Northland Rugby Union
Concussion Card Trial Review – Northland Rugby Union
Contents:
Page
Introduction
1
Implementation – On Field
2
Implementation – Off Field
3
Referee Blue Card
4
Trial Feedback Questionnaire
5
NRU Concussion Register 2014
16
•
Appendix 1 – Trial Protocol
20
•
Appendix 2 – Memo to Northland DHB
22
•
Appendix 3 – Medical Clearance Form
24
Introduction
During the meeting of the Northland Rugby Union’s (NRU) Council of clubs, the issue of player
welfare was raised. More specifically, the effects of concussion and the amount of players
suspected of playing club rugby in Northland. This was the initial thrust to ensure Northland rugby
could initiate a process to improve player welfare.
On 21st February 2014 the NRU hosted all of the Premier and Premier Reserve club coaches and
administrators to launch the 2014 club rugby season. At this launch Mike and Daryl Sabin were
guest speakers to introduce the Concussion Card. Daryl has been directly affected by repeated
concussions eventually leading to a serious head injury while playing club rugby in Northland in
2009. He now is a guest speaker talking on “Shit Happens” and a great advocate for the Blue Card
trial.
The trial was largely well received by the clubs but would reserve judgement until after the season
had concluded.
Trial outline
The trial started on the 28th February and concluded on the 23rd of August. It covered all senior
rugby in Northland which is made up of 5 different senior competitions and 1 under 18 competition.
The reason for not including all rugby in Northland was to keep the trial to one group of rugby
players and to use the more experienced referees in Northland. The concern was that if younger
less experienced referees were used, the trial data could be miss-construed and not achieve the
correct result.
Concussion Card Trial Review – Northland Rugby Union
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Implementation – on field
After the launch, focus moved into implementing the system. Education of key stakeholders in
Northland around the direct symptoms of concussion that are shown by players both directly after it
is sustained and in the hours after was the key information to get across. Referees were the first to
undergo this training. The NRU ITM Cup doctor was used to present information to the members of
the Northland Rugby Referees Association at their annual referee open day. This was a key step in
the trial as referees needed to feel comfortable in identifying key symptoms of concussion. To help
with this, key information is printed on the card that the referees will issue on the field, meaning
they would have the information with them on field to refer to if needed.
Largely from what the statistics show and the feedback given, the referees have performed
incredibly well. There have been few instances where stakeholders have provided anything but
positive feedback.
Statistic: Only one referee awarded 2 Blue Cards within the season.
It was explained to the clubs that the issuing of the Blue Card by the referee would be based on clear
identification of concussion and that under no circumstances could the player return to the field of
play during the game. It was seen to be similar as a red/yellow card.
Concussion Card Trial Review – Northland Rugby Union
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Implementation – off field
The issuing of the Blue Card initiated the major part of the trial. The process in which the players
and clubs were identified and clear guidelines were explained to ensure they adhered to the return
to play protocol.
This is outlined below:
Off-Field Processes/Procedures Undertaken
1. Issuing of Blue Card by Referee initiates:
a. Identification of the concussed player on NRU official team sheet which is
sent to NRU office by winning team manager.
b. Completion and submission to the NRU of a Serious Injury Report by:
 Match Referee
 Team Coach
c. NRU Operations Manager would send a letter to club/player confirming that
the player has been stood down from playing rugby because of concussion.
This outlined the procedure to return to play, including the medical clearance
required.
d. NRU Operations Manager to create a Concussion Database of players that are
involved in the trial for statistical purposes.
Off-Field Follow Up Processes/Procedures – Player
1. Issuing of Card (by Referee)
a. This initiates implementation of IRB Concussion Guidelines, requiring the
player to complete each stage of the IRB GRTP (Graduated Return to Play)
Protocols. (NZ Rugby DSLV Law 10.1.2)
 Recommended that suspected concussed player seek medical
attention within 24 hrs.
 Player must obtain medical clearance to resume contact training
 Player must produce Medical Certificate to NRU to resume playing.
This must be received by the NRU office 24 hours before scheduled
return to play.
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Copy of card:
Front
Indicator
Evidence
Symptoms
Headache, dizziness, “feeling in fog”
Physical signs
Loss of consciousness, vacant expression, vomiting,
inappropriate behaviour, unsteady, slow reactions
Inappropriate emotions, irritability, nervous or
anxious
Slow reactions, confusion/disorientation, poor
attention, loss of memory before and after
concussion
Behavioural
changes
Cognitive
impairment
Back:
Clarification question
Which ground are we at today?
Which half is it now?
Which team are you playing today?
Which team scored the last try today?
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Participants (13)
Name
Involvement in 2014
Fizeo Works
Waipu RFC team Physio
Mid Northern Rugby Committee
Administrators & Coaches
Whangarei Physiotherapy
Northland ITM Cup Physio
Fizeo Works
Mid Western RFC team Physio
Fizeo Works
Hikurangi RFC team Physio
Fizeo Works
Western Sharks RFC team Physio
Fizeo Works
Mid Northern RFC team Physio
Administrator/referee
Referee
Old Boys Marist Rugby Club
Premier Head Coach
Player
Mid Western Premier Player
Player
Waipu Premier Player
Player
Otamatea Premier Player
Kamo Rugby Club
Premier Coach
Questions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Did you witness the “Blue Card” being issued in 2014? If yes, how many?
Do you believe the Concussion Card Trial was worthwhile in Northland?
If so, why?
In the instances that you witnessed the Blue Card being used, was it justified?
Why?
Do you believe the referees used the Blue Card in the correct manner by the
match officials?
Do you believe concussion education should be included in coaches/referees
courses?
What are the benefits of the system that you see?
Do you see any flaws with the system?
Do you believe the NRU should have the power to “Blue Card” players for nonrugby related incidents i.e. car accidents?
Do you think the system should be used nationally?
Why?
Please list any improvements you would like to see made to the system.
Any other relevant comments?
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Concussion Card Trial Review – Northland Rugby Union
Did you witness the ‘Blue
Card' being issued in 2014?
10
3
YES
NO
If yes, how many?
1 Blue Card
2 Blue Cards
3 Blue Cards
4 Blue Cards
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Concussion Card Trial Review – Northland Rugby Union
Do you believe the
Concussion Card Trial was
worthwhile in Northland?
13
0
YES
NO
If so, why?

Player safety.

I think it ensures safety and increases awareness amongst players & coaches about
concussion.

Without the card, the players that did get concussed during a game would then try and play
the following week, where as this forced them to stay off the field.

We need to protect the players from potential life threatening injuries as a result of
concussion.

It gives extra authority and support for the medic of the team, who has the coaches and
players putting pressure on the medic to allow players to play through the game with head
knocks and concussion. It reduces the amount of players trying to battle the situation of
being able to play with concussion.

Good positive action undertaken by referees and the feedback from players and coaches
and spectators has been positive.

Player safety improved.

Try to avoid what happened to Jordan Kemp. We must do as much as we can to improve
player safety.

It doesn’t allow players to come back early. It forces them to get a proper assessment.
Because as a player we will get on the field as soon as we are allowed as we want to play.

We saw what can happen (death of Jordan Kemp). There are a lot of concussions and it is
very serious, but can be managed.

Players and coaches are removed from the equation and the win factor doesn’t come into
it.
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Concussion Card Trial Review – Northland Rugby Union
In the instances that you
witnessed the ‘Blue Card'
being used, was it justified?
9
4
0
YES
NO
N/A
Comments:
 Yes, it was always justified. All players from my club treated it extremely
seriously.
 We are happy to see it being used.
 There were clear concussion symptoms and the appropriate
management of these symptoms was required.
 Yes, the player was clearly concussed.
 Majority failed questions and rising to their feet were disoriented. Blue
Cards issued were very noticeable.
 Player had clearly been out for moments. I saw this in the way he fell
and lack of immediate movement.
 Player clearly in a concussed state early in the game, team tried to have
player stay on the field.
 Yes, the player was clearly unconscious for a long time. Right call by the
referee even though the player did not want to leave the field.
 Yes, the player thought he was ok but he was clearly not.
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Concussion Card Trial Review – Northland Rugby Union
Do you believe the referees
used the ‘Blue Card' in the
correct manner by the match
officials?
8
3
YES
NO
2
N/A
Comments:
 No problems with referees call. Only had one problem when
opposition physio informed referee. Was a correct call though.
 I think the referees should always do a test with the player themselves
and not just believe other people.
 I think referees need to double check and have a look at the players
themselves or get a second opinion from the opposing medical staff.
 Yes, used fair.
 Yes, when the referee was looking out for the best interest of the
player.
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Concussion Card Trial Review – Northland Rugby Union
Do you believe concussion
education should be included
in coaches/referees course?
11
YES
0
2
NO
DID NOT ANSWER
Comments:
 Would be very helpful.
 Definitely, I believe concussion is something that is generally overlooked
and needs more attention.
 Yes, good feedback from some who have already taken courses and so
beneficial for their support when they see players displaying symptoms.
 Yes, Rugby Smart could be expanded.
 Yes, it should be.
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Concussion Card Trial Review – Northland Rugby Union
What are the benefits of the system that
you see?
 Players were taking the right precautions and listening to anyone
who was giving advice.
 Saving future major head injuries.
 It ensures consistency in a matter that can be hard to manage.
 Safety, players can’t come back too early.
 Players cannot return to play until they have been cleared by a
medical professional.
 Yes, it can potentially save lives and ongoing problems in the future,
such as memory problems, Dementia,Alzheimer’s and Brain Damage.
 Takes pressure off side-line medic and coaches. Reassures families
and loved ones of players, that there is a clear process to follow.
 Gives the power to the referee to make a judgement call which is in
the interest of the safety of the player.
 Player safety. Up until now I have had to manage my three weeks off.
It’s always player driven which means they will return to play early.
 Player welfare.
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Concussion Card Trial Review – Northland Rugby Union
Do you see any flaws in the
system?
9
3
1
YES
NO
DON'T KNOW
Comments:

Players being removed from the field before the ‘Blue Card’ can be issued, thus not
having to stand down.

It may be worthwhile ensuring the players are sent to the doctors with appropriate
sports concussion experience for the final clearance.

Once the player was out for rugby they could swap over to play league.

Once a player receives a Blue Card, they should not be allowed to go and participate in
other sports and the union needs to figure out a way to govern this.

Referee having the strength of character to action what he saw. Does not need to be
for serious knock down only.

If the Blue Card is given in error there should be ability for the player to be cleared by a
GP within the 3 week period. I do not agree with the card automatically meaning a 3
week compulsory stand down period.

I don’t really know the system. I just know that it has been working and have heard
good things about it.

I was concussed but did not get Blue Carded. More thorough assessment is needed
from the ref? I passed all questions asked, but I just guessed.

Doctors that are not specialized in sports injury are making the call on players returning
to play.

Some referees were not buying into it. One occasion the referee went to the sideline
asking the coach to take the player off instead of blue carding him so he wouldn't be
stood down for three weeks.
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Concussion Card Trial Review – Northland Rugby Union
Do you believe the NRU
should have the power to
‘Blue Card' players for nonrugby related incidents, i.e.
car accidents?
8
4
YES
NO
1
MAYBE
Comments:
 No. Surely they will be treated by a doctor/hospital.
 Yes, after an assessment from a sports doctor.
 Yes, as further damage can be made on the field which we don’t want to
see happen.
 Yes, concussion caused by other means are just as, if not more serious
than rugby concussions, and should be treated in the same manner.
 Maybe, makes it a bit difficult for the NRU trying to find out about it.
But it could definitely be a good thing.
 Definitely not. Only incidents that happen on the field of play.
 No, too hard to police.
 No, players should take this responsibility.
 Yes. If a player is concussed outside the game is not ok to play.
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Concussion Card Trial Review – Northland Rugby Union
Do you think the system
should be used nationally?
12
YES
0
1
NO
DID NOT ANSWER
If yes, why?
 Aren’t the All Blacks & Super Rugby using it? It would be useful for
other Provincial Unions to follow our lead.
 So there can be consistency for players that move between Provincial
Unions.
 Because concussion is a serious injury, and if players transfer from a
different city, then it would be good to know if they have been blue
carded previously.
 It is an effective system that needs a few adjustments, but it looks after
players first and foremost which is a top priority.
 In the best interest of player safety. We are now better informed about
the lasting effects of concussion.
 Club Rugby only. At ITM Cup level we have full time Doctors and
Physios.
 Takes decisions out of team support hands.
 It is all about player safety.
 Especially at Club level.We are looked after at ITM Cup level.
 Common sense.
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Concussion Card Trial Review – Northland Rugby Union
Any improvements you would like to see
made to the system?
 System is working fine.
 An assessment should be conducted on the day of the concussion in
all cases.
 Once the player has a card, they shouldn’t be allowed to play league.
 The referees actually listening to the medic giving a blue card, even if
they didn’t see the player themselves, they need to go by the medics
decision.
 A way to govern players to prevent them from participating in other
sports such as rugby league etc.
 Blue card pushed with league code too so that players who receive a
Blue Card can’t go and play another code.
 Encouragement of Coaches and Managers to come forward and
equally be responsible for incidents involving their player that the
referee may not have seen as a concussion issue.
 A harder line from the referees if a concussion is suspected. More
authority given to side-line medical staff.
 Referees should be held accountable for not using the Blue Card if
someone is clearly concussed.
Any other relevant comments?
 Rugby Smart should be seen by all players, every year not just
coaches and managers.
15
Date of injury
D.O.B
Competition Playing Position
Time elasped
Description of how injury occurred
8/03/2014
27/03/1997 Prem Reserve
No 8
52
Tackle -head on wrong side of leg when
tackling
22/03/2014
21/11/1990
Premier
Lock
50
From a Ruck/Maul
29/03/2014
5/03/1987
Premier
First five
29/03/2014
10/08/1983
Premier
No 8
28
Tackle
5/04/2014
23/01/1976
Premier
First five
27
Punched during brawl on field
12/05/2014
15/07/1983
Premier
Blindside flanker
20
Tackle -hit head on ground post tackle
17/04/2014
15/09/1995 Prem Reserve
First five
60
5/04/2014
12/07/1990 Prem Reserve
Half back
22
3/05/2014
19/06/1990
Premier
Fullback
35
Tackle
10/05/2014
2/08/1991
Premier
Wing
10
No information
24/05/2014
18/08/1991
Premier
Second five
69
26/04/2014
24/05/1995
Premier
First five
44
26/04/2014
9/11/1988
Premier
Lock
25
26/04/2014
2/09/1977
Premier
Wing
30
21/06/2014
30/04/1987 Prem Reserve
Lock
19
31/05/2014
27/09/1994
First five
28
5/07/2014
27/03/1997 Prem Reserve
No 8
60
Div 2
finished game Tackle
Tackle -received blow to head as he
tackled an opponent
Tackle -tackled a player, while on ground
another player fell on his head/neck
Tackle -tackled a player and was struck
in the head by an elbow of the ball
carrier
Tackle -tackled to ground and received a
accidental knee to the head on the
ground
Tackle -received a foot to the head in the
act of tackling a player
Tackle -received blow to the head as he
tackled an opponent
Ruck - entered a breakdown, failed to
get up after play moved on
Tackle -tackled a player and hit head
hard on ground
Tackle -head wrong side of tacklePassed away from injury
17 ‘Blue Cards’ issued in 2014
17 ‘Blue Cards’ were issued in 2014
16
Concussion Card Trial Review – Northland Rugby Union
Player Positions - Blue Card
6
5
5
4
3
3
3
2
2
1
1
1
1
1
0
No.8
Lock First Five Blindside Halfback Fullback
Flanker
Wing
Second
Five
29% of players ‘Blue Carded’ were First Fives
Player Date of Birth - Blue Card
7
6
6
5
5
4
3
2
2
2
1975-1980
1981-1985
2
1
0
1986-1990
1991-1995
1996-2000
65% of players ‘Blue Carded’ were born between1986-1995
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Concussion Card Trial Review – Northland Rugby Union
Venue -Blue Card
3
2
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
0
Venue does not seem to be an issue
Competition Played - Blue Card
12
11
10
8
6
5
4
2
1
0
Premier
Premier Reserve
Division 2
65% of ‘Blue Cards’ are from the Premier division
18
Concussion Card Trial Review – Northland Rugby Union
Time Elapsed when Blue Carded
7
6
6
5
4
3
3
2
2
2
1
1
1
1
1
0
0
0-10
mins
11-20
mins
21-30
mins
31-40
mins
41-50
mins
51-60
mins
61-70
mins
71-80
mins
After
game
Most ‘Blue Cards’ happened between 21-30 minutes into the game
How 'Blue Card' Injury Occurred
14
13
12
10
8
6
4
2
2
1
1
Punched
Unsure
0
Tackle
Ruck/Maul
76% of ‘Blue Card’ injuries occurred from a tackle
Total number of senior games in 2014= 441
Blue Cards issued in 2014 =17
4% chance of a concussion to occur within a game
19
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Off-Field Follow Up Processes/Procedures – Referee and Team Coach
1. Issuing of Card (by Referee) initiates:
a. Identification of concussed player on NRU official team sheet
b. Completion and submission to the NRU of a Serious Injury Report by:
 Match Referee
 Team Coach
c. NRU Operations manager will draft a letter to Club/player confirming that the
player has been stood down from playing rugby because of concussion. This
letter will outline the procedure to return to play.
d. NRU Operations manager to create a Concussion database of players that are
involved in the trial for statistics purposes.
Off-Field Follow Up Processes/Procedures – Player
1. Issuing of Card (by Referee)
a. This initiates implementation of IRB Concussion Guidelines requiring the
player to complete each stage of the IRB GRTP (Graduated Return To Play)
Protocols. (NZ Rugby DSLV Law 10.1.2)
 Recommended that suspected concussed player seek medical
attention within 24 hrs.
 Player must obtain medical clearance to resume contact training
 Player must produce Medical certificate to NRU to resume playing,
this must be received by the NRU office 24 hours before scheduled
return to play.
b. There are no grounds for a team to challenge the issuing of a Card (except
misidentification of player)
As per Rugby Smart protocol, all players suspected of being concussed should not drink
alcohol after the game.
Off-Field Follow Up Processes/Procedures – Northland Rugby Union
1. Introduce and maintain Blue Card (player identified with concussion) register
2. Forward letter to club of player reminding club/team of need for this player to
obtain a Medical Clearance in order to return to training/play.
3. Monitor return to play of all players issued with Blue Card
4. Introduce competition rules sanctioning team/club if they play a player who has not
presented a Medical Certificate to confirm fitness to return to play.
5. Northland Rugby Union to submit Blue Card player identified with concussion)
register to New Zealand Rugby (as required).
Referee Training
All registered Northland Rugby referees must undertake a specific training and development
session focussing on identifying the symptoms of concussion. This session must be
conducted by an appropriate medical authority.
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Northland Rugby Union Concussion Trial
Introduction
The Northland Rugby Union (NRU) takes player welfare extremely seriously. In 2014 the NRU is
initiating a procedure to ensure players that are subject to concussion, receive sufficient medical
treatment before returning to rugby.
The NRU realises for this trial to be credible, the support of all Medical Practitioners across
Northland is vital to ensure player welfare. Players will require assessment by a medical practitioner
twice, after they have been removed from the rugby field by the match official.
If a rugby player presents themselves to a medical facility, please be aware that this player has been
removed from the game (as per process outlined below) and has been witnessed showing indicators
of concussion.
This is to ensure that players follow ACC Endorsed, Return To Play Guidelines for concussion.
The concussion trial has been endorsed by New Zealand Rugby Union (NZRU) who are keen to have
access to the end of season data to evaluate the trial.
The trial will be implemented from the 1st March 2014 to all grades from 1st XV Rugby and above.
Concussion Trial Process
 A player is shown a Blue Card after the referees identifies they have suffered a blow and
show indicators of concussion.
 The issuing of a Blue Card triggers formal off-field follow up processes/procedures
 The card removes any doubt as to whether the player is removed for concussion. There can
be no opportunity for the player to return to the field if he/she “recovers”.
The card that the referee will issue will be similar in concept to the yellow/red card that currently is
in use.
 NRU Operations Manager will draft a letter to the Club/player confirming that the player has
been stood down from playing rugby because of concussion. This letter will outline the
procedure for return to play.
 This initiates implementation of IRB Concussion Guidelines requiring the player to complete
each stage of the ACC Endorsed, Return To Play Guidelines.
 It is recommended that the suspected concussed player seeks medical attention within 24
hrs.
 A player must obtain medical clearance to resume training
 A player must produce a Medical certificate/official NRU letter signed by the medical
practitioner, to the NRU to resume playing. This must be received by the NRU office 24
hours before scheduled return to play.
 It is recommended that no doctor should over rule a suspected concussion or concussed
player allowing them to return to play before 3 weeks as they have been witnessed to
show signs of concussion on the field.
 It is recommended that the doctor perform a SCAT3 test on the first visit to achieve a
baseline, then completing a 2nd SCAT3 test during the clearance visit.
Link for SCAT3 test: http://bjsm.bmj.com/content/47/5/259.full.pdf, or download app onto
a smartphone.
The player is to pay for the first doctor’s visit, with the 2nd visit being paid by the NRU (or other
provider). Please invoice your usual ACC surcharge to the Northland Rugby Union, P.O Box 584
Whangarei 0140
Thank you for supporting the Northland Rugby Union Concussion Trial for 2014
Greg Shipton
Operations Manager NRU
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CONCUSSION CLEARANCE NOTICE
Player Name:
Game Details:
Date of game:
Referee:
To _____________________, (Club Official) of ________________________(Club)
The player listed above is hereby stood down from rugby until further notice due to
suspected concussion. As per the NRU Concussion Trial, this player is now required to get
clearance from a doctor prior to returning to training or playing rugby.
Please note that the medical clearance (see below), must be signed by a Medical
Practitioner and returned to the Northland Rugby Union Office 24 hours before the
scheduled match.
As per the NRU Code of Ethics 2014 – playing a player who has been concussion carded
without the required clearance will forfeit the loss of points as per the Code Of Ethics
(2014).
Thank you for your understanding in this matter and for promoting safety amongst our
players.
Regards
Greg Shipton
Operations Manager
Northland Rugby union
MEDICAL CLEARANCE
I ___________________have assessed the above player on the _______________________
and I Do / Do Not clear this player from his/her injury.
(Circle one)
________________________
(Name, please print)
Medical Registration Number _______________________
________________________
Date _________________________
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