The most important consideration in the management of concussion or a potential concussion is the welfare and safety of the player.
It is a requirement that all players who suffer a concussion seek the highest level of medical care reasonably available and follow Rugby Australia’s return to play policy to ensure concussion is managed appropriately.
A concussion is a brain injury and must be taken seriously. All players with potential head injuries or concussion must be removed from the field of play immediately.
A player suspected of having suffered a concussion will be shown a blue card by the match referee and will take no further part in the match.
Recognition of concussion may occur immediately identified from the side-line, whilst attending the player on the field of play or in the 48 hour period after the game. If any of the following signs or symptoms are present following a head injury the player should be suspected of having concussion and be immediately removed from play or training.
Any one or more of the following clearly indicate a concussion:
- Seizure (fits)
- Loss of consciousness (LOC) – confirmed or suspected – visible signs suggesting LOC – lying motionless on the ground for more than 5 seconds, slow to get up off the ground
- Unsteady on feet or balance problems or falling over or poor coordination
- Confused
- Disorientated – not aware of where they are or who they are or the time of day
- Dazed, blank or vacant look
- Grabbing or clutching of head
- Behavioural changes (eg. more emotional or more irritable)
Presence of any one or more of the following signs and symptoms may suggest a concussion:
- Headache
- Dizziness
- Mental clouding, confusion, or feeling slowed down
- Visual problems
- Nausea or vomiting
- Fatigue
- Drowsiness/feeling like “in a fog“/difficulty concentrating
- “Pressure in head”
- Sensitivity to light or noise
Failure to answer any of these questions correctly is a strong indication of concussion or at least suspected concussion.
- “What venue are we at today?”
- “Which half is it now?”
- “Who scored last in this game?”
- “What team did you play last week/game?”
- “Did your team win the last game?”
Failure to answer any of these questions correctly is a strong indication of concussion or at least suspected concussion.
- “Where are we now?”
- “Is it before or after lunch?”
- “What was your last lesson / class?” “Who scored last in this game?”
- “What is your teacher’s name?” or “What is your coach’s name?”
If any of the following are reported or noticed then the player should be transported for urgent medical assessment at the nearest hospital:
- player complains of severe neck pain
- deteriorating consciousness (more drowsy)
- increasing confusion or irritability
- severe or increasing headache
- repeated vomiting
- unusual behaviour change
- seizure (fit)
- double vision
- numbness, tingling, burning or weakness in the arms or legs'
- slurred speech
Recognise and remove and if in doubt, sit them out.
The Rugby Australia Concussion Management Procedure outlines the steps required following a concussion or suspected concussion to ensure they are managed appropriately. Additional information can be found here:
The management of concussion involves the following 8 steps; each step must be followed and completed before moving to the next step. These can be thought of as two stages:
RECOGNISE - REMOVE - RECORD - REFER
If a player has signs or symptoms of a potential head injury or concussion no person (e.g. physio, coach, trainer, or doctor) can over-ride the requirement of a player to remain off the field.
The following documents must be provided to a player, or parent/guardian, on the day of the injury:
REST - RECOVER - RECORD - RETURN
For any player is diagnosed as having concussion the stepwise graduated return to play (GRTP) process must be followed. The referral & return form must be completed.
If this isn’t completed the player will be excluded indefinitely from full contact training and match play.
Players with concussion or suspected concussion:
- should not be left alone in the first 24 hours
- should not consume alcohol in the first 24 hours and thereafter should avoid alcohol until provided with medical or healthcare professional clearance or if no medical or healthcare professional advice is available the injured player should avoid alcohol until symptom free
- should not drive a motor vehicle and should not return to driving until provided with medical or healthcare professional clearance or if no medical or healthcare professional advice is available should not drive until symptom
Rest the body, rest the brain.
At all times, players, parents, team officials, match officials and medical staff need to act in the best interest of player safety and welfare by;
- Taking responsibility for the recognition, removal and referral of players to a medical doctor (more information can be found in the Concussion Recognition Tool CRT5
- Ensuring concussion is appropriately managed as per Rugby Australia’s Concussion Procedure
A digital version of the A3 Concussion Management and Injury Reporting poster can be found here.
Concussion Management Checklist for players, teams and competition managers can be found at:
In 2018 Rugby Australia’s National Safety Committee approved the recommendation for mandatory use of Blue Cards in all club, school and domestic representative rugby beginning in matches from 1st March 2018.
In matches of U13 and older, when a player leaves the field due to signs and symptoms of concussion or suspected concussion, the referee will show the player a Blue Card.
This card is a visual cue for team support staff, it must be recorded by team officials, and triggers an off-field medical process to begin.
This off-field process (which applies to all rugby, not just U13s and older) is detailed in Rugby Australia’s Concussion Management Procedure.
Rugby Australia has included the following Law change ‘a tactically replaced player may return to play to replace a player who has been shown a Blue Card.’
Rugby Australia’s Concussion Procedure reflects best practice for the management of concussion for rugby at the community levels of the game in Australia.
To assist in the management of concussion it is recommended that all players have a baseline measurement prior to participating in rugby. These tools should be used in consultation with a medical practitioner - Sports Concussion Assessment Tool (SCAT5) and Child SCAT5.
- World Rugby - Concussion Guidance for Non-Medical Professionals
- World Rugby - Head Injury Assessment (HIA) Protocol
- Rugby Australia - Serious Injury Reporting
- Rugby Australia - Concussion Referral & Return Form