Australia's peak body for general practice has called for government investment to tackle the issue of concussion in sport, including research funding, bigger Medicare rebates for longer consults and the establishment of an Australia-wide concussion registry.
The Royal Australian College of General Practitioners (RACGP) is one of a number of groups and individuals to put in submissions to a Senate committee inquiry into the impact of concussion and head trauma in contact sports.
The RACGP said the current lack of consistent definitions for concussion was resulting in confusion and an inconsistent approach to treatment and management of concussion, while differences in protocols between sports were adding to the problem.
RACGP national president Dr Nicole Higgins said there was insufficient evidence to fully understand and determine the long-term impacts of concussion and head trauma, and that significant research was needed.
"We need a national approach to management of concussion, with evidence-based guidelines across all sports and codes, " Dr Higgins said.
"It's also important that all sports — and across all states and nationally — there's a commitment to management and reporting to ensure we have the data available."
The latest international Consensus Statement on Concussion in Sport is due to be handed down later this year.
Dr Higgins said she hoped the release would allow a consistent definition of concussion.
The RACGP's submission said the development of an Australia-wide concussion registry would provide a valuable source of data to determine long-term impacts of concussion and repeated head trauma.
The submission said GPs play a vital role in monitoring and managing prolonged concussion symptoms, such as post-concussion syndrome and suspected chronic traumatic encephalopathy (CTE).
"Applying a 10 per cent increase to Medicare rebates for longer consultations and introducing a new 60-minute-plus consultation Medicare item would make a real difference for GPs and practice teams managing these complex health issues."
Other submissions received by the committee include:
Sydney-based neurologist Dr Rowena Mobbs said in her submission that the community had "turned a blind eye to systematic concussion".
"The absence of mandatory reporting on concussion, neurological care after concussion, and stories of returning to the field too early are harrowing," Dr Mobbs said.
"Furthermore, the dearth of meaningful, fully independent, and appropriately funded research has represented a dark chapter in Australian sport."
Among her recommendations were:
- Federal government funding for longitudinal research on patients with existing symptoms of CTE
- The federal government to mandate a code of conduct for sports organisations including a public register of suspected and confirmed player concussions, funding independent neurological player assessments after concussion, and establishing sub-specialist concussion and CTE clinics for at-risk athletes
Insurance for long-term injuries 'inadequate and inequitable'
Monash University law academic Dr Eric Windholz said existing insurance arrangements for long-term injuries from concussions and repeated head trauma in contact sports were inadequate, inequitable and in some cases may operate in breach of worker's compensation laws.
Dr Windholz said injury payment schemes had maximum payment periods and ceased on the expiry of players' contracts.
He said state and territory workers' compensation schemes had exemptions for professional players, but that the arguments for the exemptions were "redundant in a world in which sport has been corporatised and commercialised".
Support 'basically non-existent' says former Australian Rules player
Retired Queensland Australian Rules player Lydia Pingel called for accountability for sporting clubs and organisations to ensure they took protocols and guidelines seriously.
Pingel had to give up the game within three seasons after suffering a series of head knocks and concussions while playing in Queensland's top competition for women through the Bond University football program.
In her submission, Ms Pingel also said support — financial or otherwise — for players affected by concussion was "basically non-existent", particularly for those who were not paid athletes.
She recommended a one-month imposed recovery protocol after sustaining a concussion, whether in a game or training, with a 12-month mandatory stand-down period for players who had three diagnosed concussions in a season.
"Having clear mandatory guidelines and practices in place with a consequence/club penalty attached if not followed with the sole objective to protect a player's brain in its present and future state is the change I want to see and the change we need to occur in all contact sports at all levels from grassroots through to the elite," she said.
Kathy Strong 'provides voice' for her late husband
Kathy Strong's husband Terry was treated for Lewy body dementia before his death in 2021 and confirmed by post-mortem to have severe CTE after playing grassroots rugby league in the 1970s and 1980s.
Her submission — to "provide a voice" for her late husband — described his struggles as being "slowly tortured by his brain", with a variety of aggressive behaviours, cognitive decline and ongoing incidents.
Mrs Strong's submission called for "comprehensive record keeping" to log incidents of head trauma, with players advised by independent medical officials and required to have mandated time off the field, enforced across all professional, amateur and youth sports.
She also called for available player insurance and financial support for affected players.
Lack of understanding, treatment options for traumatic brain injuries
Legal firm Shine Lawyers made a submission based on the experiences of their Head Trauma division. They said there was a lack of understanding by many professionals and the public when it came to mild traumatic brain injuries, and the impact they had on individuals and families, adding there was a lack of treatment options in Australia.
They made a series of recommendations, including:
- Greater transparency, accountability, education and training by governing sporting bodies
- Reducing exposure to repeat head injuries, including banning headers in soccer under the age of 14, considering weight divisions in tackle sports, and removing tackling from sports until the age of 14
- Education on TBI, concussion and CTE compulsory in schools and beyond, delivered to children and parents
- Consistent concussion protocols across all sports from grassroots to elite level
Overseas experience could be a guide
Lawyer and academic Dr Annette Greenhow said the work of governments and authorities in other countries could point the way forward.
"As an example of legal regulation designed to achieve minimum standards and education in response to [sports-related concussion], the government of Ontario implemented Rowan's Law, making it mandatory for sports organisations to:
"1.) ensure that athletes under 26 years of age, parents of athletes under 18, coaches, team trainers and officials confirm that they have reviewed Ontario's Concussion Awareness Resources every year.
"2.) establish a Concussion Code of Conduct that sets out rules of behaviour to support concussion prevention.
"3.) establish a Removal-from-Sport and Return-to-Sport protocol."
Duty to manage the 'darker side of contact sports'
Gold Coast-based rehabilitation physician Dr Benjamin Chen said that if society accepted contact sports as part of the social fabric and their positive impact, it, "would also have a duty to manage the darker side of contact sports," including supporting players who suffered repeated head injuries.
Dr Chen said that adequate funding needed to be quarantined to support contact sport players of all grades to manage the incidence of traumatic brain injury. He suggested possible sources including:
- Increased WorkCover premiums for employers
- Quarantined revenue from advertising, sponsorships, merchandise sales and gate receipts
- Employer or league-sponsored private health insurance, to continue after the playing days of a player
All full submissions can be read here.
The inquiry continues. Following a public hearing at Bass Hill in Sydney's west last month, two further hearings are scheduled: in Brisbane on Wednesday and in Canberra on March 1.
The committee is due to report by June 21.
