Difficult Situations

• In many situations, tensions are high – remaining calm is a priority.
• Most often where dispute arises, the TD or the player are not fully aware of the facts. They do not have all of the evidence or have been misinformed – always start by clarifying the facts.
• The primary issue in a disputed situation is to remove the at-risk player from the field of play.

Examples of Difficult Situations

1. A TD who is refusing to accept that a Criteria 1 is evident on video.
2. A TD who despite an abnormal off-field HIA1 assessment, believes that the player is fit to return to play.
3. A TD who refuses to remove a player for an off-field HIA1 assessment even though you, the MDD, believe this is required.
4. A coach approaches the MDD, post-game, and becomes abusive because the MDD had removed a player following a head injury.
5. There is a dispute about Criteria 1 signs, post-game – because player availability for upcoming games is affected.

Difficult Case 1

Disputed Criteria 1 sign (during a game):

• If as MDD, you feel a player has suffered a Criteria 1 event or requires an off-field HIA1 assessment, the primary action should be to remove the player from the field of play.
• Once the player has been removed from play, the video should be jointly reviewed by the TD and MDD. If there is no agreement on video interpretation, then the off-field HIA1 assessment should be performed in a quiet environment.
• When the off-field HIA1 assessment is completed, a second review of the video should be undertaken and a collaborative decision on return to play made.

Difficult Case 2

Abnormal off-field HIA1 assessment but TD recommends RTP:

• A TD may be resistant to the player being permanently removed following an abnormal off-field HIA1 assessment. First of all, re-review the incident video and explain your concerns. Where an interpreter is required make sure they are available.
• If you both agree that a Criteria 1 sign is not seen, then the issue is whether or not the player has successfully completed the off-field HIA1 assessment or not..
• Research has shown that doctors performing the off-field HIA1 assessment who use clinical judgement are more accurate than when either baseline data or normative data alone is used – a clinical approach is helpful.
• This clinical approach, however, may lead to misunderstanding. For objective tests such as balance, immediate and delayed-recall, orientation and digits backwards – player baselines are available on SCRM. Where results lie outside normal baseline there is usually little debate.

Difficult Case 3

TD resistant to removing player for off-field HIA1 assessment:

• If the TD is resistant to the player being removed for assessment, first show them the video and explain your concerns. Where an interpreter is required make sure they are available.
• If the TD disagrees, have them look at the video once more.
• If they still disagree, you must inform them that you insist on the off-field assessment. If they still disagree you must contact the 4th official or touch judge to make a temporary substitution.
• In the medical area you can again look at video footage - if you are sure there are Criteria 1 signs, the off-field HIA1 assessment should not be completed and the team informed that the removal is permanent.
• If there is doubt, or ongoing debate proceed to the off-field HIA1 assessment.
• If the off-field HIA1 assessment is normal, and the TD still disagrees that a Criteria 1 sign is visible on video, as MDD, it is imperative that you make the right decision.
• It is more important to ensure player safety than avoid disagreement with a colleague.
• You must inform the TD that in your role as MDD you must insist that the player is permanently removed. By way of mitigation you may refer the case to an independent concussion consultant to review the footage and documentation.
• The HIA2 and HIA3 must be completed as normal in this case.

Difficult Case 4

Post-game abusive coach:

• If after the game the coach approaches you about a decision you have made, you should immediately ask for the TD and only explain your rationale to the TD.
• If the coach is persistent or abusive you should ask the coach to stop. If he refuses you should go immediately to the Match Commissioner.
• If the coach continues to harass you, the Match Commissioner should approach the Team Manager for support with managing the Coach.

Difficult Case 5

Disputed Criteria 1 Sign- after a game:

• The MDD should acknowledge that the presence of a Criteria 1 sign can have a major impact on return to play decisions.
• The MDD and the TD should review the video and identify and explain why the MDD believes a Criteria 1 video sign is present. If possible there should be agreement between the two parties.
• If dispute persists advise the TD that the case will be referred to the HIA reviewer for their opinion.