World Rugby has announced details of an enhanced mechanism to standardise the analysis and review of the management of all head injury assessments (HIA) in elite adult rugby.
The HIA process is currently operational in 22 competitions globally and is a major factor in a significant improvement in the identification and permanent removal of players with suspected or confirmed concussion in the sport.
However, World Rugby is committed to driving forward evidence-based best-practice and a new mandatory HIA review process came into effect on 1 September to support unions and competition owners with HIA process management and compliance.  
This mechanism is an education, training and compliance process developed by World Rugby and independent expert advisors, designed to enhance the promotion of player welfare by further reducing the risk of incorrect application of the process.
Under the HIA process, it is mandatory for competition organisers to implement the standardised review process in line with the laws of rugby (Law 3.12). World Rugby logs video of every HIA event in elite rugby to review application, provide support, advice and monitor programme success.
Under the modified HIA review process, each union and/or competition organiser will appoint suitably trained HIA review processor(s), who will preside over the effective application of the process, which will operate two elements for every head injury event:

  • A post-game video review process, delivered by the union, competition or World Rugby, where a reviewer will consider the evidence surrounding an incident. Depending on the findings, the reviewer may recommend further education and training for the club or team medical personnel or recommend that the process moves to HIA review.
  • The HIA review process will involve a group that will formally investigate the incident and make recommendations that may include: further education and training for the club or team medical personnel; a request to World Rugby’s HIA working group to consider a change to the process, education and/or training; or a referral to the appropriate disciplinary group to consider disciplinary action in line with competition rules.

World Rugby Chief Medical Officer Dr Martin Raftery said: “We are constantly reviewing our processes and learning from the evidence to ensure player welfare is at the forefront of the game. Since its introduction, the HIA process has been proven to be hugely successful in improving the identification and management of head injuries. We acknowledge that there is no perfect system for diagnosing a concussion and that is why we continue to research methods and improve processes in this area.

“We recognise that in a small number of cases, we know the HIA process has not been implemented as directed or intended. This new review process has been introduced to address compliance issues through post-game reviews and ongoing education of medical staff. It is designed to work out if and why there has been a failure of process and then to take steps to ensure that it doesn’t happen again through process change recommendations, one-on-one education or referral to the tournament’s disciplinary committee.”