Rugby head injury protocols in spotlight after England win over Wales | Six Nations 2022
Rugby’s head injury protocols have come under renewed criticism following England’s 23-19 Six Nations victory over Wales on Saturday, with player protection group Progressive Rugby highlighting what it calls “systematic failures” in the process.
In the 19th minute at Twickenham, two Welsh players, Tomas Francis and Owen Watkin, were involved in a collision with England’s Charlie Ewels as he charged for the try line. The contact notably left Francis showing signs of a concussion. He was clearly dizzy and suffering from ataxia, symptoms which, according to World Rugby protocol, require a player to be immediately and permanently removed from play. But he continued to play.
The pressure group Progressive Rugbya group of current and former players, doctors, coaches and researchers who campaign to improve player welfare, have sent an open letter to World Rugby, the Wales Rugby Union and the Six Nations about the incident.
“Progressive Rugby has contacted the WRU, WR and Six Nations over what we consider to be systematic failures in dealing with the wellbeing of Welsh prop Tomas Francis during England v Wales,” he said. said a spokesperson for the group. “In our opinion, Francis clearly exhibited symptoms which necessitated his immediate and permanent removal, and that the use of the head injury assessment process, from which the player subsequently returned, was a clear breach of protocol. HIA of World Rugby.”
Watkin, who was bleeding profusely from a cut on his forehead, left to get treatment for the injury and returned 10 minutes later. A player requiring a Head Injury Assessment (HIA) is expected to be out for at least 12 minutes. Francis initially stayed and was about to take his place in the front row of the ensuing scrum, when referee Mike Adamson sent him out for an HIA, which he nailed. Both men were then substituted in the second half. But Francis shouldn’t have demanded an HIA at all. He fell once trying to regain his footing after contact, held his head, then tripped again and collapsed on the post for support.
World Rugby calls these “Criterion 1 Indicators”. Had the Welsh team doctor or Independent Match Day Doctor (MDD) spotted them, Francis could and should have been taken out of the game immediately. The only way Francis should have ended up needing an HIA is if the two doctors disagreed (given the video footage, it was unclear what they might have disagreed on).
And even if Francis had passed the HIA, the MDD had every right to insist that Francis stay anyway. It was clear that on this occasion the system did not work as it should. World Rugby’s own research shows that 20% of players who show Criterion 1 symptoms will still pass the assessment, which means, in their own words, that “the presence of a Criterion 1 sign is, sometimes, the only indicator for diagnosing a concussion, and that “many of the delayed concussions we see are actually missed or misinterpreted Criterion 1 cases.”
After the game, head coach Wayne Pivac said the players “had backstage testing, and they both passed the tests, so they’re cleared to play.” Francis shouldn’t have had the chance. It’s not the first time he’s been involved in an incident like this. Last year, former Dragons striker Adam Hughes, who retired due to a brain injury, said he ‘kinda berated’ Francis over an incident during the game of Wales against Ireland, when Francis was hit in the head by Peter O’Mahony. , but played without having a HIA. “But it’s not him I should be scolding,” Hughes said, “it’s the physios, the referees and the independents [doctors].”
The letter from Progressive Rugby states that “we consider the above incident demonstrates a clear flagrant violation of HIA protocol which potentially jeopardizes the short and long term health of an elite athlete. Our main concern is that the public has observed that at Rugby Union people have suffered brain damage and have been allowed to continue playing. Until satisfactory explanations are provided, we remain unable to accept World Rugby’s assertion that player welfare is the game’s number one priority.”
They also point out that they are still awaiting the results of similar failures in England’s game against Italy on February 13, and England’s Under-20 game two days earlier.
A World Rugby spokesperson said the Six Nations would be obliged to review the Francis incident and confirmed they were still reviewing the other two mentioned by Progressive Rugby. They also asked their chief medical officer to organize a “dedicated educational addition” with all match officials involved in the tournament.