CONCUSSION GUIDANCE (RUGBY PUBLIC STANDARD CARE PATHWAY)

Transcription

1 CONCUSSION GUIDANCE (RUGBY PUBLIC STANDARD CARE PATHWAY) PREAMBLE The advice within this dcument is based n the Wrld Rugby Cncussin Guidance dated April 2017 The advice in this dcument has been adapted t reflect best practice fr the management f cncussin fr rugby at cmmunity levels f the game in Australia. RESPONSIBILITIES The purpse f this dcument is t prvide guidance n Rugby Australia s Cncussin Prcedure t thse invlved in rugby unin in Australia. This dcument incrprates the changes t the Wrld Rugby Cncussin Laws (Regulatin 10, Law Implementatin August 1, 2015), and Wrld Rugby s Operatinal Definitin f Cncussin (British Jurnal f Sprts Medicine, March 2016). This dcument is prepared fr the rugby public. This is nt a medical dcument. At all times, players, parents, team fficials, match fficials, first aid attendants and medical staff need t act in the best interest f player safety and welfare by; i. taking respnsibility fr the recgnitin, remval and referral f players t a medical dctr ii. ensuring cncussin is apprpriately managed as per Rugby Australia Cncussin Prcedure. Rugby Australia s Safety Plicy states that The primary cnsideratin in all participatin decisins must be the safety f all participants as a requirement that verrides all thers. It is a requirement that all players wh suffer a cncussin seek the highest level f medical care reasnably available t ensure cncussin is managed apprpriately. ADULTS AGED 19 AND OVER the MINIMUM perid befre RETURN TO PLAY is 12 days CHILDREN AND ADOLESCENTS AGED 18 AND UNDER the MINIMUM perid befre RETURN TO PLAY is 19 days OVERVIEW THIS DOCUMENT SUPERSEDES PREVIOUS RUGBY AUSTRALIA (and frmally the Australian Rugby Unin) CONCUSSION GUIDANCE AND IN CASES OF AMBIGUITY, THIS DOCUMENT IS OVER-RIDING FOR RUGBY GOVERNED BY RUGBY AUSTRALIA. This advice may be altered frm time t time by Rugby Australia based n the evlutin f the scientific evidence abut this injury. Ensure yu have the latest versin f all cncussin management infrmatin available at In this dcument the term ptential head injury refers t an injury that has the ptential t cause cncussin r a mre severe injury t the brain. This can be caused by: 1. a direct blw t the head r 2. indirect frce transmitted t the head frm a blw t anther part f the bdy that transmits frce t the head (e.g. a whiplash injury) 1

2 Ptential head injury r cncussin must be cnsidered pssible whenever a player receives an injury t the head, either frm a direct blw r indirectly. Minr bumps and grazes t the head may nt necessarily require medical review (unless the player exhibits features f ptential head injury r cncussin see signs and symptms in the Recgnise sectin belw) but any injury t the head r face that requires medical attentin (e.g. a laceratin requiring suturing r a fractured facial bne r nse) must als be assessed fr pssible cncussin assciated with this injury. This dcument utlines the Standard Care Pathway applicable t the vast majrity f rugby participatin in Australia. Wrld Rugby defines exceptins t the standard care pathway are fr adult players nly, wh can access an advanced level f cncussin care. In Australia, an advanced level f cncussin care is nly available fr prfessinal players playing Test Rugby, Super Rugby, Natinal Sevens Rugby, r Natinal U20s, and wh can access Rugby Australia apprved advanced care practitiners. BLUE CARD IMPLEMENTATION Fllwing very successful trials in 2017, the Rugby Australia s Natinal Safety Cmmittee has apprved the recmmendatin fr mandatry use f Blue Cards in all club, schl and dmestic representative rugby beginning in matches frm 1st March In matches f U13 and lder, when a player leaves the field due t signs and symptms f cncussin r suspected cncussin, the referee will shw the player a Blue Card. This card is a visual cue fr team supprt staff, it must be recrded by team fficials, and triggers an ff-field medical prcess t begin. This ff-field prcess (which applies t all rugby, nt just U13s and lder) is detailed in Rugby Australia s Cncussin Prcedure Rugby Australia has included the fllwing Law change a tactically replaced player may return t play t replace a player wh has been shwn a Blue Card. CONCUSSION INFORMATION A cncussin is a brain injury. Cncussin causes a disturbance f brain functin. Children and adlescents are mre susceptible t cncussin, take lnger t recver, have mre significant memry and mental prcessing issues, and are mre susceptible t rare and dangerus neurlgical cmplicatins, including death caused by a single r secnd impact. Cncussin usually fllws a head cllisin, but can ccur with a cllisin t ther parts f the bdy. Symptms can cme n at any time, but usually within hurs after a cllisin. Cncussin can ccur withut the player being kncked ut i.e. lsing cnsciusness. If a player is kncked ut, they have a cncussin. Mst cncussins recver with physical and mental rest. Cncussin that is ignred r nt recgnised can be fatal. Therefre, All cncussins shuld be taken seriusly. Children and adlescents must be treated mre cnservatively than adults. All players with ptential head injury r cncussin must be remved frm the field immediately. Return t play r training n the same day is nt permitted fr any ptential head injury r cncussin. 2

3 CONCUSSION MANAGEMENT The management f cncussin invlves the fllwing steps; each step must be fllwed and cmpleted befre mving t the next step. ON THE DAY OF THE INJURY ON THE DAYS FOLLOWING THE INJURY PROCEDURAL INFORMATION STEP 1 RECOGNISE RECOGNISE REMOVE RECORD REFER REST RECOVER RECORD RETURN A ptential head injury r cncussin must be acknwledged if a player has any f the fllwing signs, symptms, r fails t answer any f the rientatin r memry questins after a head r bdy cllisin. Signs (what may be seen) Symptms (players may reprt) Memry (questins t ask) Dazed, blank r vacant lk Headache What venue are we at tday? Lying mtinless n grund / Slw Dizziness Which half is it nw? t get up Mental cluding, cnfusin, r Wh scred last in this Unsteady n feet / Balance feeling slwed dwn game? prblems r falling ver / Visual prblems What team did yu play last Uncrdinated Nausea r vmiting week / game? Lss f cnsciusness r Fatigue Did yur team win the last unrespnsive Drwsiness / Feeling like in a game? Cnfused / Nt aware f plays r fg / Difficulty cncentrating events Pressure in head Grabbing / Clutching f head Sensitivity t light r nise Seizure (fits) Mre emtinal / Irritable than nrmal fr that persn Behavir that is nt nrmal r expected fr the individual is als a sign that shuld be lked fr. 3

4 STEP 2 REMOVE Any player with signs r symptms f a ptential head injury r cncussin must be remved frm the rugby field immediately. The player must nt take further part in any rugby training r games (including ther sprts) n this day. Any player with a ptential head injury r cncussin may als have a neck injury. If a neck injury is suspected, the player must nly be remved by experienced health care prviders with spinal care training ONCE A PLAYER HAS BEEN REMOVED FROM THE TRAINING OR PLAYING FIELD WITH 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. A medical dctr wh is experienced in the assessment and management f cncussin (see belw) can nly apply return t field prtcls under the Advanced Care Pathway. Fr the avidance f dubt, return t field prtcls are nly accessible under the Advanced Care Pathway and nly apply t a medical dctr wh is experienced in the assessment and management f cncussin. In Australia, the Advanced Care Pathway is nly available fr prfessinal players playing Test Rugby, Super Rugby, Natinal Sevens Rugby, Natinal U20s and wh can access Rugby Australia apprved advanced care practitiners. Return t field prtcls d nt apply t the Natinal Rugby Champinships, Australian dmestic Under 20s turnament, Club Rugby at any level, representative rugby (apart frm thse listed abve) r any children and adlescents age 18 years and under (including thse playing senir and prfessinal rugby). Similarly, the Head Injury Assessment prcess is available ONLY fr the elite levels f the game; in Australia, it is limited t Test rugby, Super Rugby, Sevens Wrld Series and Under 20s Junir Wrld Cup playing internatinally. The Head Injury Assessment prcess is NOT available fr Rugby at any level, apart frm thse listed abve. STEP 3 RECORD Any player remved frm the field f play with a ptential head injury r cncussin must be acknwledged if a player has any f the signs, symptms r fails t answer any f the rientatin and memry questins after a head r bdy cllisin. T clarify, a head knck suffered by a player during the game where there are n signs r symptms exhibited is nt a cncussin. The player shuld be mnitred fr signs and symptms. If any f thse signs r symptms are bserved then the player is t be remved frm play, and treated as cncussed. Similarly, a player with a headache pst-game that did nt exhibit any signs r symptms during the game, nr bserved t have had a head knck, is nt classified as cncussed. The key determinant in acknwledging a player as being cncussed r suspected f cncussin is the presence f signs and symptms. Any cncussed player must be recrded n the team match screcard. This infrmatin is then entered int Rugby Link (Rugby Australia s Natinal Registratin & Cmpetitin Management system) as an injury as part f pst-match tasks. NOTE: Where cmpetitins d nt use Rugby Link, the Cmpetitin Manager/Administratr must ensure that management prcedures are in place fr the central recrding f cncussin injuries. 4

5 Cmpetitin Managers and Club Rugby Link Administratrs are ntified f any cncussin injury entered in Rugby Link. A list f all players with cncussin recrds can be fund in the incident detail reprt. The injury is cnverted t an Injury Case and defaults t cnfirmed (i.e., it will be recrded as a cncussin unless it is excluded). Cmpetitin Managers enter the length f exclusin subject t prtcls assciated with advanced and standard care pathways. Any Player wh has cnfirmed cncussin is autmatically excluded fr the exclusin perid and nt allwed t be selected n the team list/match screcard. The length f exclusin is subject t prtcls assciated with the standard care pathways (players 18 years and under, and adults 19 years and ver). STEP 4 REFER All players with ptential head injury r cncussin must be referred t a medical dctr r emergency department as sn as practical (within 72 hurs f the injury). A minimum f tw sleeps (fllwing the incident) must be bserved befre any player can be assessed t exclude cncussin, hence NO player can be cleared in a time frame less than this. The referral must happen even if symptms r signs have disappeared. Ideally, the medical dctr wh reviews the player shuld have experience in the assessment and management f sprts cncussin. The player must at all times: Be in the care f a respnsible adult. Must nt cnsume alchl. Must nt drive a mtr vehicle. Be cperative and prvide cmplete and accurate infrmatin t the medical practitiner If there are serius cncerns abut the player r warning signs ( red flags ) f significant head injury appear, the player must be taken t the clsest Emergency department immediately r a respnsible adult must call an ambulance (000): Deterirating cnscius state (i.e. becming drwsier) Increasing cnfusin r irritability Behaving unusually r a change in their nrmal behavir Fit, seizure r cnvulsins Duble visin Slurred speech Cntinuing unsteadiness n their feet Weakness r tingling/burning in arms r legs Severe r increasing headache Repeated vmiting mre than nce etc. Severe r unusual neck pain RUGBY AUSTRALIA HEAD INJURY FACT SHEET AND RUGBY AUSTRALIA CONCUSSION REFERRAL AND RETURN FORM (WITH SECTION 1 COMPLETED) MUST BE GIVEN TO THE PLAYER OR FAMILY MEMBER/GUARDIAN. The Rugby Australia Head Injury Fact Sheet prvides infrmatin n cncussin including signs and symptms and management prcesses (i.e., what t d and what nt t d). It als includes infrmatin n red flags, which may indicate a mre serius injury requiring immediate attentin. 5

6 The Rugby Australia Cncussin Referral and Return Frm cmprises three sectins. Each sectin must be cmpleted; - (i) signs and symptms nted by first-aider, referee, cach, managers, players, r medical prfessinal at the time f injury; - (ii) infrmatin fr and acknwledgement f the initial cnsultatin with the medical dctr; - (iii) final clearance frm the medical dctr t return t full-cntact training. A medical dctr wh assesses a player fr cncussin shuld be experienced in the assessment and management f sprt-related cncussin. They must have read Rugby Australia s Cncussin Management Medical Dctr dcument and shuld have a gd wrking knwledge f the Rugby Australia Cncussin Guidance, Wrld Rugby Cncussin Guidance (August 2015), and Wrld Rugby s Operatinal Definitin f Cncussin (March 2016). Specifically, a medical dctr assessing a player must be aware that the Wrld Rugby Operatinal Definitin f Cncussin: has been develped and adapted fr elite rugby but the principles f this definitin may be applied t all levels f rugby includes a three-stage diagnstic prcess (at the time f injury, 3 hurs after injury, and hurs after injury) emphasises that a cncussin fllwing a head injury cannt be excluded until an assessment is cmpleted at hurs pst injury includes the recmmendatin that any abnrmal assessment (either at the time f injury, 3 hurs after injury, r hurs after injury) be cnsidered as being due t cncussin fr the avidance f dubt, any player wh has criteria fr permanent remval frm the field at the first assessment (at the time f injury) is cnsidered t have cncussin this cannt be ver-ruled if a player has n criteria fr permanent remval frm the field at the time f first assessment (at the time f injury) but has abnrmal assessments at 3 hurs after injury and/r hurs after injury, these abnrmal assessments are cnsidered t be due t cncussin if the results f subsequent assessments (3 hurs after injury and hurs after injury) the medical dctr making these assessments determines that the abnrmal assessment is nt related t a cncussin and as such is recrded as nt cnfirmed - the dctr must identify and dcument an alternative diagnsis fr the abnrmal assessment(s). IF ANY PLAYER IS DIAGNOSED AS HAVING CONCUSSION, THE FOLLOWING STEPWISE PROCESS MUST BE FOLLOWED: There are differences in the prcess undertaken between adults and children and adlescents. Fr the purpse f this guidance dcument, adults are all players aged 19 and ver Children and adlescents are all players aged 18 and under Fr the avidance f dubt, anyne playing schls rugby must fllw the guidelines fr children and adlescents. Players aged 18 r under playing adult rugby including Clts rugby must fllw the guidelines fr children and adlescents. 6

7 STEP 5 REST REST is crucial t recver frm cncussin. THE PLAYER MUST COMPLETELY REST FOR A MINIMUM OF 24 HOURS AFTER INJURY THE AIM OF THIS COMPLETE REST IS TO REDUCE SIGNS AND SYMPTOMS TO A LEVEL WHERE ALL MEDICATIONS HAVE STOPPED (e.g. pain killers fr headache). IDEALLY ALL SIGNS AND SYMPTOMS HAVE DISAPPEARED What des rest mean? Reducing physical and mental activity t the level that symptms can settle Wrld Rugby defines that the first 24 hurs fllwing a cncussin must be cmplete physical and cgnitive rest but a lnger perid f mdified activity (i.e. relative rest) may be required t allw symptms t settle This means aviding any physical and mental activity that wrsens symptms Examples f rest include: Resting quietly at hme Missing a day r tw frm schl, study r wrk. Ging fr a walk utside / arund the blck Limit any tasks that require prlnged fcus, memry r cncentratin Avid excessive TV, use f mbile devices, gaming, cmputers and phnes as these can aggravate symptms. Hw lng shuld the player reduce physical and mental activity? Players must rest (that is reduce physical and mental activity) until all their signs and symptms have ideally disappeared AND they have stpped all medicatin required fr treatment fr their cncussin symptms (e.g. pain killers fr headaches). The minimum cmplete rest time is 24 hurs fr adults, children and adlescents. Adults minimum rest time (cmplete and relative) is 7 days. Children and adlescents require a lnger rest perid as smetimes it can take a lng time fr symptms t settle, hence their minimum rest time (cmplete and relative) is 14 days. THE REQUIRED TIME OF REST VARIES FROM PLAYER TO PLAYER SO A MEDICAL DOCTOR WILL SPECIFY THE MINIMUM TIME OF REST FOR EACH INDIVIDUAL PLAYER. STEP 6 RECOVER & RETURN TO EXERCISE ( Stages 2-4) The fcus in the recvery phase is abut getting back t nrmal life, schl, study r wrk, but NOT hard physical exercise. Once symptms and signs are settled and medicatins are stpped, the player then returns t activities f nrmal daily living (schl, study r wrk). The player may perfrm light exercise that des nt aggravate symptms. If any symptms re-ccur r wrsen during recvery, the player will need mre rest time and the player shuld be reviewed by their medical dctr. Wrld Rugby has specified in Regulatin 10, minimum time perids fr players t rest and recver. These are a minimum and a guide, s the Rest and phases may be lnger than specified. 7

8 Regulatin Any ADULT Player with cncussin r suspected cncussin: (d) must have cmplete physical and cgnitive rest fr 24 hurs; and (e) must have relative physical rest (activity that des nt induce r aggravate symptms) fr at least ne-week (including the initial 24-hur perid f cmplete physical and cgnitive rest) befre cmmencing a graduated return t play () prgramme. Regulatin Any CHILD r ADOLESCENT Player (aged 18 years r less) with cncussin r suspected cncussin: (d) must have cmplete physical and cgnitive rest fr 24 hurs; and (e) must have relative physical rest (activity that des nt induce r aggravate symptms) fr at least tw weeks (including an initial 24-hur perid f cmplete physical and cgnitive rest) befre cmmencing the graduated return t play () prgramme. Light exercise can nly start after a player has returned t activities f nrmal daily living withut increased signs r symptms f cncussin and des nt require medicatin fr their symptms. 8

9 INFORMATION The best way t return t sprt is t fllw a gradual re-intrductin f exercise in a step-wise prgressin knwn as a graduated return t play () prgramme as per the fllwing: Cncussin Prcedure Step Stage Exercise Mde Example f Exercise Activity Prgressin 5 1 Rest Cmplete rest fllwed by relative rest f the brain and bdy 6 2 Light cardivascular exercise 6 3 Rugby specific exercise 6 4 Rugby specific nn-cntact training Light jgging fr minutes, swimming r statinary cycling at lw t mderate intensity. N weights training Individual running drills and skills withut cntact N weights training Mre cmplex training drills e.g. passing drills May start prgressive (lw level) weights training 7 5 Rugby practice Full cntact practice fllwing cmpleted Rugby Australia Cncussin Referral & Return Frm being prvided t the club r schl sprt master Minimum rest perid mandatry. Medical dctr decides n any additinal amunt f time needed. If n increased symptms, start Stage 3 after minimum f 24 hurs. If symptms ccur, rest 24 hurs & repeat. If n increased symptms, start after minimum f 24 hurs. If symptms reccur r wrsen, rest 24 hurs & repeat, then prgress If n increased symptms, review by a medical dctr and presentatin f a cmpleted Rugby Australia Cncussin Referral & Return Frm required befre Stage 5. If symptms reccur r wrsen, rest 24 hurs & repeat Stage 3, then prgress Player, cach, parent t reprt any symptms t medical dctr. If symptms reccur r wrsen, then medical dctr t review 8 6 Rugby game Full cntact game Mnitr fr recurring symptms r signs The management (i.e., clinical decisin-making) f a cncussin is the respnsibility f the medical dctr wh ideally has experience in the management f cncussin. Only the medical dctr can sign ff n the cmmencement and cnclusin f the prcess. The day-t-day versight f the player during the may be cnducted by a sprts physitherapist, parent/guardian, team trainer, r any ther respnsible adult. It is essential that the individual taking respnsibility checks whether the athlete has experienced any return f signs and/r symptms befre prgressing thrugh the. It is recmmended that the respnsible individual dcument the prgress and activities f the athlete at each step alng the, fr the purpse f prviding bjective infrmatin t the medical dctr fr the sign ff at the cnclusin f the. 9

10 Rest and y ( Stage 1) Stage 1 is the rest and recvery perid. The amunt f rest will be determined by the medical dctr wh assesses the player initially. Depending n the player s prgressin, a fllw up cnsultatin with a medical dctr t decide when the player can prgress t level 2 may be required but des nt need t be in persn, e.g. it may be dne in liaisn with the player s family, r team physitherapist. Return t exercise ( Stages 2 4) Stages 2 t 4 f the are the stages where the player returns t light general exercise initially then increases the vlume, intensity and specificity f exercise. A player can nly prceed t the next stage f the if they have n increase in signs r symptms f cncussin at the time f exercise, later that day (after exercise) and n waking the fllwing day. The minimum time between stages is 24 hurs, althugh children and adlescents may require a lnger perid f time between stages. If there is a recurrence r increase f symptms at any time during the the player must: Rest fr a minimum f 24 hurs until all symptms and signs have settled. Return t the previus stage at which they had n symptms. Recmmence the prgressin f the. If a player has a recurrence f severe symptms (e.g. requiring them t miss schl, study, r wrk) r repeatedly (mre than nce) during the, r if the recurrent symptms are prlnged (mre than 24 hurs), the player shuld be reviewed by their medical dctr. STEP 7 RECORD & RETURN TO CONTACT TRAINING ( Stage 5) The player must prvide a cmpleted Rugby Australia Cncussin Referral & Return frm t their team manager fr presentatin/submissin t the cmpetitin manager prir t returning t full-cntact training (Stage 5) and/r match play. FAILURE TO COMPLETE ANY SECTION OF THIS FORM WILL RESULT IN THE PLAYER BEING EXCLUDED INDEFINITELY FROM FULL CONTACT TRAINING AND MATCH PLAY Ideally the same medical dctr wh cnsulted the player after the initial injury will review the player and decide n their fitness t return t cntact training. Alternatively, this frm may be prvided by a medical dctr with experience in assessment and management f sprts cncussin and knwledge f Rugby Australia cncussin guidance. It is nt ideal t seek medical clearance frm inexperienced medical dctrs wh d nt knw the medical histry f the player (e.g., junir hspital emergency rm dctrs). Players 18* years and under cannt return t cntact training (Stage 5) fr at least 18 days after all symptms and signs have disappeared. Adult players, 19 years and ver, cannt return t cntact training (Stage 5) fr at least 11 days after all symptms and signs have disappeared. 10

11 *THIS RESTRICTION TO RETURN TO CONTACT TRAINING AND PLAYING APPLIES TO ALL PLAYERS AGED 18 YEARS AND UNDER INCLUDING THOSE PLAYING ADULT RUGBY. STEP 8 RETURN TO PLAY ( Stage 6) A player shuld nly return t play when they have fully recvered frm cncussin. This means the player must: Nt have any signs r symptms f cncussin at rest r in nrmal daily activities (schl, study, r wrk). Have fllwed the mandatry required rest time away frm cntact training. Have successfully cmpleted the withut any symptms r signs f cncussin (during r after training and cntact training). Have prvided a cmpleted Rugby Australia Cncussin Referral & Return frm t their team manager fr presentatin/submissin t the cmpetitin manager t apprve release in Rugby Link prir t returning t full-cntact training (Stage 5) and/r match play Players 18 years and under cannt return t play (Stage 6) fr at least 19 days after all symptms and signs have disappeared. Adult players, 19 years and ver, cannt return t play (Stage 6) fr at least 12 days after all symptms and signs have disappeared. Under Rugby Australia Cncussin Guidance (Rugby Public) and Wrld Rugby Regulatin 10, the fllwing tables utline the minimum and expected graduated return t play prcesses after a diagnsed uncmplicated cncussin injury ccurring n a Saturday game. This is where the player has recvered and has NO symptms at stage 5 during the prgramme. The tables belw are examples nly. Table 1: Children and Adlescents (aged 18 years and under) SAT MATCH PLAYER shws Signs and Symptms f Cncussin Week SUN MON TUES WED THUR FRI SAT Rest Stage 1 Stage 3 Rest Stage 1 Stage 3 Stage 3 RETURN Stage 5 RETURN Stage 6 PLAY MATCH 11

12 Table 2: Adult Participants (aged 19 years and ver) SAT MATCH PLAYER shws Signs and Symptms f Cncussin Week SUN MON TUES WED THUR FRI SAT 1 2 Rest Stage 1 RETURN Stage 5 Stage 3 RETURN Stage 6 Stage 3 Stage 3 PLAY MATCH Cmplex cncussin scenaris The standard care pathway nly applies t players wh have suffered their first cncussin in a 12 - mnth perid. Certain players may have the ptential fr mre cmplex injuries. Players must see a medical dctr experienced in sprts cncussin management t fllw an individualised management plan if they have: 2 cncussins in 12 mnths. Multiple cncussins ver their playing career. Cncussins ccurring with less cllisin frce. Cncussin symptms lasting lnger than expected i.e. a few days. The management f every cncussin case shuld be individualised, but the ccurrence f a secnd, r mre cncussins in a 12-mnth perid infers that a greater duratin f recvery may be needed. It is a requirement that all players suffering tw r mre cncussins in a seasn be assessed by a medical dctr experienced in sprts cncussin management and cnfirmed that they have fully recvered frm cncussin prir t returning t cntact sprt participatin. The apprpriate Cmpetitin Manager r Member Unin shuld be cntacted fr advice n the designated Cncussin cnsultant t see in such cases. If a player suffers three cncussins in any seasn r 12-mnth perid, they shuld strngly cnsider nt playing cntact sprt fr the remainder f that seasn, and shuld receive apprpriate clearance t return in future seasns by a dctr experienced in the management f cncussin. Review In very rare ccurrences it is pssible that cncussin r suspected cncussin was incrrectly reprted. This can be either frm an alternative diagnsis r a reprting errr. In such circumstances, the cncussin case can be reviewed. Alternative diagnsis - if a player shws signs and symptms f cncussin and if the results f subsequent assessments (3 hurs after injury and hurs after injury) the medical dctr making these assessments determines that the abnrmal assessment is nt related t a cncussin, the fllwing prcedure MUST be fllwed; Dctr must identify and dcument an alternative diagnsis fr the abnrmal assessment(s). 12

13 This dcumentatin is prvided t the apprpriate Cmpetitin Manager r Member Unin. The Cmpetitin r Member Unins appinted Cncussin cnsultant will then review and either uphld r verturn the cncussin decisin. Upn satisfactin that there is n evidence t suggest the players signs and symptms were nt assciated with cncussin the case is updated t nt cnfirmed and the player may return t cntact training and match play. Reprting errr The Match Official, Medical/First Aid Staff, Team Manager/Cach are cntacted by the Cmpetitin Manager t verify that the player did nt shw any signs r symptms f cncussin. Upn satisfactin that there is n evidence t suggest the player suffered a cncussin the case is updated t nt cnfirmed and the player may return t cntact training and match play. SANCTION(S) This Rugby Australia Cncussin Guidance and related Cncussin Prcedure are Rugby Australia Safety Plicies and Guidelines fr the purpses f Rugby Australia s Cde f Cnduct. All participants must cmply with the guidance and prcedure. Intentinal r reckless disregard fr them may result in disciplinary actin pursuant t Rugby Australia cde f cnduct. OTHER INFORMATION Refer t Rugby Australia Cncussin Management at Refer t Wrld Rugby Dcuments - RELATED DOCUMENTS Rugby Australia Cncussin Prcedure Rugby Australia Head Injury Fact Sheet Rugby Australia Cncussin Referral and Return Frm Rugby Australia Cncussin Management Medical Dctr Infrmatin Rugby Australia Safety Plicy Rugby Australia Cde f Cnduct *As f 31 January