Yesterday Stefan Kung was charging towards a spot on the podium at the European Time Trial Championships in the Netherlands. In the final minutes of the race Kung veered into the barriers and crashed.
Kung was likely travelling 50km/hr if not faster. His team car was behind him and was at his side within seconds. A few seconds after that Kung was back on the bike covered in blood and with a visibly shattered helmet. He rolled across the line in eleventh place, one-minute-and-twenty-nine-seconds behind the winner.
Increasingly, sporting organisations are being held to account when they fail to uphold the standard of safety we expect for athletes. Last month, the Australian Football League (AFL) club Port Adelaide was fined $100,000 over its handling of a head knock to defender Aliir Aliir. It was determined that Aliir should not have been allowed to continue playing after an impact to the head.
Out of necessity, the NFL has developed one of – if not the – world leading in-game concussion diagnosis and management protocol. The NFL Head, Neck and Spine Committee—a board of independent and NFL-affiliated physicians and scientists, including advisors for the NFL Players Association—developed the NFL Game Day Concussion Diagnosis and Management Protocol in 2011.
The Concussion Protocol is reviewed each year to ensure players are receiving care that reflects the most up-to-date medical consensus on the identification, diagnosis, and treatment of concussions.
UCI In-Race Concussion Protocol
Less than a month ago, the world governing body for cycling, the Union Cycliste Internationale (UCI) released a video explaining their in-race UCI Concussion Protocol. While the introduction of a protocol is undoubtedly a step in the right direction, at the time I was skeptical how effective it would be in protecting riders in practice. Among other problems, the protocol fails to consider the vested interest that staff members and riders have in getting back on the bike and into the race. Further, the protocol does not require a qualified person to make informed decisions about whether an athlete has suffered a head injury.
Those of us who questioned the UCI’s in-race protocol watched on in horror as Kung went on to finish the European Time Trial Championships. It was blatantly obvious that Kung had suffered an impact to his head. It is unquestionable that the new UCI in-race protocol inadequately protected the athlete.
When Kung crashed, he and Belgian superstar Wout Van Aert were neck and neck, Kung went on to finish 46 seconds behind Van Aert.
In theory, if the UCI in-race concussion protocol was followed it means Kung crashed, undertook a concussion test and got back on the bike in under 46 seconds. It just isn’t possible that the current protocol protected Stefan Kung.
In June a lawyer representing 169 former professional and 66 ex-amateur sportsmen and women appeared in court for the first preliminary hearing in their claims against World Rugby, the Rugby Football Union and the Welsh Rugby Union. The athletes claimed that these three governing bodies had failed to take reasonable steps to protect athletes from brain injuries. It is one of several cases involving professional athletes, their governing bodies, and brain injuries. The AFL are also currently fielding a class action from former players suffering from the effects of concussion.
The UCI has a well-documented history of failing to address rider safety. Hopefully an awareness of their potential liability will motivate them to take concussion seriously.
How might they do this?
Look to other sports. If the UCI follows the NFL’s lead and introduces the four recommendations below, they will immediately improve long-term outcomes for riders. What could this look like in practice?
‘Spotting’ by Independent Medical Personnel:
Introduce ‘spotters’ that are trained experts that provide an objective assessment as to whether a rider requires an assessment.
Introduce a brief cognitive test, such as the Standardized Assessment of Concussion (SAC) or the Maddocks Score, which assess memory, concentration, and orientation. This must be performed by a trained individual.
The Maddocks questions, a standard test for assessing athletes for concussion, were pioneered by an Australian. You’ll find the Maddocks questions in most concussion game day checklists. For instance, NFL players must successfully complete this check – and many others that are administered by a practicing physician – if there is any suspicion of concussion or impact to the head.
Recording and Reporting
Public reporting on concussions is crucial for athlete safety, medical treatment, and data collection to improve concussion prevention and management while prioritising athlete health.
The protocol must involve an assessment from an independent neurological consultant to assess athletes with no incentive for the rider to continue racing.