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Reporting Procedure for Rugby-related Catastrophic and Fatal Injuries

A

rugby-related

injury that should be considered as a

potential

‘catastrophic injury’ for IRB reporting purposes includes:

  1. Spinal cord injuries with an ASIA classification at 48 hours of A to D
  2. Brain injuries with a Glasgow Coma Scale (GCS) at 48 hours of ≤12 (i.e. graded as ‘moderate’ or ‘severe’)
  3. Fatalities (including spinal cord, traumatic brain, and cardiac-related fatalities)

Criteria for an injury to be retained on the IRB database and considered as a catastrophic injury include:

  1. Spinal cord injuries with an ASIA classification at 12 months of A to D
  2. Traumatic brain injuries with a Glasgow Outcome Scale (GOS) at 12 months of 1 to 3
  3. Fatalities resulting from any rugby match or training activity.

(See

Appendix A

for definitions of the ASIA, GCS and GOS scales)

In the first instance, a representative of the National Rugby Union must report a catastrophic injury to the IRB as soon as possible, but at most 8 weeks after the event, using the ‘IRB Catastrophic Injury Report Form 1’. This form should be completed with input from the injured player (if possible), family members, and witnesses to the incident.

At or as soon as possible after 12 months (or immediately after the death of a player), a representative of the National Rugby Union must complete the IRB Catastrophic Injury Report Form 2: this form should be completed by or with input from an appropriate medical specialist.

Appendix A: Definitions of ASIA, GCS and GOS scales

1. ASIA (American Spinal Injury Association): Standard neurological classification of spinal cord injury

The full scoring system and chart are available at the following web site:

www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf

Final grading of impairment is summarised as:

A = Complete:

No motor or sensory function is preserved in the sacral segments S4-S5.

B = Incomplete:

Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.

C = Incomplete:

Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.

D = Incomplete:

Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more.

E = Normal:

Motor and sensory function are normal.

2. GCS (Glasgow Coma Scale): Assessment of coma and impaired consciousness

A description of the GCS is available in Teasdale G and Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4.

The GCS is composed of 3 sub-scales, each scored from 1 (worst) to 5 (best):

  1. Best eye response
  2. Best verbal response
  3. Best motor response

Each aspect of performance should be considered and reported but the sum of the scores provides an overview of the brain injury:

Severe:

GCS ≤ 8

Moderate:

GCS 9 to 12

Minor:

GCS ≥ 13.

3. GOS (Glasgow Outcome Scale): Assessment of coma and impaired consciousness

A description of the GOS is available in Jennett B and Bond M. Assessment of outcome after severe brain damage. Lancet 1975 Mar 1;1(7905):480-4.

Dead

Vegetative state:

Unable to interact with environment; unresponsive

Severe disability:

Able to follow commands/ unable to live independently

Moderate disability:

Able to live independently; unable to return to work or school

Good recovery:

Able to return to work or school

Appendix B: Descriptions of tackle types
Contact
Description
Example
Arm

Tackler impedes/stops ball carrier using the upper limb(s)

Collision

Tackler deliberately impedes/stops the ball carrier without using the arm(s)

Jersey

Tackler holds the ball carrier’s jersey

Lift

Tackler raises the ball carrier’s hips above the ball carrier’s head

Shoulder

Tackler impedes/stops the ball carrier with his/her shoulder as the first point of contact followed by use of the arm(s)

Smother

Tackler uses the chest and wraps both arms around the ball carrier

Tap

Tackler trips the ball carrier with his/her hand on the lower limb below the knee

Information taken from: Fuller et al. Injury risks associated with tackling in rugby union.

British Journal of Sports Medicine

2010; 44: 159-167.

Appendix C: Law 10.4 - Dangerous Play and Misconduct

LAW 10 : FOUL PLAY

Foul play

is anything a player does within the playing enclosure that is against the letter and spirit of the Laws of the Game. It includes obstruction, unfair play, repeated infringements, dangerous play and misconduct which is prejudicial to the Game.

Law 10.4 - Dangerous Play and Misconduct

(a) Punching or striking.

A player must not strike an opponent with the fist or arm, including the elbow, shoulder, head or knee(s).
Sanction: Penalty kick

(b) Stamping or trampling.

A player must not stamp or trample on an opponent.
Sanction: Penalty kick

(c) Kicking.

A player must not kick an opponent.
Sanction: Penalty kick

(d) Tripping.

A player must not trip an opponent with the leg or foot.
Sanction: Penalty kick

(e) Dangerous tackling.

A player must not tackle an opponent early, late or dangerously.
Sanction: Penalty kick

A player must not tackle (or try to tackle) an opponent above the line of the shoulders even if the tackle starts below the line of the shoulders. A tackle around the opponent’s neck or head is dangerous play.
Sanction: Penalty kick

A ‘stiff-arm tackle’ is dangerous play. A player makes a stiff-arm tackle when using a stiff-arm to strike an opponent.
Sanction: Penalty kick

Playing a player without the ball is dangerous play.
Sanction: Penalty kick

A player must not tackle an opponent whose feet are off the ground.
Sanction: Penalty kick

(f) Playing an opponent without the ball.

Except in a scrum, ruck or maul, a player must not hold, push or obstruct an opponent not carrying the ball.
Sanction: Penalty kick

(g) Dangerous charging.

A player must not charge or knock down an opponent carrying the ball without trying to grasp that player.
Sanction: Penalty kick

(h) A player must not charge into a ruck or maul. Charging includes any contact made without use of the arms, or without grasping a player.

(i) Tackling the jumper in the air.

A player must not tackle nor tap, push or pull the foot or feet of an opponent jumping for the ball in a lineout or in open play.
Sanction: Penalty kick

(j) Lifting a player from the ground and dropping or driving that player into the ground whilst that player’s feet are still off the ground such that the player’s head and/or upper body come into contact with the ground first is dangerous play.
Sanction: Penalty kick

(k) Dangerous play in a scrum, ruck or maul.

The front row of a scrum must not rush against its opponents.
Sanction: Penalty kick

Front row players must not intentionally lift opponents off their feet or force them upwards out of the scrum.
Sanction: Penalty kick

Players must not charge into a ruck or maul without binding onto a player in the ruck or maul.
Sanction: Penalty kick

Players must not intentionally collapse a scrum, ruck or maul.
Sanction: Penalty kick

(l) Retaliation.

A player must not retaliate. Even if an opponent is infringing the Laws, a player must not do anything that is dangerous to the opponent.
Sanction: Penalty kick

(m) Acts contrary to good sportsmanship.

A player must not do anything that is against the spirit of good sportsmanship in the playing enclosure.
Sanction: Penalty kick

(n) Misconduct while the ball is out of play.

A player, must not, while the ball is out of play, commit any misconduct, or obstruct or in any way interfere with an opponent.
Sanction: Penalty kick

(o) Late-charging the kicker.

A player must not intentionally charge or obstruct an opponent who has just kicked the ball.
Sanction: The non-offending team may choose to take the penalty kick either at the place of infringement, where the ball lands or or where it was next played.

Place of infringement. If the infringement takes place in the kicker’s in-goal, the penalty kick is taken 5 metres from the goal line in line with the place of infringement but at least 15 metres from the touchline.

The non-offending team may also choose to take the penalty where the ball lands or is next played before landing and at least 15 metres from the touchline.

Where the ball lands. If the ball lands in touch, the mark for the optional penalty kick is on the 15-metre line, in line with where it went into touch. If the ball lands, or is next played before landing, within 15 metres of the touchline, the mark is on the 15-metre line opposite where the ball landed or was played.

If the ball lands in the in-goal, in touch-in-goal, or on or over the dead ball line, the mark for the optional penalty kick is 5 metres from the goal line, in line with the place where the ball crossed the goal line and at least 15 metres from the touchline.

If the ball hits a goal post or crossbar, the optional penalty kick is awarded where the ball lands on the ground.

(p) Flying Wedge and Cavalry Charge.

A team must not use the ‘Flying Wedge’ or the ‘Cavalry Charge’.
Sanction: Penalty kick at the place of the original infringement.

‘Flying Wedge’. The type of attack known as a ‘Flying Wedge’ usually happens near the goal line, when the attacking team is awarded a penalty kick or free kick.

The kicker tap-kicks the ball and starts the attack, either by driving towards the goal line or by passing to a team-mate who drives forward. Immediately, team mates bind on each side of the ball carrier in a wedge formation. Often one or more of these team mates is in front of the ball carrier. A ‘Flying Wedge’ is illegal.
Sanction: Penalty kick at the place of the original infringement.

‘Cavalry Charge’. The type of attack known as as a 'Cavalry Charge' usually happens near the goal line, when the attacking team is awarded a penalty kick or free kick. Either a single player stands some distance behind the kicker, or attacking players form a line across the field some distance behind the kicker.

These attacking players are usually a metre or two apart. At a signal from the kicker, they charge forward. When they get near, the kicker tap-kicks the ball and passes to a player who had started some distance behind the kicker.
Sanction: Penalty kick at the place of infringement

(q) Advantage may be played for acts of foul play, but if the offence prevents a probable try, a penalty try must be awarded.

(r) For an offence reported by an assistant referee a penalty kick may be awarded where the offence occurred, or advantage may be played.

(s) All players must respect the authority of the referee. They must not dispute the referee’s decisions. They must stop playing at once when the referee blows the whistle except at a kick-off or at a penalty kick following admonishment, temporary suspension, or send-off.
Sanction: Penalty kick

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