Dr Micky Collins, Director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program, says Ireland needs to follow America's example when it comes to  taking decisions regarding head injuries out of the players' control.

Last weekend Brian O'Driscoll was taken out of the game against the All Blacks after Dr Eanna Falvey, who put the player through the Pitch Side Concussion Assessment (PSCA), deemed he had suffered a concussion. The decision on whether O'Driscoll would stay on the field was taken out of the star player's hands and left to the the doctor, thanks to the IRB's new protocols.

Dr Collins, who has studied the effects of concussion for the last 18 years, said that it is only recently that people have begun to understand the research.

"We learned a tremendous amount about concussion and how to manage it. We’ve done a lot of work on how to get kids and athletes back playing sports as quickly and as safely as possible. It’s a life’s work,” he said.

He said that scientific advancements are now helping the public to understand the severity of the injury.

“Smelling salts and asking ‘how many fingers am I holding up’ meant a return to play until about 1995 to 2000. Science has led the way since.”

Collins said one major development has been the ways a concussion can be now measured and managed.

“We never had a way of measuring concussion until the early 2000s. Before we had computerised neuro-psychological testing we couldn’t put numbers to the injury. The field really changed when we were able to quantify it and then the studies followed and are available now.”

He told the Irish Examiner that for a player to be assessed after a head injury, it comes down to one simple point.

“If he shows signs, he should be taken out immediately. Five minutes may be too long. Some of these tests are very rudimentary and too simple to be honest. Concussion evolves over time. A player may feel fine at the time of impact but can show signs of the symptoms after.

“It can take hours for a brain injury to fully manifest itself. What you see at the time of an injury is not necessarily what will happen a few hours later. It can evolve rapidly.”

The IRB insists that despite comparisons drawn between rugby and NFL, the two sports are completely different. However, Collins doesn’t share that viewpoint.

“Any sport that has mass acceleration and has a lot of big people running around at high speeds – concussion is going to occur. The protective equipment in football doesn’t exactly stop the injury from occurring.”

Collins said he believes countries like Ireland will continue to improve their treatment of head injuries.

“We treat 20,000 cases a year in Pittsburgh and I can tell you a lot of them are kids. And what we’re seeing is they’re suffering repetitive concussions. I bet there’s a lot of that going on in places that don’t have effective management protocols.

“If it’s happening in Pittsburgh, it has to be happening here. Because they don’t walk with a limp or have a cast on their head it’s not immediately recognised but there can be serious consequences. I’m the biggest fan of sports there is. I can’t wait to get kids back playing. I’m going to get any athlete back on the pitch as soon as possible, but safely.”