Concussion Management for Match Day Medical Staff using the HIA Protocol

During the match

  • Support the Team Doctor with on field medical issues, if requested. This may be delegated to the Immediate Care Doctor if available.
  • As from August 1 2013, determine if a blood injury is suitable for a temporary replacement up to 15 minutes.
  • Enforce current guidelines pertaining to a blood injury:
    • Suturing is completed in the designated medical room and not at the field side.
    • All blood stained apparel and dressings are replaced prior to the player returning to the field.
    • A player with a blood injury returns to play within 15 minutes of substitution. Failure to return within 15 minutes makes this substitution a permanent substitution. In determining the 15 minutes, half-time is regarded as actual time and included in the 15 minute period.
    • Team Doctors are wearing glove(s) and are not using previously used towels or community ice bags to stem the flow of blood.
  • Identify players who have the following signs and enforce permanent removal from further participation in the game:
    • Tonic posturing
    • Confirmed loss of consciousness
    • Balance disturbance / ataxia
    • Clearly dazed – eyes vacant, blank expression, wandering eyes
    • Definite behavioural changes
    • Oculomotor signs (e.g. spontaneous nystagmus)
    • Convulsion
    • Suspected loss of consciousness
    • Player not orientated in time, place or person
    • Definite confusion
    • On field identification of sign or symptom of concussion
    • Under-19 – Recognise and Remove
  • Identify players who have the following signs, not identified by the Team Doctor or the Referee and request a HIA via the 4th Official (having discussed the case with the team doctor first):
    • Head impact where diagnosis not immediately apparent
    • Possible confusion
    • Sub-threshold Criteria 1 sign e.g. possible balance disturbance, possible LOC etc.
    • Possible behaviour changes
    • Injury event witnessed with potential to result in a concussive injury
    • Other symptoms or signs suggesting a suspected concussion
  • Either complete HIA if responsibility is assigned by the Team Doctor or observe the HIA being completed by the Team Doctor for all players identified as having suspicious symptoms or signs.
  • If the Match Day Doctor believes a player should be removed from further game participation on account of an injury, this opinion MUST be discussed with the Team Doctor. If a dispute persists, the Match Day Doctor does have the authority under Regulation 15.2.1 (d) to stop this injured player from further participation in the game.
  • Confirm on each HIA1 form the decision regarding return to play.
  • Assume responsibility for the management of an injured player if referred by a Team Doctor. These duties may be delegated to a match day immediate care doctor/lead. The MDD should liaise with the immediate care medical team to ensure appropriate management of serious injury.

As from August 1, 2013, the MDD has the ultimate authority to decide if a temporary substitution is required for a blood injury. This should only be undertaken AFTER discussion with the Team Doctor. If there is no MDD, then the referee is the decision maker (Regulation 15.2.1.c).

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