World Rugby has concluded its collaborative review with the RFU of the handling of George North's head injury incident during the Leicester Tigers v Northampton Saints Aviva Premiership match on 3 December 2016.

World Rugby initiated discussions with the RFU in relation to the handling of the incident and the findings of the independent Concussion Review Group initiated by the RFU and Premiership Rugby (PRL) published on 21 December. This was in order to further understand what lessons could be learned and what appropriate measures could be implemented to reduce the risk of a repeat incident in any competition. The discussions were highly constructive.
Despite the failing by the club to correctly apply World Rugby's head-injury management protocols, World Rugby has recognised that the RFU and PRL acted swiftly and appropriately to implement measures with Northampton Saints and other clubs to reduce the probability of future non-compliance. 
Specifically, World Rugby found:  

  • The robust head injury protocols defined within the Tournament Player Welfare Standards were not fully adhered to at the match in question. Prioritisation by the medical staff given to evaluating a potential spinal injury to North, was advanced as the principal reason for the non-compliance of head injury protocols. 
  • The non-application of the protocols resulted in North not being immediately and permanently removed from the field of play as he should have been, without requiring a Head Injury Assessment (HIA). 
  • Actions underpinning the ongoing education programme run by the RFU, PRL and the Rugby Players' Association (RPA): 
  • Following the incident, the RFU and PRL have communicated with all stakeholders to remind them of their obligations to ensure that immediate and permanent removal is observed in all such cases.  
  • As part of the review, World Rugby is satisfied that Northampton Saints' medical staff were educated on the permanent removal process. 
  • RFU and PRL to continue to run robust education programmes across the Aviva Premiership clubs this season. These educational interventions are in addition to World Rugby's global education programme.

World Rugby recognises the actions taken by the RFU and PRL as appropriate in order to re-emphasise the protocols and are encouraged by the renewed efforts. firstly, in the setting up of the Independent Untoward Incident Review Committee and, secondly, in the subsequent action taken since the publication of the independent review committee's findings to mitigate the risk of a repeat failing. 
While it is impossible to completely remove the risk of error, World Rugby remains disappointed that there was a failure in this case to identify and manage the injury appropriately, in particular considering North's medical history. With this in mind and to ensure that best practice is implemented in all elite competitions, World Rugby has instructed all unions and elite competition owners to ensure:  

  • Complete compliance with the mandatory six-point head injury education, prevention, and management programme as outlined within the conditions of use of the HIA tool.
  • Any clear or suspected symptom of concussion results in immediate and permanent removal of the player from the match or training session. The HIA is not applicable where a symptom of suspected concussion is observed – Recognise and Remove.
  • Individual risk stratification of players as outlined in the conditions of HIA adoption is a priority and all management should undertake concussion education as outlined on World Rugby's player welfare website HERE.
  • They are aware of their obligation under the conditions of HIA adoption that untoward incident reviews should operate where there are cases of apparent non-compliance with rugby's head injury protocols.
  • They prioritise Recognise and Remove education via social and digital platforms to educate the entire rugby community in the importance of recognising symptoms and immediately permanently removing any players with clear or suspected symptoms from playing or training. 

World Rugby's evidence-based approach to in-competition HIA is recognised as field-leading by the Berlin Concussion Consensus group and as a tool to test for suspected concussion. The HIA is successfully protecting players at the elite level. Less than four per cent of players with a confirmed concussion at Rugby World Cup 2015 remained on the field following their injury. Prior to the introduction of the HIA, 56 per cent of concussed players returned to play following their injury – a significant and highly positive reduction.

World Rugby Chairman Bill Beaumont said: "While we acknowledge that errors in the correct application of the process may happen from time to time, we must continue to strive to make our game as safe as possible for players at all levels of the game. The head injury management process, including the HIA, is successfully protecting players and what this case shows is that all stakeholders must redouble their efforts to ensure they are implemented fully and correctly. I'd like to thank our colleagues at the RFU for their full cooperation in this matter and for conducting a thorough review. World Rugby will continue to work closely with all unions to ensure an environment of compliance in this important area.”