Abby Dow incident shows rugby still at concussion crossroads
“I’d be surprised if she doesn’t go off for an HIA. It’s one of those collisions that almost always leads to the doctors at least checking”, says Nick Mullins in commentary. But following a 65th minute head collision with Kennedy Simon in the 2021 World Cup final, Red Roses winger Abby Dow got back to her feet and returned to the field of play.
Things just didn’t feel right.
Dow was assessed by doctors on the field, re-joining the fray for a further two minutes before eventually being hauled off for further assessment.
And while Dow later passed her HIA and returned in the closing stages, the manner in which her situation was dealt sat horribly with those watching.
What spiked attention most in regard to the Dow incident is the fact she wasn’t removed immediately.
RFU chief executive Bill Sweeney, who spoke to the pitch-side doctor following the game, reported he was told Dow was left on the field because they were not 100% sure she was unconscious following the collision.
If accurate, this is deeply concerning. From the evidence of Sweeney’s word, the doctors seem to have reached the conclusion that Dow cannot have suffered a brain injury because she hadn’t been knocked unconscious.
However it’s an established fact, not just in rugby but across all sport, that traumatic brain injury does not require the loss of consciousness to occur. Not only that, this fact is written into World Rugby’s own protocols.
Under Stage 1 of the World Rugby HIA Protocol, it states: “Players displaying obvious on-pitch signs of concussion (Criteria 1) are immediately and permanently removed from play, and the completion of the off-field Assessment tool is not required. Any other cases, where players have the potential for concussion (Category 2), but without clear on-pitch symptoms or signs, undergo an off-field assessment.”
According to this protocol, for Dow to not be removed either under Category 1 or Category 2, the doctors must have concluded that the incident had no potential for concussion, so much so that an off-field assessment was unnecessary.
This is utterly baffling. Look at the footage, watch Abby Dow sway as she gets to her feet. Try and argue there was no obvious force to the head, that there were no ‘obvious on-pitch signs of concussion’, and you’ll find yourself scrambling for words.
Leaving Abby Dow on the field was nothing short of gross negligence.
The fact she subsequently passed an HIA1 is of little relevance, for we now know these assessments are ultimately not fit for purpose. Rather, what is so affronting is that removal and off-field assessment was not the first port of call.
In the current rugby eco-system where the issue of brain injury is so salient, how this has occurred in a World Cup final is truly astonishing.
Now that we know the risks of brain injury, rugby should have reached a position where over-caution is basic standard. It’s written right there in the protocols, but there remains a gaping chasm between policy and practice.
There are serious and well-known risks to leaving a player on the field with a brain injury As is succinctly put by the Concussion Legacy Foundation: “If an athlete is not immediately removed from play following a concussion, they are at an increased risk for prolonged concussion symptoms, Post-Concussion Syndrome (PCS), and Second-Impact Syndrome (SIS).”
“If this was the men’s game we’d be criticising the decision to have Abby Dow returning. She went off for an HIA, she was showing signs, I think, of needing permanent removal. So I think that needs to be scrutinised.”
Chris Jones, BBC rugby correspondent #ENGvNZL #RWC2021 pic.twitter.com/TrwCw8r8xZ
— Progressive Rugby (@ProgressiveRug) November 13, 2022
This incident feels like a sliding doors moment, a crossroads at which rugby must decide where the game is going to go.
The fact it occurred in the World Cup final, and a women’s World Cup final at that, where we know the issues around brain injury are particular, has to be the symbol strong enough to finally change how brain injury is dealt with on the rugby field.
Over-caution must become the starting point in everything that is done around brain injury, because we now know the terrible circumstances. Watch the recent Steve Thompson documentary and try and argue that caution is not the way forward.
The decision has to be taken out the players’ hands. There is no doubt that Abby Dow would have wanted to stay on that field; it’s a World Cup final, you can’t blame her for wanting to, particularly given her incredible fightback from injury to get on that field in the first place. It’s the responsibility of those away from the furore of the pitch to make that decision.
The narratives have to change. While debate rages on social media about stringent red cards protocols ruining games, the evidence of this game shows they aren’t strong enough.
Red card protocols are severe, supposedly, because player safety is the absolute priority. And yet Kennedy Simon was shown yellow rather than red because her contact with Dow’s head was ‘indirect’, riding up to the danger area after initial contact with the shoulder.
In opting for the ten-minute sanction, referee Holly Davidson was faultless in her execution of the law (Law 9.13). However, nobody can doubt that there was significant force to the head. The laws were applied properly by Davidson, but the issue is that the laws themselves fail to properly sanction and deter head contact.
If a red card had been awarded, Dow would almost certainly have been removed from the field. We will never know for sure, but by definition a red card would have determined that Dow had received direct contact to the head with force.
November 26th marks the anniversary of the death of Siobhan Cattigan. The doors are sliding shut for the game, and rugby must find itself on the right side.
