The long-term effects of repeated head knocks in sport has recently been in the spotlight. But, as Zac Stanton found out, just one hit can be life changing.
It was an ordinary day, during an ordinary suburban Aussie rules game, and what seemed like a fairly regulation collision between two players.
What shocked everyone present was the cracking sound Zac Stanton's skull made.
Zac describes himself as a tenacious, if not overly talented footballer.
"I was just a bit of a battler, probably, I wasn't exceptionally skilled or fast or anything like that. I think I just love the challenge of the one-on-one contests."
It was the toughness of Aussie rules that he loved about the game, but it's also what got him into trouble.
On June 19, 2021, Zac's club, Wilston Grange, were visiting Redland Victoria Point in the QAFL, Queensland's semi-professional Aussie rules competition, which is basically two rungs below the AFL.
"I was feeling good. Thought I was having a pretty good game," Zac, who was 25 at the time, says.
"I just went for an intercept mark — running sort of side on so I didn't quite see what was coming from the other side and neither did the opposition forward.
"And we had a big head-and-shoulder clash.
"The main comment I got from people was that they could hear it at the opposite end of the ground, they could hear the noise."
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Zac tried to get straight back up, but was quickly ordered by medical staff to stay down.
He lay back and blacked out for about 30 seconds. Blood and another fluid was coming out of his right ear.
After some minutes he sat up, grimacing, with his teammates standing nearby in an uneasy huddle. The other player involved in the clash gingerly walked away.
Zac was eventually stretchered off.
"The whole world was spinning.
"And then there's quite a bit of vomiting in the change rooms and clean up with the ear and the blood and fluid.
"Then just trying to settle everything down, I guess, while waiting for the ambulance."
His mum, Krishna Stanton, wasn't at the game that day. She received a call from one of his teammates.
"He said: 'I just want to let you know, Krish, that Zac has, I think, suffered a concussion. And he's been taken to the local hospital. And I think that you should come.'"
On the long 45-minute drive to the Redland Hospital, Ms Stanton tried to assure herself that things were going to be OK, that lots of people get knocked out.
"But the things that evolved from that first phone call were nothing of what we expected.
"When I got to the hospital, they refused to take Zac out of the ambulance, because at that stage they were aware that it was more than just concussion.
"Basically, they said, 'We're going to put the sirens on, please don't follow us. Because we have to get to the PA [Princess Alexandra] hospital as quickly as we can.
"And so that's when I went, OK, this is more than just a minor injury."
Zac remembers that moment in the ambulance when he first felt real fear.
"It was still extremely painful. But you know, it can get managed with certain drugs but I knew that there was something serious going on, which was very frightening.
"They turned me away [from Redland Hospital] just because of the state of me, like just blood everywhere."
He was rushed to the PA for treatment by specialist brain trauma doctors.
The Stantons were told that the fluid coming out of Zac's ear was cerebrospinal fluid and that his skull was fractured behind his right ear. Bone had permeated his brain membrane.
Doctors at the PA were worried about blood clots.
"The fracture and the hit was very close to the artery," Ms Stanton says.
"So that's when they said that that was their main concern to make sure that that artery hadn't been impacted.
"Phillip Hughes, the cricketer, was hit with a ball in a very similar spot to Zac.
"They said it was millimetres away from the artery.
"So he's a very, very lucky young man."
The aftermath
The long-term affects of multiple head knocks and concussion in professional sport has recently been in the spotlight, thanks to increased media awareness and the Senate inquiry into concussion and head trauma in sport.
But, as Zac found out, just one hit can be life-changing — and for an amateur athlete, financially crippling.
Over a 10-day hospital stay Zac, when he was able to interpret the medical jargon, began to realise some of the life-long ramifications of his accident.
He was told "pretty bluntly" that his cochlear had been smashed and he was permanently deaf in his right ear, as well as partial hearing loss in the left.
"He was just shaking his head and going, 'like, is that correct?'" Ms Stanton says.
He learned he would never play contact sport again, a particularly brutal blow for him.
"He was realising that life wouldn't be the same or as he had envisaged," Ms Stanton says.
"He saw himself playing AFL until he was old, or playing touch football with his mates or in a mixed team.
"It's really hard to go and watch your teammates play a game you love, that you can't anymore.
"And even just going for a run, all those things that we take for granted, were taken away."
And then there was the lack of clarity about the future.
"In terms of the brain injury, it's so uncertain," Zac says.
"The big question of balance was the main thing, balance and vision.
"I basically had to learn how to walk again, in hospital and carrying that into home life.
"My balance was terrible. I couldn't put on shorts by myself.
"That's what comes along with the vestibular [ear] damage that I've had, and that it's so uncertain, they couldn't really give me any answers on that.
"So it was a lot of unknowns. And still is."
Ongoing effects
Almost two years on from the incident, Zac is still unsure of how long the effects will last.
His mother says "he is not the same young man we once knew".
He describes regular headaches and permanent tinnitus in his right ear.
It has affected his gait, his balance, concentration and his eyesight; he now wears glasses.
He suffers from insomnia, and finds it harder to focus and concentrate.
Employed as a tradie, he initially spent three months off work, before easing back doing half days on light duties.
It took him eight months to go back full time, but it was in a limited capacity.
He has to be considered in his movements, and focused on his footing, and he has days where he is too exhausted to work.
Zac now spends hours every day rehabilitating himself.
"He has worked so hard on trying to retrain his brain and overcome a lot of these things," Ms Stanton says.
"It's going to be a lifelong ongoing training process for him to continually work on the effects of the accident on his brain.
"I think he's tried to be positive, but it's frustrating when you find it hard to concentrate when you're tired.
"The fatigue is probably the thing I noticed most.
"For a 27-year-old to be so tired all the time. That's not normal."
Zac says he's still got a long way to go.
In many ways he is fortunate to have people around him who have been well-placed to help.
His father was a physio for the Brisbane Lions and Geelong, with all the connections within AFL that entails.
He regularly flies to Melbourne to see a specialist.
New battle begins
As Zac battled to regain his health and some sense of normalcy, he and his family began what felt like another fight on a different front.
Having paid club registration fees, which included injury insurance, for Zac's entire junior and senior footy career, the Stantons always assumed that if he was injured, he would be adequately looked after by his club, AFL Queensland and the insurer, AHI.
But two years on from the incident, Zac says it has been a "massive battle" to get help, during the most difficult period of his life.
While he has received a sum of money for the permanent hearing loss, he feels he should be entitled to compensation for the other effects he continues to suffer — with no guarantee he will ever fully get back to normal.
Brain injury is not even mentioned as a category in the insurance policy attached to his registration fees.
"At the start, there's simple forms to fill out," Zac says.
"Trying to just get back to the insurer, you wait a while, but then obviously, my situation was quite serious.
"Waiting, like there doesn't seem to be any urgency, when at times, things that were needed very quickly in terms of financial help.
"It definitely should not be this hard."
When it comes to brain injuries, there's very little coverage out there, according to a lawyer who specialises in head trauma, Jamie Shine.
"So when it comes to insurance policies, I certainly believe that they need to be updated," she says.
"We know that the brain is the computer system that controls everything in our body. And we know now that it can be easily damaged in contact sports.
"So we need to ensure that not only are our fingers and thumbs and our legs and knees covered in these policies, but also our brains, when they are so vital to everything that we do."
Ms Shine says people with brain injuries find it particularly difficult to deal with insurance companies at a vulnerable time in their lives.
"They're the ones that have difficulty with executive function, concentration, memory.
"And they're the ones that insurers find it easier to dispute, delay.
"So imagine your brain's not working at 100 per cent capacity and yet they're going to throw you very complex legal issues and contract disputes and say you need to sort this out.
"It's impossible.
"So the people that need a clear pathway and clear access to funding and treatment are often the ones that are left having to, 'well explain that, or there's not enough evidence, or there's not enough information or you don't fit the definition within the contract'."
Ms Stanton says it has been "arduous" to prove "over and over again" that there are ramifications of a sporting injury.
"Imagine trying to prove that a 25-year-old young man is going to have permanent physical and mental damage, from playing a game he loved, for the rest of his life.
"And it's disheartening to have to keep trying to get reports. After we've done everything that we were initially asked, to get more reports."
'The brain is unique'
The latest request from the insurer was to work out what percentage of Zac's body has been affected by the accident.
"And that's an unclear line to judge. So we're trying to work at getting something we think is fair," he says.
Associate Professor at the Queensland Brain Institute at the University of Queensland, Fatima Nasrallah, says there are limitations in how we can gauge damage to the brain.
"If you break your arm, you can clearly see that you can't move it, you have to get it fixed, you have to get it stable.
"In the brain, there might be limitations to the sensitivity of the machines that we use that we can't see that."
Dr Nasrallah says the current Senate inquiry into concussion and head trauma in sport is looking at how long-term brain injuries can be measured.
"Brain injury is a sort of silent epidemic, especially the mild spectrum of it.
"How we assess whether a person is going to suffer longer-term consequences, or whether they're going to recover from what is said to be a 'minor' injury is something that I think the Senate inquiry is very interested in."
Dr Nasrallah says much more research is needed into the continued consequences of head trauma injuries.
"If you speak to somebody two years down the track, they really want their brain to function properly.
"And this is where the cognitive and the executive function play a much larger role in the longer-term quality of life.
"So how do we prognosticate that? And how do we define that?
"And unless we do these longitudinal studies where we can identify what are the different factors that contribute to recovery over time?
"It's not a one-size-fits-all, and every person is different, every injury is different.
"The brain is unique, and it defines us. Cognitively, if you're not functioning well, you can't do anything and you can't build a proper foundation in society."
Read the fine print
Ms Stanton says, like most parents, she never expected anything like this would happen to her son.
She says if someone is of working age and playing amateur sport, they need to have income protection, which Zac did not.
"And make sure that you talk to the club about what their insurance covers.
"It's not Wilston Grange's fault that Zac had a head collision with another player.
"But there is a responsibility, I feel, from AFL Queensland to step up, and even reach out."
Ms Stanton says she spoke on the phone with AFL Queensland months ago and was told someone would get back to her, but they so far have not.
"I'm disappointed in the club firstly and AFL Queensland they did not try to step in with any financial support or fundraising for Zac, and it's been nearly two years.
"If he did not have family to support him he could have been homeless.
"AFL Queensland needs to acknowledge that the insurance policy does not help players like Zac, who suffer terrible long-term effects from playing AFL."
In a statement to the ABC, AHI said:
"While AHI remain sympathetic to Zachary Stanton's situation following his injury, we maintain that we have provided all support that could have been reasonably provided under the circumstances in dealing with his claim as fairly and efficiently as possible within the scope of coverage taken out at the time."
The insurer declined to comment on how frequently it pays out brain injury claims.
Ms Shine says many players and their parents would be surprised to learn what is and isn't covered in their policies — and that they should check before something happens.
"Parents and players don't actually look at that policy until the damage is already done and when they do look into it, they do realise 'hang on this is pretty limiting'."
Ms Shine made recommendations to the Senate inquiry about better education and multidisciplinary treatment for concussion and mild traumatic brain injury.
"But it was also raising awareness about the lack of insurance and funding when it comes to treatment for individuals.
"So even if they were to be diagnosed and treatment is recommended, who's going to look after these individuals after they've suffered life-altering, multi-system injuries?"
Ms Shine says insurance in sport needs an overhaul if it is to be sustainable for the future.
"Cost definitely factors into decision-making and what they will or won't cover. But there needs to be a balance here.
"There is funding available. We have CTP insurers, we have the motor accident insurance commission, who are dedicated to funding that rehabilitation to funding research into improved outcomes.
"But if you're injured in a game of sport, who's there paying for that research, paying for that treatment? And is it the obligation of the rest of Australians to fund that? Is it the obligation of Medicare to fund that? Or is there a need for others to contribute to better outcomes, rehab, treatment funding, which currently isn't the case?"
In a statement to the ABC, and speaking on behalf of Wilston Grange, AFL Queensland said:
"AFL Queensland (AFLQ) expresses its sympathy to Zachary and his family following the incident on the field. AFLQ prioritises the health and safety of participants at all levels of the game.
"As part of the Australian Football National Risk Protection Program, AFLQ participants have access to personal accident cover for injuries sustained whilst participating. This program is reviewed on an annual basis with the support of the insurance broker appointed on behalf of AFLQ with a balance being struck between quality insurance coverage available in the market and the sustainability of such cover for community football organisations and participants."
Zac says he still has many good friends at Wilston Grange who he keeps in touch with.
"But the brain injuries are a hard thing for people to understand and realise that there's still things going on as well.
"I do come across sometimes like I'm quite fine. I understand that.
"But I do feel let down by the club a bit in terms of just helping me with financial support since then.
"They named an award after me and offered coaching roles, but I feel as if a fundraiser or something at least would have been appropriate."
Zac says the club has called him in the past week asking how it could improve its relationship with him.
His affection for the game of Aussie rules remains untarnished, in spite of what happened to him on the footy field.
"I love the game.
"So my message is probably just to be aware of what you're actually covered for when you go out there and you give your all for your team.
"Make sure you know what you're covered for in terms of injuries.
"Every day I spend hours trying to recover from this.
"Hopefully, things keep improving. There's no guarantee of that.
"I don't have the opportunity to play the sport that I love anymore.
"I still am lucky I still live a great life, but it's changed my life 100 per cent.
"I'm not sure what the rest of my life is going to look like."
Credits
- Reporting: Jessica Stewart and Dan Colasimone
- Original pictures and video: Mark Leonardi, with Michael Lloyd and Curtis Rodda
- Production: Dan Colasimone
