Independent Concussion Consultants to be introduced to support Graduated Return to Play process in elite rugby

World Rugby has announced details of a major programme that will further objective care of elite players returning to play following a confirmed concussion.

Starting this month, a panel of Independent Concussion Consultants (ICC) will be made available to the game to provide independent expert opinion on whether a player should return to play following the successful completion of the six-stage Graduated Return to Play process for elite competitions. The panel of ICC experts will be funded by World Rugby.

It will be mandatory for teams to seek an ICC review in the following scenarios:

• If a player has a confirmed concussion and return to play within or on the 10th day is expected, then the team doctor must seek an ICC review regarding return to play
• Reflecting the sport’s focus on an individualised approach to concussion management, players deemed higher risk in the following scenarios will undergo an ICC review when they are deemed fit to return to play irrespective of the time taken to return:
  1. Players who have been concussed within last three months
  2. Players with two or more concussions in the last 12 months
  3. If a player has had five or more concussions since starting to play rugby

World Rugby has identified a global panel of experts who will act as Independent Concussion Consultants to operate across the international level of the game. For domestic competitions, unions may avail of this panel or appoint their own, in accordance with minimum criteria. The panel will operate independently of any World Rugby input.

Rugby’s concussion return to play protocols are aligned with expert opinion and are managed on an individual basis. The Independent Concussion Consultant Review process builds on the environment that has successfully operated at the last two men’s Rugby World Cups, supporting team doctors with additional and objective expert opinion, recognising the imperative to manage players on an individual basis as they exit the six-stage Graduated Return to Play process.

There is no set timeframe for completion of the six-stage Graduated Return to Play protocol with the player having to progress through each stage without the presence of any symptoms or signs of a concussion. Currently, via this player-first, supervised return to play process, less than a third of players return to action within seven days following a concussion.

This return to play protocol, combined with the Head Injury Assessment (HIA) process used to assess head injuries during and after a game, has transformed the identification, removal and supervision of players with concussion in elite rugby, an approach followed by other sports.

The announcement forms a key part of World Rugby’s player welfare action plan announced today focusing on six key focus areas, including science and research, of which this initiative is central.

World Rugby Chief Executive Alan Gilpin said: “This commitment to provide and fund a central panel of Independent Concussion Consultants for the elite game launched today is an important initiative which starts to deliver our player welfare action plan, and reflects our mission to advance the care of players at all levels of the game, furthering a return to play process that protects players.”

World Rugby Chief Medical Officer Dr Éanna Falvey added: “We have successfully operated a programme of Independent Concussion Consultants at previous Rugby World Cups, providing an invaluable resource for team doctors when there have been tight turnaround times between matches, or where team doctors have sought support in their decision-making on return to play.

“Our commitment to expand this initiative across the elite game, making leading experts available for all competitions, is another major step forward in our player welfare commitment. It completely recognises and supports the need to ensure an individualised player approach based on risk, rather than an arbitrary stand down time.”

International Rugby Players board member Dr Sharron Flahive added: “This is a progressive step in the treatment of head injuries and something that I’ve seen have a positive impact during the recent Super Rugby competition in Australia.

“Involving an independent concussion expert as another level of assessment, provides support for the doctor as to when a player is ready to return to play. It also gives a secondary level of evaluation for the player prior to return, as players will always retain an urgency to get back on the field.”