World Rugby has clamped down on concussions in rugby union and have developed a protocol that supports the recognition, diagnosis and treatment of concussion. The protocol is supported by a governance system of checks and controls.
The Head Injury Assessment (HIA) protocol is broken up into three stages.
This stage comprises of four components:
- Eleven immediate and permanent removal criteria (Criteria 1 indicators).
- An off-field screening tool.
- Pitch-side video review.
- Clinical evaluation by the attending doctor.
The HIA1 assessment is not limited to the off-field screening tool but rather the off-field screening tool is one component of the assessment.
If any of the Criteria 1 indicators are met than a diagnosis of concussion is automatic and the player is to be removed from the field immediately and completion of the off-field screening and medical evaluation is not required.
If the player has the potential for concussion (Criteria 2 indicators) but does not exhibit clear on-field symptoms or signs then the player is to be removed from play. The player is to be assessed by a medical doctor supported by the off-field screening tool.
The off-field screening tool is a re-formatted Sports Concussion Assessment Tool (SCAT5) which was recommended by experts from the international concussion consensus meeting.
HIA1 includes the use of video footage that assists in the identification of potential head injuries, confirmation of Criteria 1 signs indicating immediate and permanent removal of the player and assistance with return to play protocol.
In HIA2, any player that enters the HIA protocol undergoes a medical evaluation using the HIA2 clinical assessment within three hours of the match. This is used to assess clinical progress and determine an early diagnosis of concussion.
In this stage, further medical testings are conducted after 36-48 hours post-head impact event. This is to assess clinical progress and to determine a late diagnosis of concussion.
Players who present late symptoms or signs of concussion can enter the HIA protocol at a later stage and undergo HIA2 and/or HIA3 assessments as appropriate.