Fatalities and spinal cord injuries are high consequence, low incidence injuries that occur in collision team sports and individual sports, such as horse riding and gymnastics. It is incumbent on all stakeholders from governing bodies to individual athletes to manage the risks associated with these injuries through the introduction of appropriate risk mitigation strategies, such as the laws of the game, protective equipment or education and training programmes. The normal method for demonstrating that risks are managed effectively is through the process of risk assessment, which is an element within the broader framework of risk management. No activity is risk free and the process of risk management is not intended to reduce levels of risk to zero; however, it is generally regarded that in most aspects of life, there are some levels of risk that are acceptable and others that are unacceptable. In this context, the Health and Safety Executive in the UK has defined norms for what can be regarded as negligible, acceptable, tolerable and unacceptable levels of risk. An acceptable level of risk generally relates to the risk of a serious adverse consequence, such as a fatality or a spinal cord injury resulting in permanent neurological deficit, occurring on average between 0.1 and 2 times/100,000 people per year. The aims of this project were to assess the level of risk associated with catastrophic injuries in rugby union, to reach a conclusion about whether the level of risk is acceptable and to review current guidance on coaching and refereeing.
The scientific literature was reviewed in order to collect data on catastrophic injuries (defined here as fatalities and spinal cord injuries) sustained during rugby union activities in England (1956-2002) and other countries (1970-2005). In addition, equivalent data were collated for catastrophic injuries sustained in a range of other sports and non-sports activities. The probability of sustaining catastrophic injury in rugby union (number of events/100,000 exposed population per year) was compared with the probability associated with these other activities and with the Health and Safety Executive’s guidelines on negligible, acceptable, tolerable and unacceptable levels of risk.
The results indicated that for rugby union players in England, the risk of sustaining a catastrophic injury (0.84/100,000 per year) came within the Health and Safety Executive’s ‘acceptable region’ of risk (0.1 to 2/100,000 per year), whilst the average risk of catastrophic injury experienced by rugby players in other countries (4.6/100,000 per year) fell within the ‘tolerable region’ of risk (2 to 100/100,000 per year). The risk of sustaining a catastrophic injury in rugby union in England was generally lower than that experienced in a wide range of other collision sports, such as ice hockey (4/100,000 per year), rugby league (2/100,000 per year) and American Football (1/100,000 per year). The risk of catastrophic injury in rugby union was comparable with that experienced by most people in UK work-related situations (0.8/100,000 per year) but less than that experienced by motorcyclists (190/100,000 per year), pedestrians (3.7/100,000 per year) and car occupants (2.9/100,000 per year).
The results presented here indicate that the laws of the game and the guidance provided by the RFU adequately manage the risk of catastrophic injury in rugby union in England. However, the Rugby Football Union should not be complacent, as there does not appear to be a coherent, multidisciplinary, game-wide strategy aimed at players, coaches and referees for managing the risk of catastrophic injuries. In addition, epidemiological data about these injuries in England depends on a voluntary reporting system by clubs and schools with little information collected about the specific nature or the causes of the injuries or the total population of rugby players exposed to the risks of injury. Without this type of information it is difficult to evaluate the effectiveness of intervention strategies for reducing the incidence of catastrophic injuries. The RFU’s Catastrophic Injury Task Group has recognised many of the existing procedural weaknesses and made recommendations to the RFU Management Board about how these issues could be addressed. The positive initiatives related to the management of catastrophic injuries that have been made by the RFU Medical and Coaching Groups should be supported and further developed by the RFU Management Board.
The risk of injury in many sports is high and therefore all stakeholders from sports governing bodies to individual athletes have a responsibility to manage these risks and, where possible, reduce the level of risk. Both UKSport (Fuller, 2004) and the Australian Sports Injury Prevention Taskforce (Department of Health and Ageing, 2003) advocate the application of risk management principles for managing the risks associated with sport.