CA medical boss backs Aussie team doctor

Cricket Australia's chief of sports medicine Alex Kountouris has backed Australia's team doctor Richard Saw for his handling of Steve Smith’s concussion in the second Ashes Test, saying removing a player from a game who hasn’t displayed signs of concussion would be an "overreaction".

Kountouris, the Australian men's team's former physio and now CA's Sports Science & Sports Medicine Manager, said he was "100 per cent happy" with how team doctor Saw followed process on days four and five of the Lord’s Test, when Smith was struck on the back of the neck before being ruled out of the match the following day.

Having been hit during Saturday’s play, Smith was removed from the field and underwent a series of tests, conducted by Dr Saw. The tests showed that the 30-year-old did not display signs of concussion and he was allowed to continue his innings at the fall of the next wicket. But when Smith displayed concussion symptoms the following day, he was ruled out of the match.

Given only around 20 per cent of head impacts in cricket result in a concussion, Kountouris says removing a player from the game every time they were struck in the head would be unnecessary.

"The reality is only about one in five or six head impacts end up in concussion," he said.

"If we pulled out every player who had a head impact, we’d be pulling out 80 per cent of players who don’t have a concussion and taking them out of the game. So that would be an overreaction.

"If you look at that game, there were three other head impacts and only Steve had a concussion.

"He didn’t have a concussion at the time (he was hit) so he was allowed to play. If we took him out of the game, we would have been leaving him out of the game for no reason other than what we saw on the field."

CA’s research shows that delayed concussion, where symptoms don’t develop until several hours after the initial blow, occur in approximately 30 per cent of cases.

Kountouris added the fact Dr Saw forced Smith to withdraw from the match ahead of play on day five, meaning Australia had to bat out a draw without their best player, proved that Smith’s health was put ahead of the team’s success.

"At the end of the day, our doctor pulled him out of day five of the Test match, which was a pretty critical part of the game," he said.

"Our doctor is an expert in his field, he’s trained to pick up even the minor signs of concussion.

"(He) was brilliant. Everything he did was according to the protocol, he was very thorough and we know he’s very thorough. We’re 100 per cent happy with what happened over there."

Smith's exit from the game, and the inclusion of Marnus Labuschagne in his place, was the first time a concussion substitute has been used in an international match. Cricket Australia pioneered concussions substitutes in its domestic competitions almost three years ago, a forerunner to their introduction at the top level.

The International Cricket Council's policy around concussion puts the responsibility into the hands of the team doctors, not an independent medical professional. Kountouris said while a case could be made for independent doctors to be mandated in international matches, to avoid any suggestion of bias or coercion, his experience over the past three years of Australian domestic cricket indicated that was not necessary.

"It’s possible that doctors could be put under pressure, but we’ve put as many things as possible in our policies to mitigate for that,” he said.

"The doctor (is) the sole determinant; not the player, not the coach, no-one else.

"We haven’t had any problems with that over the last three or four years that we’ve been doing this."

2019 Qantas Ashes Tour of England

Australia squad: Tim Paine (c), Cameron Bancroft, Pat Cummins, Marcus Harris, Josh Hazlewood, Travis Head, Usman Khawaja, Marnus Labuschagne, Nathan Lyon, Mitchell Marsh, Michael Neser, James Pattinson, Peter Siddle, Steve Smith, Mitchell Starc, Matthew Wade, David Warner.

England squad: Joe Root (c), Jofra Archer, Jonny Bairstow, Stuart Broad, Rory Burns, Jos Buttler, Sam Curran, Joe Denly, Jack Leach, Jason Roy, Ben Stokes (vc), Chris Woakes.

First Test: Australia beat England by 251 runs at Edgbaston

Second Test: Match drawn at Lord's

Third Test: August 22-26, Headingley

Tour match: Australians v Derbyshire, August 29-31

Fourth Test: September 4-8, Old Trafford

Fifth Test: September 12-16, The Oval