Head injury assessment review (Wales v England)

george north


(ISN) – London – Following a full post-incident review, World Rugby believes that Wales player George North should not have remained on the field of play following a head impact in the 61st minute of the Wales versus England RBS 6 Nations match at the Millennium Stadium on Friday night.

The World Rugby head injury protocol clearly states that a player should be immediately and permanently removed from the field of play where there are any visible symptoms or suspicion of a potential concussion.

However, following thorough discussions and input from the expert independent Concussion Advisory Group, World Rugby accepts the WRU’s explanation that neither the team medical staff nor the independent doctor had sight of the incident and understands that the medics acted within the framework of information they had at the time and would have taken a different course of action had they had direct pitch-side visibility or access to the same broadcast footage seen by those watching on television.

The impact was the second sustained by the player in the match, following a first half temporary removal for a head injury assessment. Having reviewed the incident report, World Rugby can confirm that the WRU followed correct protocols when assessing North following this first incident. The WRU has outlined that the player continues to undergo close medical supervision and is undertaking supervised graduated return to play protocols.

Player welfare is World Rugby’s number-one priority and the incident highlights the importance of ensuring that medical staff are given the best-possible level of support to minimise the chance of a repeat incident and further enhance the protection and support of players.

World Rugby will be immediately investigating, evaluating and promoting the implementation of the following measures:

1. World Rugby will investigate the practicality of the television match official technology being expanded to identify head injuries as they happen on the field.
2. All elite competitions will be requested to provide pitch-side video for medical staff.
3. All elite tournaments will be encouraged to adopt the Rugby World Cup 2015 player welfare standards.

Independent medics and video review are a important feature of the Rugby World Cup 2015 player welfare standards announced in November 2014 that will operate at all 48 Rugby World Cup matches and also a central feature of other World Rugby tournaments and events.

This approach also includes defined team and event medical staff minimum standards, mandatory completion of World Rugby concussion education, compulsory pre-tournament concussion baseline testing and a raft of other education modules aimed at further strengthening player welfare. It is World Rugby’s intention that these standards are implemented universally.

Concussion management and education is at the heart of World Rugby’s player welfare strategy designed to protect players at all levels of the game and promote the very highest standards of education, coaching and medical care.

World Rugby would like to thank the WRU for its full cooperation and welcomes the proposed initiatives by the union to strengthen further the ability to correctly identify head impacts on the field of play.


Concussion Advisory Group: Professor Caroline Finch (Injury Prevention Researcher, Federation University Australia), Professor Bob Cantu (Neurosurgeon, Boston University), Dr Willie Stewart (Clinical Neuroscientist, NHS Greater Glasgow and Clyde and Glasgow University) and Dr Jon Patricios (Sports Physician, South Africa)

Rugby World Cup 2015 Player Welfare Standards – Concussion

a) All teams must have appropriately-qualified and HIA-educated doctor at all such Matches as defined in the World Rugby HIA concussion guidelines
b) All medical staff and team staff must adhere to the immediate and permanent removal criteria for players following a head injury that suggests a confirmed or suspected concussion
c) All medical staff and team staff must adhere to temporary removal from the field of play criteria that indicate when a HIA assessment should be completed
d) All players and team staff must have completed concussion education within the year prior to their first participation each season. The minimum content of this education is set out in the World Rugby HIA concussion guidelines
e) Annual baseline concussion testing on all players participating in such matches, as a minimum using the tools as set out in the World Rugby HIA concussion guidelines
f) Annual risk stratification of all players participating in such matches to support concussion management on an individual basis. This concussion risk stratification may be undertaken as set out in the World Rugby HIA concussion guidelines and/or as appropriate in accordance with medical practice in the relevant jurisdiction;
g) All competitions or tournaments must monitor the implementation and compliance of the HIA protocol in such matches and, as requested, promptly provide feedback to World Rugby on overall or individual case compliance within ten days of request
h) Union or tournament organisers must ensure that rules require all persons involved in the tournaments and/or matches to comply with Law 3.10 ii and this Regulation 10 and set out that any non-compliance therewith constitutes a breach of such rules as a strict liability offence by, as a minimum, the relevant team’s medical staff, team manager and head coach as the persons primarily responsible for the welfare of the players in their team, and any relevant players and/or other persons. The union or tournament organiser’s rules must also stipulate that the club, rugby body and/or union responsible for the team shall be vicariously liable for any proven breach of such rules by its personnel. Unions and tournament organisers must institute proceedings and impose appropriate sanctions in the event of any such breaches. Unions and tournament organisers must provide World Rugby with a summary of any such cases and, upon request, all supporting documentation and information.