National Rugby League Medical Officers have supported a strengthening of concussion guidelines as part of a review of procedures. NRL Director of Football Operations, Mr Nathan McGuirk, initiated the review through Chief Medical Officer Ron Muratore in early March and which resulted in a phone hook-up with medical officers and leading Neurologist, Dr Richard Parkinson, last night. The game’s existing concussion management procedures detailed in the Chief Medical Officer’s Handbook state that: “a player must not return to play until there is a full clinical and cognitive recovery.” The Medical Officers have agreed that this should be amended to reflect the following:
“In recommending the change the doctors made it clear that concussion is a medical diagnosis and that it is easy to mistake symptoms,” Mr McGuirk said. “The original focus of the review was to standardise testing procedures across all clubs and that is something that has also received support.” All Club Medical Officers will be asked to adopt a modified SCAT 2 Testing procedure used in the NFL during the game. All clubs will also adopt the ‘CogState’ testing system - a computer-based system that assists in both the diagnosis of and the tracking of concussive episodes. Clubs have also been further reminded that the referee can stop play and allow an interchange at any time in the game that he believes a serious injury has occurred and that there is a need for the club medical officer to enter the field of play. The NRL has re-emphasised that the ‘ten man interchange’ rule was designed to accommodate injuries, including concussions and ‘blood-bins’, as well as tactical rotations. “There was consideration at the time for having less interchanges but it was not felt that this would provide sufficient safeguards for players,” Mr McGuirk said. Current guidelines applying to the initial on-field assessment by suitably qualified trainers in the management of concussion will remain:
Under the new concussion rules in the event of any one or more of the following being observed by the Club Head Trainer or Club Medical Officer during a match, the player must be taken from the field to undergo a Sideline Concussion Assessment (SCA) by the Club Medical Officer:
The SCA is to take no longer than a period of 15 minutes begining from the time the player is in the care of the Club Medical Officer. If the player is cleared by the Club Medical Officer during the SCA, the player must report immediately to the Interchange Official prior to or at the completion of the 15 minute SCA to return to the field of play. The 15 minute time period will not be assessed against the official match time or clock. The timing of the SCA period will be monitored by the NRL.
The concussion interchange will not count against the 10 interchanges. With the return to the field interchange of that player also not counted as a interchange if it occurs within 15 minutes.
A player’s failure of any of these indicates the need for the player to be removed from the field for further assessment by the Club Medical Officer. In all cases the Cog State testing system will be introduced across every club. “It is important to understand that we are talking about a proper diagnosis and not simply the view of people looking on,” Chief Medical Officer Ron Muratore said today.
If, according to a series of tests, he is not fit to return, the new rules deem any contravention of that illegal. If clubs flout the new rules and a concussed player returns to the action, Greenberg outlined a number of possible sanctions which included:
May 7 - NRL Strengths Concussion Laws
The NRL will strengthen concussion rules to make clubs more responsible for identifying and assessing players that may have suffered a concussive injury. NRL Head of Football, Mr Todd Greenberg, said today the new rules introduced for the 2014 season had seen a significant improvement in the way players are treated after suffering a possible concussion. But he said the game has identified opportunities to further strengthen these rules to place greater onus on clubs to identify players that have possibly suffered a concussive injury. Mr Greenberg said the rules have been tightened to require a player to be taken from the field as soon as they exhibit any signs of a possible concussion. “In other words, we are putting greater onus on the clubs to ensure they identify any player exhibiting signs of concussion and take them from the field immediately,” he said. “To help them do this, club trainers – who have restricted duties – will be required to help identify players who may have concussion and remove that player from the field for assessment by the club doctor. “It will no longer be an excuse for clubs to say that the club doctor and trainer did not observe any concussion signs – it is the club’s responsibility to do so.” Mr Greenberg said the NRL would continue to make changes to the concussion rules if required. “New rules always undergo some tweaking to ensure they are effective and that is what we are doing,” he said. Clubs would be fined $20,000 for a breach. With a first breach, $10,000 will be suspended but the club will be liable to pay this if there are any further breaches during the season. The club will five working days to respond to the breach notice.