Significant changes to concussion management in England

This season will see major changes to the way the risk of concussion is managed across the professional game in England.
The Rugby Football Union, Premiership Rugby and the Rugby Players Association have worked together to focus specifically on concussion awareness and education, game day management and the graduated return to play for those players who have suffered a concussion.
A new mandatory online concussion awareness module will be required to be completed by all registered professional players, coaches and referees within a two month period. This will include all male registered  Premiership Rugby and Championship players over 18 and contracted England Sevens players (which will cover all of the EPS Squad, Saxons and U20s players).
In the women’s game, England representative players over the age of 18 (which will also cover England U20, ESP and Sevens players), coaches and referees will be asked to complete the course.
The objective of the module is to improve the understanding of concussion and the behaviours needed from all groups to manage it effectively. It also includes an end-of-module assessment that is required to be completed by all groups.
There will be automatic fines if the module is not completed by the required date. If a player or coach does not complete the module we have the ability to make a player or coach ineligible to play or coach until such time as they have completed it.
All Premiership Rugby and Championship medical staff will also undertake additional mandatory concussion management training as part of the annual Immediate Care in Sport (ICIS) programme. The Head injury and concussion section has been updated to reflect recent changes in concussion management.
On gameday, the Head Injury Assessment (HIA) process, formerly the Pitch Side Concussion Assessment process (PSCA) will again be used in Premiership Rugby and England matches in the 14-15 season to help doctors manage head injury events where they are unsure of the diagnosis. Cases of confirmed or suspected concussion will continue to be permanently removed from the field of play.
Two components of the assessment tool have been expanded, with the memory test strengthened and the balance test altered, enhancing the information team and independent doctors have available to them when making a return-to-play decision. The period for this assessment has also been extended from five to 10 minutes.
At all Premiership Rugby grounds and at Twickenham stadium, doctors will have access to live TV feeds and replays when they conduct a Head Injury Assessment to aid their decisions on whether to permanently withdraw a player from the field of play.
There also will be an independent review of the on-field management of confirmed and suspected concussion cases and all HIAs that occur during Premiership Rugby and England matches. They will be conducted by two experienced independent medical practitioners who will review the match footage and seek further information if needed from team medical staff. The review process is linked to the RFU disciplinary process.
RFU Chief Medical Officer Simon Kemp said: “These significant changes were driven by the Professional Game Board Medical Advisory Group review of the 2013 Concussion Forum and continues the programme of work that we have been delivering over the last ten years on concussion.
“Working closely with Premiership Rugby and the RPA we believe this will provide a comprehensive package of processes designed to enhance all elements of professional player concussion management. The education module, game day management and return to play protocols have been independently reviewed and validated as well as backed by compliance.
“Importantly these changes are consistent with the Recognise, Remove, Recover, Return message, which is relevant to all levels of the game and will deliver key knowledge and behaviours needed. Following the initial roll out of the module our aim is to make a version of it available to all levels of the game.”
Premiership Rugby Director Phil Winstanley said: “The welfare of our players is the number one priority for Premiership Rugby.
“The enhanced protocols and game-wide awareness training will ensure that players, coaches and referees are equipped to deal with concussion and that symptoms are recognised and treated optimally before players continue to play or retake the field after an assessment.”
RPA Director Richard Bryan added: “Player welfare is the top priority of the RPA and so these enhancements to concussion management and the education of players, coaches and referees are very welcome.
“While these changes represent significant steps in the right direction, it is crucial that concussion management and education continue to be monitored and evaluated to ensure effectiveness and that advances in the understanding of concussion are incorporated into the ongoing safety of players.
“Ultimately we believe it is the collective responsibility of all stakeholders in the professional game to deliver a culture change in attitudes towards concussion.”
IRB Chief Medical Officer Martin Raftery said: “Concussion education, management and research is at the very heart of Rugby’s player welfare strategies aimed at protecting players at all levels of the Game. I would like to congratulate the RFU, Premiership Rugby and the RPA for their forward-thinking education programme that not only provides consistency with our own Recognise and Remove programme, but will play a large role in changing culture in the Game.”
Sports Legacy Institute Founding Executive Director Chris Nowinski said: “The Concussion Education Module provides players, coaches, and referees with critical information necessary to better recognize and respond to brain injury in an engaging style. Commendably, the program provides full disclosure of the serious risks involved with concussions as we know them today, and focuses on the important task of changing the culture together. I am proud to have participated in the content development and impressed by the final product.”Ends-