ARU welcomes new pitch side concussion assessment trial

by staff

Australian Rugby Union today welcomed SANZAR’s decision to trial the new Pitch Side Concussion Assessment (PSCA) Protocols during the inaugural Castrol EDGE Rugby Championship.

The PSCA protocols are a first in world sport and provide a standardised procedure of player assessment in line with global medical best practice.

The protocols were trialled during the Junior World Championships in South Africa earlier this year with good results which has led to the IRB allowing Unions to trial the protocols in their elite domestic competitions should they choose.

Under the trial players who have sustained a head injury with suspicious symptoms or signs will be able to leave the field of play and can be temporarily replaced for up to five minutes while a standardised assessment is undertaken.

The assessment, undertaken simultaneously by the team doctor and an experienced independent doctor, includes looking for common symptoms associated with concussion, such as headaches, nausea and dizziness; memory questions, a balance Test and observation for any abnormal behaviour.

If the player passes the PSCA they are allowed to return to the field of play, however should a player be found to be suffering symptoms or signs of concussion then their replacement becomes permanent.

Any player not passed fit to return to the field of play is required to undertake further testing in line with IRB regulations to be either cleared or diagnosed as suffering from concussion.

Qantas Wallabies Team Doctor, Warren McDonald, said he was looking forward to participating in the world leading trial.

“The management of concussion has received a lot of publicity in recent years and there has been debate in medical circles as to the best way to diagnose and treat concussion,” Dr McDonald said.

“These protocols, which have been developed by a team of experts, provide a very clear and medically sensible approach to assessing and diagnosing whether players are fit to continue following a head knock.

“The opportunity to assess a player away from the field of play, without the game continuing around them ensures a thorough evaluation can take place.”

The PSCA protocols were developed by an IRB working group consisting of experienced international team physicians, a player representative and internationally recognised medical experts in the field of concussion including a French neurosurgeon and an Australian Physician with a PhD in concussion.

When developing the protocols the group were asked if, when implemented, the protocols would; improve player safety, not undermine the fabric of the game and not be open to tactical manipulation by coaches.

IRB Chief Medical Officer, Martin Raftery, said the development of the protocols and the extension of the trial was a clear indication that Rugby was leading the field in assessing, diagnosing and managing head knocks in sport.

“These protocols are first and foremost about player welfare and protecting the players, Rugby does not take any risks when it comes to head injuries,” Dr Raftery said.

“We’re the first sport in the world to have developed a new tool and changed our laws to manage and diagnose pitch side concussion.

“The process we are now undertaking, trialling the protocols during The Castrol EDGE Rugby Championship, the Junior World Championships and a number of other elite competitions, is to ensure the protocols work as they are intended to.

“This coordinated research needs to be undertaken so we can prove that these protocols are improving outcomes for the players and the game.

“It will also help us better determine what the best way forward is when dealing with pitch side concussion and if there is a requirement to make changes or amendments to the protocols as they stand.

“So far all of our testing has shown us that those who have been removed from the field permanently have had concussion following their additional testing.

“All the players who have been allowed back on under the PSCA have not had a concussion.

“These results are pleasing, but it is still early days and the opportunity to trial the PSCA protocols in the Championship will assist greatly in ensuring Rugby continues to lead the way in this space.”

Under the PSCA protocols:

• The recommendation to remove the player can be made by either the referee, the independent match day doctor or the team doctor from the player's team.

• Once that command is made, the referee will indicate that the player is leaving the field of play with a hand signal where he touches his head three times.

• Once the player has been removed from the field of play and temporarily replaced, the team and independent match doctors will proceed through an IRB pitch-side concussion assessment procedure incorporating standardised questions and observations.

• If the player fails any aspect of the assessment and has relevant symptoms he will not be able to return to the field of play and the substitution becomes permanent.

IRB policies in concussion are in line with concussion evaluation guidelines for suspected concussion as outlined within the Zurich Consensus Statement, of which the IRB is a signatory.

Within the PSCA, the IRB has altered a protocol to allow for off-field assessment and an assessment tool incorporates Maddocks questions, balance tests and symptoms review as recommended by Zurich.

In 2011 the IRB introduced revised protocols governing concussion evaluation and Graduated Return to Play guidelines, driven by the Concussion Working Group which includes Union medics, independent experts and player body representation.

It also launched a fully interactive concussion management education website for players, coaches and doctors,