Concussion protocols should be strengthened following Eliesa Katoa incident, neuroscientist says

One of Australia's leading concussion researchers has called on the NRL to strengthen its protocols to avoid players being concussed in warm-ups and then playing the match.

Eliesa Katoa was hospitalised and underwent brain surgery after suffering multiple blows to the head during Tonga's Pacific Championships match against New Zealand on November 2.

Katoa suffered a brutal head knock in the warm-up but was allowed to play in the match, where he suffered two more head knocks.

He was in clear distress after suffering the third knock and subsequently had a seizure and later surgery for a brain bleed.

He remains in hospital in Auckland.

The NRL has reviewed the incident and interviewed relevant officials, but has said it would not release the findings until Katoa is out of hospital and in better health.

Neuroscientist Alan Pearce, a professor at Swinburne University and a member of the Australian Sports Brain Bank team, said Katoa's incident should not have been allowed to happen.

Professor Pearce is an expert in chronic traumatic encephalopathy (CTE), a degenerative brain condition that can only be diagnosed after death, and said the initial impact head knock during the warm-up clearly showed he was concussed.

"He shouldn't have played," Professor Pearce said.

"It was really quite concerning about the intensity of that impact in the warm-up and the fact that he also went down and showed clear signs of concussion, which surprised me that he was then allowed to play."

Professor Pearce cited the Consensus Statement on Concussion in Sport, which lays out clear rules on what to do with a concussed player.

In response to Katoa's concerning incident, Professor Pearce said he hoped the NRL would strengthen its concussion protocols.

"I would like to see stronger protocols around not allowing the player to play the game, even if it's during the warm-up," he said.

"We know that warm-ups and training accidents occur, but we still have to have the same level of rigour that they would have in a game.

"To let a player continue on and start the game should just not happen.

"I hope the learning experience for the NRL is to change their policy around that or strengthen it up even more so that any concussion in a warm-up means no play."

The NRL has independent doctors monitoring all matches from the league's central bunker to ensure club doctors do not miss potential concussion incidents.

But those doctors are restricted to only watching the vision that is televised once the game begins.

Professor Pearce said the doctors should be located at the grounds where the matches are played.

"I would like to see that independent doctors actually come to the game at the same time so they can be there as part of the warm-up," he said.

"I'm sure there have been other incidents in the past, but not as high-profile as this.

"So, for an extra hour of an independent doctor's time — they would be renumerated for that time — so I can't see why it would be an issue that they only have to come on when the game starts.

"We shouldn't be talking about something like this in 2025, given that sport organisations like the NRL and AFL are putting athlete health front and centre and saying that the health and wellbeing of their players is the greatest priority — well, show it.

"This has been a terrible incident, and we don't want another one."

The NRL declined to comment on Professor Pearce's calls for changes before they released the findings of their review into Katoa's injury.

Professor Pearce is also calling on Australia's other major football code, the AFL, to change its in-game concussion protocols to have independent doctors monitoring games from the ground.

The league employs concussion "spotters" in its central AFL Review Centre (ARC) to watch for concussions and alert club doctors.

A spokesman for the AFL told ABC Sport those concussion spotters were independent doctors.

The spokesman added doctors were better placed to monitor concussions in the ARC because of their access to multiple televisions and camera angles.

"Their role is to monitor the video, make real-time assessments and communicate directly with club doctors," the spokesman said.

"The AFL continues to invest in, and support, research into concussion, that work never ends."

The ABC understands that were an AFL or AFLW player concussed during a warm up, they would be subject to the normal concussion assessment.

Professor Pearce said all sporting codes had improved their concussion protocols, but added there was still work to do.

"We have made some real progress in this area, but it means that we still need to be vigilant, and we can't just sort of take things for granted anymore," he said.

"If this is happening at the professional level, what's happening at the community level?

"The game is played at a you know, much broader in the participation space, so we've got to be able to demonstrate at the elite level what the standard is in order for that community level to appreciate that this is a serious issue."