Coroner says league player’s death after second head injury preventable

A coroner has taken aim at Runit competitions saying they should not be recognised as an official sport.

Coroner Bruce Hesketh slated the competition as having “all the hallmarks of perilous activity that makes no attempt to mitigate head injury”.

He made the comments in a finding into the death of 32-year-old Pāpāmoa man Tere Livingstone, who died from a severe head injury sustained in a tackle during a game of rugby league in June 2023.

Livingstone suffered a concussion in an earlier, pre-season game on May 27 which he didn’t tell anyone in the team about. However, two days after he was hit in the jaw by an opposing player’s forearm, he began suffering a severe headache in the back of his head, and nausea.

The young dad went to his GP who advised him not to play contact sport for three to four weeks and that he should discuss the situation with his team’s physiotherapist. She also advised him to return immediately if his symptoms, which by the time of the appointment had largely reduced, returned and she would refer him for a CT scan.

Livingstone played down the doctor’s concern with his partner however he did not play league the next weekend due to being out of town for a family event.

Coroner Hesketh said Livingstone did not appreciate the seriousness of his condition because on June 6 he wanted to go to training but his partner convinced him to stay home and rest.

The following weekend, on June 10, Livingstone played another game in a pre-season tournament in Tauranga. In the first half, he was tackled, landing on his back and his head hit the ground in a whiplash movement. He went off the field and knelt down on one knee, saying he was fine but within seconds he fell forward and suffered a seizure.

An off-duty nurse came to his aid and an ambulance was called. Livingstone was transferred to Tauranga Hospital where he was diagnosed with swelling and a brain bleed. He was flown from there to Waikato Hospital in Hamilton for nuerosurgery but his condition deteriorated and, after five days, he was declared brain dead. His life support was switched off after organ donation.

Coroner Hesketh said, although the family objected to a post-mortem, he was satisfied after receiving expert advice, that Livingstone developed a rare condition known as second impact syndrome (SIS), when a person suffered a second head injury before fully recovering from a previous one.

“The athlete will rapidly develop altered mental status and a loss of consciousness within seconds to minutes of the second hit, resulting in catastrophic neurological injury,” the Coroner wrote.

“SIS is described as acute brain swelling and bleeding that occurs when a second concussion is sustained before the first one has healed properly. This can be difficult to treat and can be fatal.”

In 2021, there had only been 45 cases of SIS recorded — all boys and men between the ages of 10 and 29 with the period between the first and second concussions ranging from one hour to five weeks. Eleven of the injured recovered and 19 died.

Coroner Hesketh said if Livingstone had told his coach, team manager or referee about the first head injury, he would have been stood down for the mandatory 21 days required in sports.

“Had that occurred and had he followed the graduated recovery and return stages set out on the [New Zealand Rugby League] website, I am satisfied from the literature I have read and the advice I have received, he would not have experienced second impact syndrome.”

He said Livingstone’s death was preventable.

‘I record my concern about Runit’

Coroner Hesketh was critical of Runit competitions, saying they should not be recognised as an official sport.

“As a matter of public interest I record my concern about a developing contact competition in New Zealand called ‘Runit’. There appears to be no governing body, the activity is not regulated, and has no written publicly accessible rules of participation. Neither is there any information to players around the signs and dangers of concussion or concussion management.”

He noted the competition was said to be built around the actions seen in rugby union, league, the NFL (American National Football League) and the AFL (Australian Football League).

“However, those sports have invested heavily in concussion prevention, identity, and management. The same cannot be said for this latest trending competition.

“The principle of operation in Runit requires two opposing individuals, one being the ball carrier and the other the tackler. The two stand at opposite ends of a 20 metre by 4m field and run full speed at each other and colliding to try and knock each other over.”

Hesketh said “understandably”, medical specialists and organisations assisting those in hospital or in the community recovering from head trauma had expressed concern about the dangers these competitions gave rise to traumatic brain injury and/or chronic traumatic encephalopathy – a brain disorder caused by repeated head injuries.

“Runit competitions are attempting to set up in New Zealand as a legitimate sport.”

However, he said in the sports Runit copied, the object was to avoid being tackled, or to be tackled in a way that the player carrying the ball could protect themselves by side-stepping or turning into the tackler to lessen the blow.

There were also strict rules around high tackles.

“Furthermore, all the applicable team sporting bodies involved have invested heavily in concussion awareness, prevention, identity, and management.”

He recommended athletes take head injuries seriously.

“This unfortunate and sad case emphasises the need for those who play approved team contact sports to adhere to the concussion guidelines. Both the NZRL and NZRU websites have significant information around concussion prevention, identification, and management. Significantly more can be found on the ACC website.”

Symptoms of concussion include:

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