury needs when, SCI repair becomes universally available in NHS Hospitals. 

SCI repair interventions are on the horizon so it is vitally important that patient injury details are recorded. The reason being, that when repair becomes available, the basic details of the what, where and how for all SCI paralysed people, must be available to enable the NHS to be able to locate and help them with the appropriate treatment or intervention necessary. Similarly recording all injury in schools and clubs results in readily available relevant data, indicating the size of the problem, where the problems actually exists, then enabling remedial action to take place while learning from such events.

Since initially compiling this information, it has come to light that the IRB have included on their website, reference to players keeping eyes up! Although I applaud this positive move in the right direction, I still feel let down that the USA Football authority approach of nailing the detail clearly visible to all, with advisory video and othe information being universally made available for trainers and save player injuries is a major short-fall. I will continue until I am convinced that the full message is being relayed as I specified above #.

 

6. Reference Information

Heads Up Video                                           https://www.youtube.com/watch?v=KkBAiK7WEFA

USA Football Training Videos #                 https://usafootball.com/programs/heads-up-football/youth/      

                                                         NB: This link has a number of videos - scroll page to view, how in the USA the basic info has been

taken by the training authorities and developed materials to ensure the safe play message is 100% clear universally. 

This link contains a number of good example video copies which include a Trainer Copy plus others showing the details of the exact training requirements for coaching young USA Football Players. This includes the basic movements, correct body posture, exact head position to avoid contact etc. UK/IRB Rugby needs a similar DETAILED video training facility.

NB: Other Information such as P-A’s Accident Video (available from the Author).

Some of the people consulted who agree to the benefit of EYES UP Player Training.

EVERY COACH & FATHER OF A RUGBY PLAYING YOUTH that has listened & understood the simplicity & implications!

Mr David Cobner Dean of Sport UWIC Prof.

Dr Roger Evans Past Medical Consultant to the WRU  

John Fairclough Orthopaedic Surgeon WRU

John Anthony ("Tony") Jewell MA FRCGP FFPH past Chief Medical Officer for Wales

Mr Sashin Ahuja, FRCS (Orth), Consultant Spinal Surgeon.

Dr Stephen Hunter Medical Director UHW - Past Deputy Health Minister Wales. 

JPR Williams MBE - former Wales International & British Lion - FRCS Orthopaedic Surgeon.

Gwyn Jones former Wales Captain & International, GP/ BBC Wales Rugby Presenter.

Graham Thomas Journalist - past BBC Wales TV Sports Presenter.

Ms Bethan Jenkins AM  - Mr Mark Drakeford AM   -   Mr Peter Black AM etc.

Jenny Randerson AM (now Dame)

Dr Brian Cunniffe English Institute of Sport

Dr Ian Jeffreys Medical/Surgical Management - Faculty of Health & Sport Glamorgan University. 

Mr David Pickering Chairman WRU (IRB Member)

Prof. Allyson Pollock Professor of Public Health Research and Policy

Dr Mike England Medical Director England RFU Twickenham

IRB International Rugby Medical Conference Twickenham November 2010    (30 player nations present)

The list goes on.