World Rugby to make permanent use of a 2019 RWC concussion tactic

World Rugby has announced that the use of independent concussion consultants - an initiative used at the 2019 World Cup in Japan after it initially featured at England 2015 - will be introduced to support the graduated return to play process in elite rugby following a confirmed concussion.

A panel of independent concussion consultants (ICC) will be made available to the game to provide independent expert opinions on whether a player should return to play following the successful completion of the six-stage graduated return to play process for elite competitions. This panel of ICC experts will be fully funded by World Rugby.

It will now be mandatory for teams to seek an ICC review in the following scenarios:

• If a player has a confirmed concussion and return to play within or on the tenth day is expected, then the team doctor must seek an ICC review regarding return to play.
• Reflecting the sport’s focus on an individualised approach to concussion management, players deemed higher risk in the following scenarios will undergo an ICC review when they are deemed fit to return to play irrespective of the time taken to return:

1. Players who have been concussed within the last three months;

2. Players with two or more concussions in the last twelve months;

3. If a player has had five or more concussions since starting to play rugby.

A statement on the setting up of the ICC panel of experts read: "World Rugby has identified a global panel of experts who will act as independent concussion consultants to operate across the international level of the game, starting this month. For domestic competitions, unions may avail of this panel or appoint their own, in accordance with minimum criteria. The panel will operate independently of any World Rugby input.

"Rugby’s concussion return to play protocols are aligned with expert opinion and are managed on an individual basis. The independent concussion consultant review process builds on the environment that has successfully operated at the last two men’s Rugby World Cups, supporting team doctors with additional and objective expert opinion, recognising the imperative to manage players on an individual basis as they exit the six-stage graduated return to play process.

"There is no set timeframe for completion of the six-stage graduated return to play protocol with the player having to progress through each stage without the presence of any symptoms or signs of a concussion. Currently, via this player-first, supervised return to play process, less than a third of players return to action within seven days following a concussion.

"This return to play protocol, combined with the head injury assessment (HIA) process used to assess head injuries during and after a game, has transformed the identification, removal and supervision of players with a concussion in elite rugby, an approach followed by other sports.

"The announcement forms a key part of World Rugby’s player welfare action plan focusing on six key focus areas, including science and research, of which this initiative is central."

Eanna Falvey, the World Rugby chief medical officer, said: “We have successfully operated a programme of independent concussion consultants at previous World Cups, providing an invaluable resource for team doctors when there have been tight turnaround times between matches, or where team doctors have sought support in their decision-making on return to play.

“Our commitment to expanding this initiative across the elite game, making leading experts available for all competitions, is another major step forward in our player welfare commitment. It completely recognises and supports the need to ensure an individualised player approach based on risk, rather than an arbitrary stand downtime."