What's 'far more concerning' about the Tomas Francis' concussion incident

Progressive Rugby have pointed out what they see as the most concerning aspect of the Tomas Francis concussion incident during the Six Nations - and it's not that his onfield concussion symptoms were missed.

This week a Six Nations review found that Francis should have been “immediately and permanently removed” from the field during last month’s Guinness Six Nations match with England, a review panel has concluded.

Francis suffered a head injury midway through the first half of his country’s 23-19 defeat at Twickenham on February 26.

Television footage showed the 29-year-old staggering near his own try line following a clash with team-mate Owen Watkin, while he appeared to require the pads of the posts to hold himself up after getting back to his feet.

He was subsequently taken off the pitch for assessment by an independent match-day doctor and, having been deemed fit to continue, played until the 56th minute.

While the head injury review panel judged that Ospreys player Francis should not have been permitted to return under World Rugby guidelines, no disciplinary action will be taken against those involved.

Six Nations Rugby said it would work in collaboration with its unions and the governing body to mitigate the risk of a similar incident.

The HIA (head injury assessment) review panel concluded that in this instance one or more “Criteria 1” indications had been present that should have resulted in Francis being immediately and permanently removed from play,” read a statement released by the Six Nations.

“As part of the review process, the panel found that a number of factors appeared to have contributed to the failure to identify these indications that ultimately led to Francis not being removed from the field of play.

“The panel highlighted that it had the benefit of time for review of the video footage and the other materials at length, without any match-day pressure, and also had access to more camera angles and clips than the match-day medical team.

“The HIA review panel made no recommendations in respect of disciplinary action against those involved in the relevant incident, and Six Nations Rugby Limited will not be taking any subsequent disciplinary action.”

The majority of recommendations included in the review findings already form part of World Rugby guidelines.

However, the panel suggested “appropriate minimum standards for the size of screen(s) and number of screen(s) available pitch-side for video footage review should be set by the relevant competition or tournament organiser.”

Progressive Rugby however have said that the bigger issue with the incident is the fact that the HIA process failed to pick up an obvious concussion.

The investigation by Six Nations gave journalists what they wanted – an admission – but in truth this conclusion was never in doubt.

It would have taken a brave panel to deny what thousands of viewers had seen for themselves - Francis struggling to get up, moving unsteadily on his feet, appearing to use the post to support himself and then grabbing his head when play finally stopped.

But it’s actually what followed this distressing footage and initial failing to remove Francis immediately that is far more concerning.

The fact is that Francis then not only wrongly underwent a Head Injury Assessment (HIA), but worse still he passed it and was thus allowed to return to the field with brain injury.

An acknowledgement that Francis was concussed is, by definition, an equal acknowledgement that the HIA failed to identify an obviously concussion. The protocol failed to do the one critical job it is relied on to do.

If the 12-minute test (it actually usually takes about 7 minutes) can’t identify an obvious concussion, then how many less evident cases is it missing?

How many players are returning to the field with a brain injury and putting their short and long-term health at risk?

(Photo by Getty Images)

And if that’s a concern, which it absolutely has to be given the findings, then where is the recommendation for an urgent review of the HIA protocol?

There is almost no evidence an elite rugby player’s brain is any less delicate or susceptible to trauma than those of us who turn out for our local club side.

And while we all like to think we play at the same intensity as the All Blacks, the truth is the physical collisions at the top end are colossal and unrelenting.

Just one more reason why it makes no sense that community rugby has a 19-day minimum stand down following concussion, but under the six-stage Graduated Return to Play (GRTP) elite players can, and do, return in just six days.

So, in our view this review is another golden opportunity missed.

If a system that returns players to the pitch with brain injury isn’t ringing alarm bells, the level of scenario that will is becoming increasingly frightening.

The Welsh Rugby Union (WRU) said the actions of its medical team were “entirely appropriate” while reaffirming its commitment to player welfare.

“The head injury assessment (HIA) is an extremely important protocol,” read a WRU statement. “We do not – and will not – compromise on player welfare.

“We note the Six Nations HIA review process findings and cooperated fully with the review undertaken by Six Nations.

“Our medical personnel are very experienced and we completely support all of their actions during the England v Wales Guinness Six Nations match, which were entirely appropriate and in accordance with all the relevant protocols.

“They were unsighted to the incident involving Tomas Francis in real time and, as had been agreed prior to the match, Francis was removed from the field of play to undertake his HIA with the independent match-day doctor.

“We are committed to continuing to work with Six Nations, World Rugby and other unions in respect of these matters.”