UNDERSTANDING THE 3-STAGE HIA PROTOCOL
Figure 1 on the following page summarises the HIA Protocol identifying when each Stage arises and when these Stages are entered by a player displaying suspicious signs or reporting suspicious symptoms.
CRITERIA 1 IDENTIFIED – PROCEDURES
If the independent match-day doctor identifies, from the side-line or on video, a suspicious head impact event resulting in a possible or probable Criteria 1 sign then the decision of the MDD is simply that the player be removed.
A second video review is then undertaken with the MDD and Team Doctor present. If HIA1 immediate removal criteria (Criteria 1) are identified, the player is permanently removed from play without further evaluation. If there are no Criteria 1 signs evident on video, the player undergoes the off-field assessment supported by the screening tool.
If after viewing the video there is a dispute between the Team Doctor and MDD regarding the presence of a Criteria 1 sign the off-field HIA1 assessment is completed. If the off-field screen is abnormal the player is removed. If the off-field screen is normal and the MDD still believes a Criteria 1 sign is evident then the video is reviewed again with both doctors’ present. If after this second viewing the dispute continues the MDD has the power to unilaterally and permanently remove the player from the game.
MATCH DAY DOCTOR RESPONSIBILITIES
Each nominated competition or tournament is able to determine if 'independence’ of the MDD is mandatory and if so, what is the definition of 'independence’ for their competition or tournament.
- Confirm location where off-field HIA1 assessment will be performed with the Team Doctors, match officials (referees) and the Match Commissioner
- Confirm with both Team Doctors who will be undertaking the HIA (Team Doctor can assign responsibility and decision making for HIA to the MDD).
- Prepare CSx (side-line) software by entering game details and Maddocks Questions for both teams
- Confirm with Match Officials and Team Doctors the hand signal indicating that a player is leaving the field with a head injury - head touched on three occasions.
- Support Team Doctor with identification of suspicious events
- If Criteria 1 sign identified request player be removed from play and review video to confirm or exclude Criteria 1 sign. No unilateral decision by the MDD can be made at this point in time.
- Observe the Team Doctor undertaking an HIA unless assigned responsibility by the Team Doctor to perform the HIA.
- If MDD disagrees with a decision to return a player to play this MUST be raised with the Team Doctor. The MDD does have the power under Regulation 15.2.1 (d) to unilaterally remove an injured player from further participation in a game. It is strongly recommended that this be done only following discussion and consultation with the Team Doctor.
- Confirm that all players who have undergone an HIA1 off-field screen during a match irrespective of the result have completed a post-match, same-day assessment using the World Rugby HIA Form 2.
- Complete the HIA2 Form if requested by the Team Doctor or observe completion of the HIA2 Form by the Team Doctor. If completed the Team Doctor must sign to confirm the diagnosis.
- If the MDD completes the HIA2 Form, they will not be responsible for undertaking the neurological assessment or determining the clinical diagnosis.