A coroner’s report in September 2013 investigating the death of Carrickfergus Grammar School rugby player Benjamin Robinson took concussion from being an accepted sports injury to one of overriding importance for both professional and schoolboy players.
The inquest heard that in January 2011 the 14-year-old died from second impact syndrome, where two concussive injuries were sustained in a short space of time.
Coroner Suzanne Anderson said she believed the teenager had sustained concussion during a heavy collision at the start of the second half, but despite this, continued playing against Dalriada. His was the first recorded death of its kind in Ireland or Britain.
In the last 12 months medical opinion in Ireland has hardened on the subject and at the end of last year the IRFU introduced a concussion guide aimed at amateur players, officials and parents.
At the launch, Dr Rod McLoughlin, IRFU head of medical services, stressed there needed to be a culture change. The sport's SAFE programme was accompanied by booklets and posters and emphasised caution, vigilance and rest as it has been shown that developing bodies are more susceptible to bad outcomes following head injury.
Now mandatory
It is now mandatory for anyone seeking coaching accreditation to complete an International Rugby Board (IRB) concussion module before they can be accredited at even mini-rugby level.
Another key element is the extension of time out of the game for players under 20 and here the IRFU have a more conservative approach than the IRB. Any player under the age of 20, who suffers a concussion, is automatically removed from play for a minimum 23 days. The critical element is that the extra days out ensures it includes three match-day weekends. Any adult amateur player over 20 is removed for a minimum of 21 days, which must include two weekends.
These minimum rest periods go beyond the latest recommendations of the IRB, which for teenagers from 16 to 19 is 12 days.
This season the Six Nations Championship, for the first time, adopted IRB protocols for professional players, which are still on a trial period.
The protocols have previously been in use in other jurisdictions, although they were discredited last summer, when a clearly staggered Australian player, George Smith, was helped from the pitch in the third Test against the Lions only to be reintroduced some minutes later.
The outrage that followed forced the IRB to stiffen up the application of Pitch-side Suspected Concussion Assessment (PSCA), which allows for a five-minute time out for the medical assessment of players with suspected concussion.
The IRB have said it has resulted in a 25 per cent increase in injured players remaining out of games.
Eminent critics
Eminent critics, the most outspoken of which is Brian O'Driscoll's uncle, Dr Barry O'Driscoll, argue that a five-minute window is inadequate to determine whether a player has concussion. He maintains concussed players are being sent back into "a most brutal arena".
Currently Ireland’s Luke Marshall has been stood down by his club Ulster after suffering his fourth concussion in 12 months. The 23-year-old centre had three concussions in succession last season, which kept him out of the Irish team tour to the US and Canada.
In Connacht, captain Craig Clarke has also been forced to stop playing for an unspecified time after his 10th concussion in 22 months. In 2011, two international hookers from Leinster, Bernard Jackman and John Fogarty, retired because of repeated concussion, Jackman had 20 over three seasons.
