Written evidence submitted by the England and Wales Cricket Board
ENGLAND AND WALES CRICKET BOARD SUBMISSION TO THE DIGITAL, CULTURE, MEDIA AND SPORT SELECT COMMITTEE INQUIRY INTO CONCUSSION IN SPORT
As the National Governing Body (NGB) for cricket in England and Wales (ECB), we are responsible for all aspects of the game from grassroots through to the elite level. We are a not-for-profit organisation, with all revenue generated being reinvested to sustain and grow cricket. We are the only NGB which oversees every aspect of our sport: international teams (men’s, women’s, and disabilities), professional clubs and the recreational game.
CONCUSSION/HEAD INJURY IN CRICKET
Injury surveillance shows that the risk of concussion in cricket is significantly lower than a number of the most popular sports. Nevertheless, it carries significant risk in that the cricket ball can be projected at a high velocity directly at someone’s head within the laws of the game.
Approved protective headgear is mandatory for batting, wicketkeeping and all close fielding and is increasingly worn by umpires. However, it not worn in all situations, and the design of helmets does not completely remove the potential for concussion. Improvements have seen the development of further BSI standards in neck protectors to further cover the occiput although mandating their use has been delayed by the impact of Covid on manufacturing. ECB injury surveillance indicates head injuries are still most common when wearing protective headgear whilst in the process of batting and in close fielding positions. Less common are injuries to bowlers and as a result of collisions in the act of fielding.
MANAGEMENT OF CONCUSSION IN CRICKET
ECB understands the importance of protecting the short term and long term welfare of players and staff. It has a dedicated Chief Medical Officer overseeing a unique Department: Duty of Care’ (DoC) and a Safety in Cricket Committee (SICC) whose sole focus is the wellbeing and safety of all individuals in the game and reports directly to the ECB Executive, Board and Regulatory Board. Its budget is solely directed to prevention activities, research and evidence based decision making through audit and surveillance.
In relation to concussion, the ECB DoC and SICC has sought to mitigate these risks through the ECB Concussion Guidelines, in the event of a concussion within the professional and recreational game.
The ECB concussion and head injury guidelines are based on current evidence and will be updated after the Paris Consensus meeting in 2021. The current guidelines are based on the Berlin Consensus Statement published in the British Journal of Sports Medicine in November 2016, ongoing sports and indeed cricket related research and a number of recent multisport forums, consensus panels and direct consultation with world leaders and research centres in the field of concussion.
The ECB medical panel has looked at best practice across sports and consulted CMOS and guidelines from NFL, AFL, FIFA Concussion Guidelines, BHRA and World Rugby/RFU.
Implementation is then undertaken following a consultation processes that includes ECB Medical panel, First Class County Cricket Club Chief Medical Officers and Neurosurgical and Neurosciences concussion research team from NIHR Birmingham.
The ECB’s Concussion guidelines have been developed around a consistent Return to Play (RTP) protocol: The 4 Rs, following the principles of Recognise symptoms, Remove individual from field of play, Recover (and reduce) exposure to brain activities such as video games and watching television if the individual is symptomatic, Return on a graded basis once the individual is symptom free.
Further tailored resources are available for Players, Coaches, Parents, Umpires and Healthcare professionals here including an education module, posters and training for professional and recreational game with attention given to ensuring match officials are fully briefed on their roles in this situation.
The ECB is dedicated to ensuring the game is safe for participants and support staff and that the continues to audit and engage with the research community supported by relationships with the Repetitive Concussion in Sport (RECOS) research groups and Universities and its continued sponsorship of the annual UK Sport Research Symposium, along with the FA, RFU, BHRA and the Drake Foundation.
The ECB mantra is simple. If in Doubt You’re Out.
ECB PREVENTION OF CONCUSSION PROGRAMME
The ECB deploys the 5th edition of the Sport Concussion Assessment Tool (SCAT5 and Child SCAT5) Edition) for adults and children respectively. Annual preseason assessment is mandatory across all of the professional game including pathways.
In order for the true incidence, prevalence, pattern and nature of concussion to be best understood, all head injuries, concussions and ‘near misses’, mandatory recording using the ECB injury surveillance system is required, with reporting to the ECB Chief Medical Officer, a member of the ECB medical panel or National Lead for Physiotherapy. All completed SCAT5 forms are independently monitored and processed by the concussion coordinators / medical interns from Loughborough University. In addition, all video clips of injuries and helmet strikes are recorded through the ECB performance analysis teams that record all professional cricket.
As a result of video analysis, the ECB’s concussion guidelines and online education programmes, which are reviewed by the ECB’s medical team on an annual basis, have developed cricket specific video recognition of signs, behaviours and severities of balls strikes, that uniquely can predict increased likelihood of concussion in game.
In order to continually assess and improves our Concussion guidelines, the ECB mandates all professional players undertake a baseline testing with a minimum being a SCAT5 assessment and bi-annual complex neurocognitive assessment. This forms part of the off-season player profiling screening and allows comparison to post-injury scores in both the diagnosis of a concussion and the RTP evaluation. As part of this analysis, an IMPACT / long term cognitive tracking baseline test must be undertaken every 2 years in the off-season or repeated annually in players who have had a helmet strike that season. Furthermore, the video uploads for all concussion and helmet strikes filmed in domestic and international cricket are mandatory with subsequent analysis by a dedicated Concussion / head injury researcher.
With the RTP protocols and follow up procedures now fully embedded throughout the recreational and professional game, the ECB’s medical team over the past 5 years have undertake the following to continue to evolve the game’s understanding of, and mitigation against, concussion:
RECOMMENDATIONS AND NEXT STEPS
The ECB should be happy to address any further queries the Committee should have.