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Sunday, May 11, 2014

Outcry as Florian Fritz returns to play after severe knock to head

Toulouse missed out on a Top 14 Semi Final place for the first time in years as they lost to Racing Metro on Friday. An ugly incident in the first half caused a bigger outcry though, as Florian Fritz was knocked out and bloodied, but later returned to the pitch.

Racing Metro won the play-off game 21-16 thanks to seven Jonny Sexton penalties, but fans and the rugby media couldn't help but be shocked and outraged by what occurred earlier in the match.

Fritz had an unfortunate clash with the knee of Francois van der Merwe, which split him open almost instantly, and appeared to knock him out for a while. He got to his feet eventually but as you can see there was blood everywhere, he was disoriented and struggled to walk.

His night appeared to be over, but just fourteen minutes later Toulouse coach Guy Noves could be seen seemingly urging him and the medical staff to get him back out on to the pitch. It could be viewed as courageous by the player, but as one of the commentators said, it's was 'bonkers.'

The IRB concussion protocols are in place to prevent precisely this type of occurrence.

"It is shocking players are still being allowed to return to the field after such obvious signs of concussion," said former IRB medical adviser Barry O'Driscoll. "If rugby doesn't wake up to this and start demonstrating a zero tolerance approach to head injuries, it will be storing up some very serious legal problems for itself."

Fritz came back on around the 33rd minute, with 7 stiches and 5 staples, and didn't take contact, receive the ball or need to make a tackle, thankfully. He did leave the field at half time though, as common sense seemed to prevail and his condition clearly didn't improve.

"I had a small KO. I don't remember everything," he reportedly told French TV station, Canal Plus.

Both Noves and the medical staff involved will come under investigation and of course, severe scrutiny. Another knock to the head could have had dire consequences. As it is, players with repeated concussions run the risk of ending their careers early, as well as long term complications.

There have been reports that referee Jerome Garces did not order a concussion test to be done, so it never happened. Those tests are there to check when it isn't entirely obvious. In this case it seemed clear that by Fritz's behaviour he shouldn't have come close to returning.

Below you can see an English commentary video with the incident and his return to the field

Posted at 8:28 am | 46 comments

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Viewing 46 comments

Rugby101 May 11, 2014 9:46 am

No place for this in the modern game. No excuses for sending a concussed player back on the field regardless of scoreline or game situation. I hope an example of this is made to prevent further situations like this from occurring!

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No9scrum May 11, 2014 9:50 am

Totally agree!

Truly idiotic from the toluse coach! He has to face disiplinary action from someone!


I am surprised the ref even let him back on though, he should have the power to override the coaches in these situations if the coaches are acting so stupidly!

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ToulouseFan May 11, 2014 9:47 am

Absolute stupidity from the staff indeed. But this guy has got to be the greatest warrior in world rugby, the ovation from the crowd was completely mad !

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Canadian content May 12, 2014 12:13 pm

Smart warriors live to fight another day.

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TC May 11, 2014 10:07 am

Absolutely appalling. Doesn't do the game any good!

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cKei May 11, 2014 10:08 am

You know what ? Noves wasn't urging the medical staff and Florian to go back on the pitch asap no matter what his condition, but only told them that they only had ten minutes to stitch him if he was allowed to go back on.

Now that's clear there has been several breaches on this matter, but it's not to the manager to decide if a player has had a KO or if he is in condition. We have a medical staff for this, as well as a dedicated protocol which obviously has not been repected.

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DanKnapp May 11, 2014 11:56 am

Bullshit. The coach has a duty of care to his players. Medical protocols exist in order to add a safety net, not to remove all responsibility from educated adults. The coach could clearly see the guy had taken a severe blow to the head, there was claret everywhere, and he wasn't up on his feet immediately - far from.

A professional coach, knowing what we now do about head injuries, would have not let him back on the field. The man is an absolute fool and/or completely negligent.

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nzbougnat May 11, 2014 10:32 am

I'm 95% appalled at the stupidity of bringing Fritz back to the pitch. And I am certainly not condoning such disregard for players' safety. Yet, I must confessed that I am 5% in awe at his dedication and have fond memories of such bloodied players muscling through pain 10-20 years ago...

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ChillDoubt May 15, 2014 2:41 am

Bloodied players 20 years ago is indeed an iconic image.
A concussed player suffering convulsions or a collapse as a result of a serious head injury is an entirely different matter altogether.
This wasn't a case of warrior spirit, this was a player whose decision making was clouded as a result of obvious concussion and he should have been automatically excluded from any further part by his coach and medical staff.
I trust the IRU will take a very dim view of what occured.

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Bunn May 11, 2014 10:48 am

He fails the concussion test as he walks off the field showing confusion, coordination problems and aggression! These are the worrying signs they look for after head trauma at accident sights and in a&e! Baffling, absolutely baffling how they let him play on

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Tractorman May 11, 2014 11:27 am

Both coach and player need to be brought to book, do we need a death bedore concussion is taken seriously?
This is no example of bravery just stupidity, underpinned by greed or the want of fame.
This is no example to set young players.

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DanKnapp May 11, 2014 11:57 am

The player doesn't need to be brought to book - he was almost certainly concussed at the time of the 'offence'.

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FatProp May 11, 2014 6:13 pm

I agree, I think the player's state of mind (if there was any) was completely taken advantage of. He had absolutely no idea about any implications of himself going back onto the field.

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Mike May 11, 2014 11:57 am

the player will always want to go back. The medics are there to protect us from our own stupidity. Medical opinion has to override any other interests. In my time it was as simple as "How many fingers can you see?" Medical science has gone further than that by now but what's the use if protocols are ignored?

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kanpai May 11, 2014 12:48 pm

So much hostility....
I agree that Fritz should never have returned to the pitch, but let's not forget there is a standard protocol for these situation.
Normally, you can suffer from a concussion and still go back to the pitch if the medical staff say so. If the med staff said Fritz was ok to play, then why would Noves, who could just ask them for advice, say otherwise ? It happens every week in every championship.
But there is clearly two mistakes :
- the ref not asking for the "commotion protocol" even if it was obvious Fritz was ko
- the med staff who didn't say that he shouldn't go back to the field.

PS : Noves wasn't urging his player to go back to the field, he was just saying that if he was able to, there were only a few minutes left, and he has to make a decision. And as soon as he was able to speak with fritz at half-time, he replaced him.

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Rugbydump May 11, 2014 1:15 pm

Fair point. It's all speculation at this stage (it's been reworded in the article).

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cKei May 11, 2014 2:15 pm

What i said higher, but better worded ;)

Also should add that Fritz was not knocked out cold, he was conscious the whole time, just a little groggy from the impact and the loss of blood.

I don't think the referee stopped the game for a KO suspicion but more for the bleeding (even if with this kind of strike, he should have asked for the protocol).

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Warhorse May 11, 2014 12:56 pm

All I have to say here is summed up perfectly by this story: http://www.bbc.co.uk/news/uk-northern-ireland-23943642

It can only take one more knock to the head before he ends up brain damaged or even dead

After all that has happened in the NFL, it cannot go on like this, and I fail to understand how a severely concussed player is of more value to a coach and their team during a game than a fresh, fit international replacement (Gaël Fickou)...?
Just can't make sense of any of it

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Foxy May 11, 2014 3:11 pm

Absolutely tragic tory.

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stroudos May 11, 2014 9:28 pm

Aside from the sheer stupidity / irresponsibility of it all, I also don't understand the decision from a practical point of view.

I mean this is the key phrase for me:
Warhorse: I fail to understand how a severely concussed player is of more value to a coach and their team during a game than a fresh, fit international replacement (Gaël Fickou)...?

Pretty insulting to Fickou, I would say!!

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Frenchie May 11, 2014 1:48 pm

There's now a lot of talking and at the highest level in France about this incident. The FFR and the medical commission of the FFR want to ear the Stade Toulousain Club and understand why Fritz came back on the pitch.
it seems that the protocol hasn't been followed entirely.

Guy Noves told the press (among other things) that Fritz seemed to be able to go back on to the pitch for a short time and until half time.
After that the staff took a final call.

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10stonenumber10 May 11, 2014 1:58 pm

Madness on the medical team's behalf. He was out cold. Bled a shedload. Couldn't stand, and tried to fight off the medical staff when they were mopping up the blood. Soaked his unchanged strapping too (health and safety?). And back out on the pitch?

Were the same people doing the dressing and testing as the ones who were out on the pitch? There has been uproar down South about players cheating the knock tests, if the medical peeps didn't see the incident and only went by his word, they could have easily let him slip through and play on.

Were they more concerned and pre-occupied with the stitches, staples and vaseline to perform the knock test? Surely all the blood soaked strapping would need to be changed too...

Was Florian Fritz auditioning for the Walking Dead?
http://media.heavy.com/media/2013/05/dead.jpg

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Facepalm May 11, 2014 7:34 pm

It seems clear to me that three things need to happen here.

1) Appoint an independent doctor to carry out impartial concussion tests. This way there will be no bias to keep a player on the pitch. The only concern will be of individual player welfare.

2) Scrap the 10 minute rule. The medical staff were so rushed for time and, as you said, seemed too preoccupied with the blood to focus on the more pressing issue. The assessment has to stringently cover all aspects of the player's situation. Pressurising whoever's in charge with an arbitrary time constraint is madness.

3) Sack whoever was responsible for allowing Fritz back onto the pitch - be it the manager or the medics.

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Canadian content May 12, 2014 12:20 pm

Agree with the first two, but not with sacking noves. Everyone deserves an opportunity to learn from their mistakes. I guarantee he's far from the only pro coach who either encourages or turns a blind eye to players suffering from head injuries, some at kickoff!

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Foxy May 11, 2014 3:09 pm

This is a disgrace. We all know our players are tough and brave in what is a brutal game at times but the coach and medical staff have a responsibility to look after the health of the players.
This is a clear case of putting the result above the health of a player and that cannot be allowed. severe consequences for the coach in my opinion and perhaps there should be an independent matchday doctor to make the final decision (like in boxing) rather than the club doctor if (in this case not others) they cannot be trusted to act as a professional and do their job.
Also the coach has no part to play in the decision and shouldn't be in the room / doorway.

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Colombes May 11, 2014 3:33 pm

Interesting debate here. Concussion protocoles should become a major concern in the following years. And irb refs should be more informed on the medical rugby risks.
As said above, the 2 mistakes come from Garces who misread the ko.. in a blood injury.
And the Toulouse medic team who should not have listened Fritz will to go back on the pitch. Suicidal.

And i cant critic Noves as he seemed to believe in the blood injury. He formed dozens and dozens of young players, not crash test dummies.

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Ricardo May 11, 2014 4:13 pm

Here's the important part to remember for both sides of the argument: He could have died.

I'm sure that the medical staff cleared him to return but regardless if Fritz takes another shot like that to the head, the pressure his brain is exerting on his skull could be so great that a doctor would not be able to save his life even if he/she was on the field the moment after the hit.

As a player, I look at this coach and wonder if he cares more about winning (as Florian Fritz is a beast center) or the personal welfare of his players. Shame on him for not sitting Fritz for the rest of the game.

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Goldih May 12, 2014 9:14 am

Even if you were a doctor, without actually being there, how can you make that medical conclusion? A career in media awaits you..

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Gonzoman May 12, 2014 5:25 pm

To be fair, Ricardo said the pressure "could" be great enough that Fritz might die if he took another similar shot to the head.

In this he is correct - Second Impact Syndrome (SIS) has been documented in numerous research papers, and occurs when the brain is concussed while still suffering symptoms from a prior concussion. It is fatal nearly 50% of the time. Even more shocking is that it has a morbidity rate of almost 100%, meaning that nearly all people who suffer from SIS become disabled or die. Treatment for SIS requires immediate intervention including the hyperventilation of the victim, and the use of osmotic agents to reduce the pressure within the skull but recovery is unlikely.

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Goldih May 23, 2014 5:16 pm

Top response! Reading further it is quite sport specific. Scary stuff! I guess it is a matter of time until something like this does happen and until then it is doing our utmost to avoid it regardless of any extrinsic rewards (competition, moneyt, reputation)
http://linkinghub.elsevier.com/retrieve/pii/S0278591905700594?via=sd&cc=y

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Mozza May 11, 2014 4:14 pm

I don't often use the word "disgraceful", it's so often used in an exaggerated reactionary way. But this really was disgraceful. I know it's a professional game and all, but coaches seem to be putting winning and the subsequent business benefits before players' welfare and that can't happen. Playing through a bit of pain or a cut is one thing and every rugby player does it, but when he struggled to stand and seemed to not know what was going on around him surely the concern should be for his health? Not even as a coach but as a fellow human being?

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DW May 11, 2014 5:19 pm

No doubt that it should not even be considered a possibility for Fritz to play on. Madness and a blatant disregard for player health in this instance. Not really any mitigating factors for the team making the decision to put him back on.

However, a players health not being put before the teams results is an unfortunate reality of professional sport. I certainly don't condone what happened but at the least serious end of the scale you've got guys still carrying pretty serious knee or shoulder injuries dosed up on painkiller every game just trying to reach the end of the season before getting surgery, and at the more serious end you have guys returning to the game with plates in their neck or back yet we don't give this much criticism which seems somewhat hypocritical and a big risk for the players involved.

Medical staff will always act with the best interests of the team and pressure from the manager at least partially in their minds, even if it is only a small factor. If an average Joe fractures their cheekbone for example then we'd be resting until it healed but for a pro rugby player you have to be on the pitch the next week. A lot of the pros are literally held together with sticky tape! BOD, Martyn Williams, Moody for example can't have been fully fit for at least the second half of their careers.

No excuse for mishandling head injuries but not super surprising given the pressures in the pro game. The only important thing now is the sanction which will set the tone for mishandling such head injuries in future...

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Reality May 11, 2014 9:21 pm

Absolutely disgusted at the lack of concern for player safety. Regardless of whether it was the coach's fault, the referee's or the medical staff's, he simply should not have come back on and somebody's head needs to roll for this before a player's does. He was absolutely all over the place after the collision and everybody should have known that his game was over.

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cheyanqui May 11, 2014 11:24 pm

Honestly, sacking a medical staff will do little to fix the problem.

The real issue here are who stands to benefit to benefit from risking the injured players - and that's the coaches and owners / administration of a team.

Sack them, fine them, dock them points, kick them out of the playoff or H-Cup.

Blaming solely a doctor is a scapegoat solution, as these are NOT the people in the limelight. it's like blaming rank-and-file soldier who do something the generals are actually pressuring them to do.

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jnd May 12, 2014 4:07 am

I think it was definitely courageous and if you look at him when he comes back on the field, he has one wavering blink, settles his eyes and he's good. I'm not condoning it, but the reality is that his job as a professional athlete is the top of the pyramid of professional sport. I think the mistake was trying to get him off the pitch so quickly in the first place to deal with the blood. That is an instance where the game should pause appropriately. Like a broken femur. I'm still not convinced that he wasn't alert the whole time, just obviously a bit shaken up from the sheer force of the contact.. As he's walking off, he says "hang on, I've earned the right to have a seat on the pitch for a sec". Not a good example for your kids, agreed, but neither is war. Warrior.

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DrG May 12, 2014 9:24 am

I've seen it written up there and some of you might know my stance on the comments that involve words like "could've". However someone did write "He could've died" which in this circumstance could have been an outcome.

Not going to dwell too much on the incident, merely because I feel everyone has the same view as myself and I think the main points have been covered, however one point I have seen which really stood out is "scrap the 10 minute rule".. I think this is a very valuable point. If Fritz took 9 minutes to stitch up they have 1 minute to assess, there should be no time frame.

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DanKnapp May 16, 2014 2:10 pm

So... you're saying he could have died? ;)

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ConnachtMan May 12, 2014 9:59 am

Jesus, that is shocking, club should be fined.....

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cheyanqui May 12, 2014 2:21 pm

I think you can't really scrap the 10 minute rule. If you give the player TOO long, then suddenly, it turns into an issue where it can become a strategic sub.

Say, a player is hit in minute 10. The coaches use the concussion rule to play a sub for 40 minutes, and then the originally injured player is suddenly "OK" to come back for minutes 50-80.

Either way, the amount of time allowed puts that player at risk -- too short means things like this happen. Too long a rest, and then a player spends 20-40 minutes on the sidelines champing at the bit to come back, and the tide of a match may turn, driving him/her or coaches to make equally bad decisions.

It's not about the time limit - it's about having player safety trump the wins/losses on the day.

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Eddie-g May 12, 2014 4:14 pm

I'm not sure about your concluding paragraph here, RD. I am 100% in favour of the concussion protocols, and clearly here, I think we can all agree Fritz should not have returned.

But I disagree with the idea that the tests are there for when concussion "isn't entirely obvious". Tests are there to be used whenever there's a risk - regardless of whether it looks obvious. With this particular injury, which I have to say, until Fritz took a seat on his way off the field, looked a whole lot more like a nasty blood injury than a concussion, it's imperative someone - fourth official maybe? - requires a concussion test before the player returns.

Those ten minutes a team has when a player goes off for blood are absolutely frenetic for the medical team, trying to stitch up the player; for me, absolutely the best time to run the test and without getting in the way of everything else the medics and coaches are working on, is right when you ask to reverse the blood bin. You gotta pass the test to return, and Fritz surely would not have here.

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DrG May 13, 2014 2:47 pm

The part where RD writes "isn't entirely obvious" is; I'd imagine, in the case of where there is an obvious head knock or risk of head injury where the player still gets on his feet at some point. In the case of what IS entirely obvious, I think RD would be referring to someone who is still fast asleep as they're being stretchered off the pitch...

So someone that bashes their head and leaves the field with an arm over two other guys shoulders singing "somewhere over a rainbow" would probably fall into the fairly obvious class and you'd forgive medical staff if they didn't bother doing the tests that are required in order to RE-field the player.

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Gonzoman May 12, 2014 5:29 pm

I might be making this up, but can a team not take the 10 minutes for a blood sub, then ask for an additional 5 for the concussion protocols? I know that in cases were there is a suspected concussion teams/referees can have the player temporarily replaces for 5 minutes to assess their condition. I don't recall anything in the rules that you can't take both a blood sub and a head check...

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el diablo May 13, 2014 9:46 pm

Toulouse need t be disciplined. The issue here is that kids will see this as "bravery"...to play on when concussed. My own son played on after being concussed a couple of years ago in an u16 match. I can't believe I was so ignorant of the danger that I didn't intervene. For the sake of the game action needs to be taken on this extreme and obvious case.

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