Medical room assessment following temporary substitution – HIA process

The Medical room assessment of the player following a temporary substitution using the Head Injury Assessment process should follow a standardised approach. The World Rugby Head Injury Assessment 1 Tool should be used.

See Appendix 2 for the current version of the HIA 1 tool.

Knowing a player can be an important component in the on-pitch or medical room evaluation, and any suspicion that the player with suspected concussion is not his or her ‘normal self’ should highlight the possibility that they are concussed.

Following permanent removal from the field of play

When the player has been permanently removed from the field of play, a standard secondary survey should be performed and there should be a further clinical assessment of the player by a suitably qualified medical practitioner supported by the SCAT6 tool (see Appendix 3). If concussion is confirmed then player should not be left alone, and regular monitoring for deteriorating physical or mental status is essential.

Players with concussion need appropriate discharge home, to remain onsite until the end of the game, or transfer to an emergency care facility. This is not always an easy or straightforward decision and regular re-evaluation is needed until the final disposition is determined. The follow-up evaluation should be discussed with the parent/guardian of children. Signs or symptoms that should prompt an emergency department review following discharge from the event, should be provided as written head injury advice (see SCAT6).