REGULATION 10.  MEDICAL

Concussion is a brain injury, which is serious and can be suffered by a Player of any age.

Concussion and suspected concussion must be taken extremely seriously by all those involved in the Game in order to protect the safety, health and welfare of Players.

Extra caution must also be taken with children and adolescents who have a greater risk of concussion and associated complications.

10.1 Concussion

ADULTS (19 years and older)

10.1.1 Any ADULT Player with concussion or suspected concussion:

(a) must be immediately and permanently removed from training or the field of play; and

(b) should be assessed by a medical practitioner or an approved healthcare professional (as approved in the relevant jurisdiction); and

(c) must not return to training or to play in a Match on the same day and until symptom free; and 

(d) must have physical and cognitive rest limited to routine daily activities (no exercises or ‘thinking activities’) for 24 hours; and

(e) must have relative physical rest (activity that does not induce or aggravate symptoms) for at least one week (including the initial 24 hour period of rest) before commencing a graduated return to play (GRTP) programme referred to at 10.1.1(f)-(g) below. The Player must be symptom free before commencing the GRTP; and

(f) must successfully follow and complete a GRTP programme which must be consistent with 520ccc.com’s GRTP Protocol contained in the 520ccc.com Concussion Guidance which is available ; and

(g) should receive clearance from a medical practitioner or approved healthcare professional prior to commencing the full contact training stage of the GRTP programme.

10.1.2 The following exceptions may apply:

(a) The one week rest period (in 10.1.1(e)) is obligatory regardless of whether the Player has become symptom free unless the Player has successfully accessed an ‘advanced level of concussion care’ (as defined in the 520ccc.com Concussion Guidance and below). In any event, there is no exception to the initial 24 hour period of physical and cognitive rest;

(b) the completion of a GRTP programme stipulated in 10.1.1(f) is obligatory except in cases of suspected concussion where the Player has accessed an ‘advanced level of concussion care’ (as defined in the 520ccc.com Concussion Guidance) AND has been medically cleared to return to training or to play on the grounds that the Player had not in fact been concussed.

10.1.3 The temporary replacement procedure for head injury assessment set out in Law 3.26 is only applicable in elite adult Matches, Series of Matches or Tournaments, which have been approved in advance by 520ccc.com.

10.1.4 If a Union, Association or Tournament Organiser wishes to obtain access to temporary replacement for head injury assessment in approved elite adult rugby Matches, an application for approval must be made to 520ccc.com. Application procedures are set out in the 520ccc.com Head Injury Assessment Protocol (“HIA Protocol”) available for elite level match day medical staff .

10.1.5 Approval will only be given by 520ccc.com for access to the temporary replacement procedure in the elite adult game if the relevant approval criteria identified in the HIA Protocol are met, which include confirmation by the applicant that:

(a) The Tournament or Matches are elite adult Tournaments or Matches;

(b) The Core (mandatory) Concussion Player Welfare Standards set out in the HIA Protocol will be adopted and complied with;

(c) There will be an HIA Review Process in place; and

(d) They have facilitated access to video to assist with the management of head impact events occurring during Matches.

CHILDREN AND ADOLESCENTS

10.1.6 Any CHILD or ADOLESCENT Player (aged 18 years or less) with concussion or suspected concussion:

(a) must be immediately and permanently removed from training or the field of play (this is known as ‘Recognise and Remove’); and

(b) should be medically assessed by a medical practitioner or an approved healthcare professional (as approved in the relevant jurisdiction); and

(c) must not return to training or to play in a Match on the same day and until symptom free; and 

(d) must have physical and cognitive rest limited to routine daily activities (no exercises or ‘thinking activities’) for 24 hours; and

(e) must have relative physical rest (activity that does not induce or aggravate symptoms) for at least two weeks (including an initial 24 hour period of complete physical and cognitive rest) before commencing the graduated return to play (GRTP) programme referred to at 10.1.6(g)-(h) below. The Player must be symptom free before commencing the GRTP; and must have relative physical rest (activity that does not induce or aggravate symptoms) for at least two weeks (including an initial 24 hour period of complete physical and cognitive rest) before commencing the graduated return to play (GRTP) programme referred to at 10.1.6(g)-(h) below. The Player must be symptom free before commencing the GRTP; and

(f) must be managed with Recognise and Remove as described above and must not be managed using the HIA 1 off-field screen. This Recognise and Remove approach applies to all players aged 18 years and younger, even if the game is an elite adult game, approved for temporary replacement and uses the HIA Process; and     

(g) must successfully follow and complete a GRTP programme, which must be consistent with 520ccc.com’s GRTP programme contained in the 520ccc.com Concussion Guidance which is available at ; and 

(h) should receive clearance from a medical practitioner or approved healthcare professional prior to commencing the full contact training stage of the GRTP programme.

10.1.7 The following exceptions may apply:

(a) The two week rest period (in 10.1.6(e)) is obligatory regardless of whether the Player has become symptom free unless the Player has successfully accessed an ‘advanced level of concussion care’ (as defined in the 520ccc.com Concussion Guidance). In any event, there is no exception to the initial 24 hour period of physical and cognitive rest;

(b) the completion of a GRTP programme stipulated in 10.1.6(g) is obligatory except in cases of suspected concussion where the Player has accessed an ‘advanced level of concussion care’ (as defined in the 520ccc.com Concussion Guidance) AND has been medically cleared to return to training or to play on the grounds that the Player had not in fact been concussed.