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MMA – to regulate or remove?

Mixed martial arts (MMA) is a full-contact combat sport that is growing in popularity in Ireland and abroad.  Ireland boasts its very own global superstar in the sport with the current UFC Featherweight Champion Conor McGregor.

However, given the very obvious physical nature of the sport, it is not a surprise that there has been a significant debate about the health and safety aspects around MMA.

Such debates have recently become more pointed, especially after high profile incidents such as the death of Portuguese MMA fighter Joao Carvalho following serious head injuries in an MMA fight at the National Stadium in Dublin last April. The Medical Independent (MI) has been told that the Garda investigation into the incident continues, while the Health and Safety Authority (HSA) has concluded its investigation (see panel).

MMA has prompted mixed reactions within the medical community, both in Ireland and abroad. Some doctors and representative organisations have called for an outright ban because of the dangers involved, while others have urged tighter regulation in the sport.

The IMO has told MI that while it has concerns over the lack of regulation of MMA in Ireland, it does not have a specific policy on the issue. This is in contrast to the British Medical Association (BMA), which has a clear policy against the sport.


IMO President Dr John Duddy, an SpR in neurosurgery, told MI that while he does have concerns about MMA, he is not in favour of a ban. 

“The priority is the health and safety of participants in any combat sport,” said Dr Duddy.

“Banning it would only drive it underground, thus increasing the risk to participants.”


Dr John Duddy, IMO President

Across the water the BMA has held a position in favour of banning the sport for a number of years. 

“The BMA is opposed to mixed martial arts and boxing,” a BMA spokesperson told MI.

“This opposition is based on medical evidence that reveals the risk, not only of acute injury, but also of chronic brain damage to those who have survived a career in the sport as a result of the cumulative effect of repeated blows to the head.”

The BMA spokesperson acknowledged that there are arguments in favour of MMA in how it can improve the lives of young people. However, these benefits are significantly overshadowed by the potential medical risks involved, the BMA says. 

“Though sometimes defended on the grounds that they enable young people to learn to work through their aggression with discipline and control, the BMA believes there are many other sports which require a similar degree of discipline but do not pose the same threat of brain injury,” said the spokesperson.

The BMA first campaigned to have boxing banned in 1982 and this was later extended to MMA in 2007. 

But whether banning the sport on health grounds in Ireland is feasible or warranted is something that many people disagree on.

Senator Catherine Noone has spoken publicly on the issue of MMA and health and safety. Last year she addressed the ‘Injury Prevention in MMA’ seminar in the RCSI, where she spoke about the political and legislative position of the sport and its regulation in the country.


Senator Catherine Noone

Having previously held a different view, Senator Noone now echoes Dr Duddy in not calling for the sport to be banned. However, she does believe that the authorities should provide more regulation. 

“I think it should be recognised and regulated,” she told MI.

“Having previously advocated banning the sport, I realise that proper recognition and regulation is what’s required. A ban would arguably have the effect of making it more attractive.”

Safe MMA, a not-for-profit medical project dedicated to the safety of MMA fighters in Ireland and the UK, agrees. 

“It is impractical to ban such a widely practiced and popular sport,” a spokesperson for the Safe MMA committee told MI.

“A ban would drive the sport underground beyond the reach of regulation, thus putting participants at greater risk and preventing proper risk assessment and development of safety statistics and improvements to the sport over time

“As with all contact and combat sports, risks should be objectively weighed up against health and social benefits.”

Tragedy puts focus on MMA safety  

Following the death of Portuguese MMA fighter Joao Carvalho after a fight in Dublin last April, both An Garda Síochána and the HSA launched investigations. 

“The matter is being investigated as a sudden death in accordance with the Coroners Acts,” a press spokesperson for An Garda Síochána told MI

“A comprehensive file is being prepared for the Coroner and an Inquest will be held at a later date.”

However, this newspaper has learned that the HSA has now completed its investigation into the incident and will not carry out any further investigation. 

“Following the examination of the circumstances relating to the death of Mr Carvalho the Authority sought to determine whether there was any employer/employee relationship involving Mr Carvalho, in relation to the MMA event in which he participated,” a spokesperson for the HSA told MI.

“We have determined that Mr Carvalho participated as a professional self-employed fighter in relation to the MMA event. 

“The nature of his participation was such that there was no employer/employee relationship between Mr Carvalho and anyone else involved in staging or promoting the event.

 “The Authority has therefore ended its inquiries with no further action under health and safety legislation being taken.”

MI has been told that Minister for Transport, Tourism, and Sport, Mr Shane Ross, would like to see the sport formally recognised to “maximise the safety for all participants”.

“There was a deep sadness felt by the Minister and within the Department by the tragic death of Joao Carvalho in April 2016,” a spokesperson for the Department of Transport, Tourism, and Sport, told MI.

“The Minister would like to see MMA formally recognised under Sport Ireland to maximise the safety for all participants. 

“To that end the Department is aware that there is a process underway involving Sport Ireland and MMA representatives. National Governing Bodies of Sport recognised by Sport Ireland are responsible for setting and overseeing appropriate standards, including standards relating to safety and governance.”

Medical staffing

Dr Duddy maintains that steps should be taken to help regulate MMA and improve health and safety.

“Prof Dan Healy has already publically stated his concerns around the lack of regulation of MMA in Ireland and the IMO would share those concerns,” said Dr Duddy. 

Prof Healy, Consultant Neurologist at Beaumont Hospital, Dublin, has spoken publicly about the need for improved medical standards at MMA events and is a member of the Safe MMA Ireland task force. 

Safe MMA told MI that “as with any unregulated contact or combat sport, unregulated MMA poses increased risk to its participants”. Safe MMA Ireland provided MI with a list of its recommendations to make MMA safer in Ireland (see panel page 16).

Dr Duddy said the IMO agrees with these calls, saying “a clear set of regulations setting out the minimum medical staffing requirements for MMA events must be introduced”. 

“These must include ensuring staff have the necessary skills, including advanced airway skills, to manage a patient who has lost consciousness due to a presumed intracranial haemorrhage,” he told MI.

“Rules similar to those in place for professional boxing events in Britain requiring event promoters to inform the local neurosurgical unit of an MMA event should also be included. In addition, children aged under 16 should be prevented from participating in any MMA-style event. 

“There must be mandatory reporting of any adverse event at a MMA event to the relevant authority, eg, Sport Ireland or the Health and Safety Authority.”

The way that MMA events are currently held concerns some in medical and political circles. 

“I do have serious health and safety concerns,” agreed Senator Noone.

“It is an inherently dangerous activity and such concerns are increased by the lack of proper medical personnel being present at all games and other such measures that would insure the safety of participants.”


The role that organisations like the HSA can play in this area is restricted by legislation. 

“The role of the HSA is to enforce the Safety, Health, and Welfare at Work Act,” a HSA spokesperson explained to MI.

“The Act places the onus on the employer/manager/owner of any place of work to manage and conduct undertakings in such a way as to ensure, as far as is reasonably practicable, that his or her employees are not exposed to risks to their safety, health, and welfare.

“Whether or not any sporting event comes within the remit of the Health and Safety Authority is therefore dependant on the nature of the involvement of those participating in the event. 

“Any person who is involved in such an event in a professional, self-employed, or employee capacity is covered by the Act. For sporting events this may include those participating in the event as well as those who may be present to provide associated services to the event.

“There is no requirement for organisers of sporting events to make contact with the HSA in advance of the event taking place.”

Safe MMA recommendations 

Safe MMA says that it “supports the recognition and regulation of the sport”.

Safe MMA Ireland’s medical recommendations include the following and, “although not enforced by regulation, these are currently being implemented for all professional MMA competition in Ireland via voluntary consensus by the MMA community”, according to Safe MMA. 

All athletes completing annual medical examinations, blood tests (hepatitis B, hepatitis C, HIV), MRIs/ MRAs (brain and neck) and ophthalmology tests.

All athletes undergoing pre and post-fight medical examinations at the event.

The enforcing of medical suspensions between promotions.

At least two appropriately qualified doctors per ring with anaesthesia induced airway management.

At least two advanced cardiac life support paramedics per ring.

At least two ambulances (ambulance onsite at all times).

Events to take place within 15 minutes’ travel distance of an emergency neurological unit.

Local emergency units pre-notified of event.

Immediate referral for CT scans (brain).

At least one medical room provided onsite for first aid/medical care.

“Other areas for consideration include the training and licensing of referees, coaches, and cutman, issues around insurance for the sport, quality control of products, implementation of health and safety practices at events, implementation of safeguarding policies, event sanctioning and inspection,” says Safe MMA.


Currently, MMA is not recognised by Sport Ireland, but there have been calls for recognition to take place to help ensure the regulation of safety standards. 

Former Minister of State for Tourism and Sport, Mr Michael Ring, held a meeting “with representatives from the MMA community” on 23 January 2014, this newspaper has been told. 

“Minister Ring also met with representatives of Sport Ireland, the International Mixed Martial Arts Federation (IMMAF) and a representative of the MMA community in Ireland on 27 April 2016,” a Department spokesperson told MI. This meeting followed the death of fighter Joao Carvalho.

“Sport Ireland is taking the lead in relation to discussions in relation to the recognition process.”

Mr David Gash from Sport Ireland told MI that initial meetings have taken place regarding possible recognition, but that this remains in the very early stages. 

“We don’t recognise sports, we recognise national governing bodies,” explained Mr Gash. 

“There is an organisation called the Irish Mixed Martial Arts Association (IMMAA), which has very recently been set up. We would have met with them just outlining the criteria of recognition for national governing bodies. These are initial talks outlining the criteria. They are an amateur body as well. In terms of the commercial mixed martial arts, we have no relationship at all. 

“As it stands we don’t currently recognise MMA in any form. But we do continue to liaise with the IMMAA on matters relating to the establishment of a recognised governing body, offering them any guidance they need in setting up the organisation. It’s at the very early stages of setting up and there is no formal application for recognition as of yet.”

However, Mr Gash said that health and safety issues are not the main part of these discussions. 

“The recognition process would not involve any validation of safety standards, it’s just a recognition process,” he said.  The accreditation scheme would not necessarily benchmark safety standards. 

“But responsibility for safety at an event, either amateur or commercial, would rest with the national governing body or the commercial operators themselves.”

The IMMAA is an amateur body and Sport Ireland has no role in commercial MMA events that take place in Ireland.

However, there have been other voices within sport that are against MMA being recognised. In August, RTÉ reported that the Irish Martial Arts Commission, which has been asked to consider taking MMA under its umbrella, “wrote to the International Olympic Committee in April of this year saying that MMA, in its current form, is not a sport, and like dog fighting did not deserve to be legitimised”.

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