New Concussion Management Standards and education initiatives

THE RUGBY FOOTBALL UNION is putting in place new standards relating to the management of concussion and extending the reach of its concussion education initiatives.
The return to play pathway for players who have sustained a concussion is dependent on the player’s age and the medical resources that they can access.
The new routine minimum stand-down period is 19 days for adults and 23 days for Under 19s.
The minimum stand-down period for those in an Enhanced Care Setting – typically professional and elite age-group players – is six days for adults and 12 days for Under 17-19s. These are players whose return to play pathway is closely supervised by an appropriately trained and suitably experienced medical practitioner.
New education measures include a mandatory player safety course for RFU Licensed Coaches and additional promotional materials that add to acclaimed existing resources.
The standards, which come into effect immediately, have been put in place following revised guidelines from the International Rugby Board.
The IRB acknowledge the diversity in health care support available in different countries and at different levels, and permit member Unions to adapt their guidelines to suit their local circumstances.
The RFU has consulted with the game and independent medical experts to create simplified and standardised return to play pathways that cover players of all ages and at all levels. These stand-down periods are to be seen as the minimum periods before a player can return to play and may be longer where appropriate.
The return to play pathway is made up of rest and Graduated Return To Play (GRTP) phases. Taken together they form the minimum stand-down period. The length of these phases for an individual is determined by the player’s recovery and informed by clinical assessment.
THE GRADUATED RETURN TO PLAY PROTOCOL
The revised RFU guidelines simplify and standardise the return to play pathway and timelines for all players, especially those under the age of 19 which is consistent with the advice to manage children and adolescent players more conservatively.
The measures have been approved by the Professional Game Board and the Community Game Board, the two bodies that manage the game in England.
Dr Mike England, the RFU Community Rugby Medical Director, said: “We hope everyone involved in the game – parents, players, coaches and medics – take the rationale for the changes on board and find it helpful in managing concussion in conjunction with the online HEADCASE resources the RFU provides and the guidance we've made widely available to the game through coaching, refereeing and medical education.
“Expert advice is that concussion should be managed on an individual basis. There is a need however for more clarity and guidance to reinforce the message that players need time to recover fully before returning to play and that young players in particular need to be managed more conservatively than adults. What hasn’t changed is that being able to return to play is still a clinical decision based on an individual player’s recovery.”
Dr Simon Kemp, the RFU Chief Medical Officer, said: “The revised guidelines are consistent with the IRB guidelines and the Zurich Consensus statement and will bring greater consistency to the management of all players but especially the concussed player over 16 who is part of the performance pathway. They recognise that not all players can presently access the same level of concussion care but will act as a driver for the development of Enhanced Care Settings in clubs, universities and schools.”
Concussion and player safety information is already built into the RFU’s coach, referee and medical education programmes as part of the “Don’t be a Headcase” programme, while the HEADCASE online resource developed with the Headway charity has been praised as the leading resource in sport in the UK.
This has been supported with collateral including 200,000 awareness cards distributed to the game, whistle lanyards for referees, beanies for players and coaches, and most recently by new changing room billboards.
Other education measures include:
• RFU Licensed coaches (9,500) to take a Player Safety Course as part of licensing and re-licensing process
• Player Safety Course offered to all registered coaches (about 15,000) and upgraded face-to-face concussion education added to mandatory Rugby Ready coaching foundation course (6-8,000 annually)
• Concussion education delivered by RFU and others as part of community programmes
• Delivery at regional coaching seminars for schools this summer
The quality of the RFU’s resources have been endorsed by Dr Richard Greenwood, a Consultant Neurologist at Homerton Hospital and the National Hospital for Neurology and Neurosurgery.
Dr Greenwood said: "Having reviewed the RFU’s HEADCASE resource as an independent expert, I think that it is an excellent source of information for those involved with rugby. It is an accurate, thorough and appropriate source of information, based on the most up to date medical consensus. The RFU should be applauded for making this available in such an accessible format."
www.rfu.com/headcase