[Junior] Potential Head Injury

[thepercy]

U-19 Girls Match, competition rules cap score at 40 point lead, after this normal substitution laws are suspended.

After (another) try is scored, Blue 7, is squatted down, both hands holding her head, eyes are bloodshot and glassy. As AR I alert referee and get the trainer on to check her out, she leaves the field, is in the medical tent for 25 minutes, and is cleared by the medical professionals, no head injury according to them.

Since we are now in a rolling subs situation, would you allow B7 back on the pitch?

 

[Phil E]

U-19 Girls Match, competition rules cap score at 40 point lead, after this normal substitution laws are suspended.

After (another) try is scored, Blue 7, is squatted down, both hands holding her head, eyes are bloodshot and glassy. As AR I alert referee and get the trainer on to check her out, she leaves the field, is in the medical tent for 25 minutes, and is cleared by the medical professionals, no head injury according to them.

Since we are now in a rolling subs situation, would you allow B7 back on the pitch?

Do you consider that at the time of the injury (or subsequently) she displayed signs of concussion (See HERE).
If yes, then you are well within your rights (and encouraged) to refuse to let her back on.

 

[ChrisR]

Congrats for noticing and taking action but it's a tough decision re. letting her return. She had been cleared to play by a certified (???) medical professional and you don't know what the issue is or why she spent time under supervision. I think I'd like to know these things before I just agreed to her playing again.

 

[VM75]

Suggestion:

When a Medical Professional sanctions the player as being 'Fit to Return to Play', they should evidence the same by giving the referee a signed personal business card [or a similar production] with the players name / number / club.

The referee can then keep it and produce it if/when needed.

If the MedPro won't sign such a thing, then he hasn't taken Professional Ownership in which case the decision remains with the referee.

 

[Pegleg]

If I suspect she has concussion at the time of her leaving the field she is not coming back on. Medical opinion or not. HIA does not apply at that level (here in Wales anyway).

 

[Pinky]

I don't think anyone should be allowed to return if medical treatment took 25 mins. HIA (and like Wales not done in Scotland below professional game) needs to be done in 10 mins as does blood substitution.

 

[beckett50]

If it was me, I would advise the coach - when she is removed from the pitch for medical assistance - that she is not returning to play as IMO it would be unsafe for her so to do and player welfare on the pitch is my responsibility

Tough call and I can imagine quite a few coaches baulking at the suggestion.

 

[Ciaran Trainor]

I wouldn't let here back on.
If the coach insisted I'd tell him I wouldn't be continuing

 

[SimonSmith]

"The Trainer" isn't presumably a qualified doctor. In this area your direct observation of her immediately on the field trumps his 25m overview, by which time she could have shaken the signs off; that doesn't mean she wasn't concussed.

Every referee society would back you 100% if you said she shouldn't play. And I think there are referees on here who have the anecdotes to back that play

 

[BikerRef]

Suggestion:

When a Medical Professional sanctions the player as being 'Fit to Return to Play', they should evidence the same by giving the referee a signed personal business card [or a similar production] with the players name / number / club.

The referee can then keep it and produce it if/when needed.

If the MedPro won't sign such a thing, then he hasn't taken Professional Ownership in which case the decision remains with the referee.

I like this approach. USA Rugby doesn't allow a HIA at any level in the US except International Test matches. The stated directives allow for an MD to assess. If they diagnose a concussion, there is no return to play allowed. If the sideline diagnosis by an MD is no concussion, I'd want it in writing before considering allowing a return.

 

[ChuckieB]

,

If it was me, I would advise the coach - when she is removed from the pitch for medical assistance - that she is not returning to play as IMO it would be unsafe for her so to do and player welfare on the pitch is my responsibility

Tough call and I can imagine quite a few coaches baulking at the suggestion.

Lots of learning material available but I am not readily aware, at my level of involvement at least, of anything more formal beyond the rfu concussion protocols that are part of the entry level competency requirement for referees. At what level do more formal protocols come into play in rfu land? A formal HIA, 10 mins max, etc?

At any level , you are likely to be guided by the opinion of a suitably trained person, more credence given to the judgment of someone who holds themsleves out as being qualified. You will no doubt raise the question as to the credentials of anyone giving you such an opinion if you are in doubt. A coach himself acting contrary to the same protocols that govern you raises serious questions about their integrity. It doesn't matter what anybody says, it's always your call (3.10). Should it be any different to the consideration you would give to a sending off offence. I am sure You'd expect be robust in your approach in such an instance. This is no different as regards a questioning of the authority of the referee.

Safety comes before equity and before the laws.

 

[Pegleg]

A Suitable trained (medical) person? What does that constitute? Concussion (head / brain) is not a general discipline. So a "normal" "physio" is highly unlikely to be "STP". Indeed, out in the sticks the "Physio" probably has very limited abilities past "First Aid".

Secondly, Would you recognise a qualification on paper? Do you trust the phrase: "I'm a doctor Let me through!"?

The Buck stops with YOU the ref! If YOU let that player stay on and YOU had any doubt. YOU are in trouble.


I'm not talking about the elitie level where the medical staffing set up if far more complex with sides having speciallist and an independent (UNION ACCREDITED) doctor is many cases being present. But where you will be refereeing, at least initially ChuckieB, Your comments about 3.10 and safety trumping everything are king. Your union will back you up.

We had an incident at a cup final (I was AR3) recently where there was a head injury with the player bleeding from the ear. The player was "out" and lying prone, The physios of his team did not want to move him until the ambulance arrived. The away coach announced that he was a lecturer in medicine at the local Uni and his assessment wa the player could be moved. His reasoning sounded very technical and plausible. The ref was willing to accept the coaches opinion. I told him to hang on as we had no idea what this guy's qualification was. He sounded plausible. However, context: His side we 8 point behind & there was 10 minutes on the clock. His side were a man up due to a red card. They did not want the game to be abandoned. I and the AR1, 2 & 4 all agree the ref should not have the player moverd. We persuade the ref not to comply. Who knows why the coach wanted him to be move. To win the game perhaps? Maybe I hould not be so cynical. Maybe not.

Simple answer, unless you have a protocol (in writing) that allows a different action, if you, as referee, are not happy that he is fit to continue (ANY INJURY NOT JUST THE HEAD) the player leaves the field. No ifs and no buts!

 

[Balones]

I have always supported the referee's decision on such matters. When refereeing I have made the decision about the player's suitability to continue and/or return. This has occasionally put me in conflict with coaches and even 'doctors' on the sidelines that I know are properly qualified. More than once I was told 'you are not qualified' or 'he's a doctor' etc. My reply has simply been along the lines of "I don't care ,I have to live with the decision and you accept my decision or this game doesn't have a referee". One coach did complain to the organisers of the game and the society got a note but they simply supported my decision and put the club/coach in his place.
I was assessing at a L5 game a few seasons ago when the referee took a hard line with a team captain/coach who had been knocked out. The referee ordered him off the pitch and said he wasn't to return. There was a brief argument on the pitch but the referee stood firm. At half time the other coaches of the team and the 'medic' continued to harass him, quite forcibly and I had to step in. Five minutes into the second half the player concerned was found slumped unconscious in the technical area. I made sure that the referee had the most grovelling apology possible from the team and management on the day and commended the referee's approach in the report.

 

[DocY]

I'm disappointed to hear about the arguments refs are still having with head injuries. I've found that over this season coaches have become much more understanding and I don't think I've had even a discussion about a player going off - which has not been the case in previous seasons.

 

[Balones]

I'm disappointed to hear about the arguments refs are still having with head injuries. I've found that over this season coaches have become much more understanding and I don't think I've had even a discussion about a player going off - which has not been the case in previous seasons.

I have agree that the situation certainly has improved over the last couple of years since the matter of concussion has been more high profile. The experiences I have mentioned in my post are from a few years back. It does however occasionally raise its head.

 

[The Fat]

Pretty straight forward Down Under.
HIA at elite levels only.

At our level;
Player assessment a collaboration between Referee and qualified First Aid Officer. If either ref or first aider see ANY signs or symptoms of a suspected concussion, the player is off (doesn't matter if the world's leading medical authority on concussion happens to be present and thinks the player is OK, the decision has been made). The player is noted on the Match Sheet as having a suspected concussion which triggers the Competition/Zone Admin Officer to record the suspected concussion on the RugbyLink website. The player must see a doctor within 72 hours and give the doctor a form (legal document) that basically tells the doctor that the player had shown signs or symptoms of a suspected concussion and therefore MUST be treated as having had a concussion. The doctor's role is to check the player for any other symptoms and is to guide the player through the GRTP (Gradual Return To Play) protocols i.e. minimum 12 days before returning for 19 years or older and 19 days for 18 years and younger, after the player is symptom free. Player gets a clearance from the doctor when he can return to full contact training (and play).
Basically doesn't matter if there is a doctor at the ground. He may assist as a club's Medical Officer, but he cannot carry out a HIA and he cannot deem a player fit to return to play.

 

[didds]

thefat - that sounds an excellent protocol... one question thopugh... what checks and balances are in place down in the weeds to make sure that

The player must see a doctor within 72 hours and give the doctor a form (legal document) that basically tells the doctor tha"t the player had shown signs or symptoms of a suspected concussion and therefore MUST be treated as having had a concussion. The doctor's role is to check the player for any other symptoms and is to guide the player through the GRTP (Gradual Return To Play) protocols

ie - how does anybody with rugby KNOW that the doctoire has been consulted, has acted up[on the info etc?

We do have similar GRTP in RFUland and my club take this seriously. But in recent history we have had a junior concussion whereby the parents didn't think it was worth going to hospital, and when eventually seen (because he was ill at school the next day and the school sent him home!) the doctor complained that his time was being wasted and he couldn't be bothered to write a note (to fulfill our criteria for GRTP etc). which of course further exacerbated the parent's view of "why are medically unqualified coaches insisting on this".

ie part of the problem being that large parts of this protocol are handled by people with their own agendas.

We can all agree that "it isn't right" but nonetheless it exists.

I can see scenarios whereby a willing participant in the protocols cannot fulfill them too - eg concussed senior player is about to go away on business for several days etc.

didds

 

[Pinky]

ChuckieB, Your comments about 3.10 and safety trumping everything are king. Your union will back you up.

Agree with this about 3.10, however not so keen on your comparison with a RC, CB. For a head injury, if there is any evidence of concussion, the player is off. "If in doubt, sit them out" A RC can only come from you being satisfied that there was clear and obvious foul play that warranted the RC.

 

[Pegleg]

...however not so keen on your comparison with a RC, CB. For a head injury, if there is any evidence of concussion, the player is off. "If in doubt, sit them out" A RC can only come from you being satisfied that there was clear and obvious foul play that warranted the RC.

Whatt are you talking about? I made no comparison with a RC Here is my full post for you to reconsider.

A Suitable trained (medical) person? What does that constitute? Concussion (head / brain) is not a general discipline. So a "normal" "physio" is highly unlikely to be "STP". Indeed, out in the sticks the "Physio" probably has very limited abilities past "First Aid".

Secondly, Would you recognise a qualification on paper? Do you trust the phrase: "I'm a doctor Let me through!"?

The Buck stops with YOU the ref! If YOU let that player stay on and YOU had any doubt. YOU are in trouble.


I'm not talking about the elitie level where the medical staffing set up if far more complex with sides having speciallist and an independent (UNION ACCREDITED) doctor is many cases being present. But where you will be refereeing, at least initially ChuckieB, Your comments about 3.10 and safety trumping everything are king. Your union will back you up.

We had an incident at a cup final (I was AR3) recently where there was a head injury with the player bleeding from the ear. The player was "out" and lying prone, The physios of his team did not want to move him until the ambulance arrived. The away coach announced that he was a lecturer in medicine at the local Uni and his assessment wa the player could be moved. His reasoning sounded very technical and plausible. The ref was willing to accept the coaches opinion. I told him to hang on as we had no idea what this guy's qualification was. He sounded plausible. However, context: His side we 8 point behind & there was 10 minutes on the clock. His side were a man up due to a red card. They did not want the game to be abandoned. I and the AR1, 2 & 4 all agree the ref should not have the player moverd. We persuade the ref not to comply. Who knows why the coach wanted him to be move. To win the game perhaps? Maybe I hould not be so cynical. Maybe not.

Simple answer, unless you have a protocol (in writing) that allows a different action, if you, as referee, are not happy that he is fit to continue (ANY INJURY NOT JUST THE HEAD) the player leaves the field. No ifs and no buts!

 

[DocY]

Whatt are you talking about? I made no comparison with a RC Here is my full post for you to reconsider.

I think he was replying to ChuckieB