Rugby’s head injury protocols have come in for renewed criticism after England’s 23-19 Six Nations victory over Wales on Saturday, with the player welfare group Progressive Rugby highlighting what it calls “systematic failures” in the process.
In the 19th minute at Twickenham two Welsh players, Tomas Francis and Owen Watkin, were involved with a collision with England’s Charlie Ewels as he charged for the try-line. The contact left Francis in particular showing signs of concussion. He was clearly dazed, and suffering with ataxia, symptoms that, according to World Rugby’s protocol, require a player to be immediately and permanently, removed from the game. But he played on.
The lobby group Progressive Rugby, a group of current and former players, medics, coaches, and researchers who are campaigning for improvements in player welfare, have sent an open letter to World Rugby, the Wales Rugby Union, and the Six Nations about the incident.
“Progressive Rugby have contacted the WRU, WR and Six Nations in relation to what we regard as systematic failures in dealing with the welfare of Welsh prop Tomas Francis during England v Wales,” said a spokesman for the group. “In our view, Francis clearly presented symptoms that required his immediate and permanent removal, and that employing the Head Injury Assessment process, from which the player subsequently returned, was a clear breach of World Rugby’s HIA protocol.”
Watkin, who was left bleeding heavily from a cut on his brow, went off to have the wound treated, and came back on 10 minutes later. A player requiring a head injury assessment (HIA) is meant to be off for a minimum of 12 minutes. Francis initially stayed on, and was about to take his place in the front row of the ensuing scrum, when referee Mike Adamson sent him for a HIA, which he passed. Both men were then substituted in the second half. But Francis shouldn’t have required an HIA at all. He fell once while trying to regain his feet after contact, held his head, then stumbled again and slumped into the post for support.
World Rugby calls those “criteria 1 indicators”. If either the Welsh team doctor or the independent match day doctor (MDD) spotted them, Francis could, and should, have been immediately removed from play. The only way Francis should have ended up needing an HIA is if the two doctors disagreed (given the video footage, it wasn’t clear what they could have disagreed on).
And even if Francis had passed the HIA, the MDD had the right to insist that Francis stayed off regardless. It was clear that, on this occasion, the system didn’t work as it is supposed to. World Rugby’s own research shows that 20% of players who have criteria 1 symptoms will still pass the assessment, which means, in their words, that the “the presence of a Criteria 1 sign is, sometimes, the sole indicator for diagnosing concussion, and that “many of the delayed concussions we see are in fact missed or misinterpreted Criteria 1 cases”.
After the match, head coach Wayne Pivac said the players “go through some testing behind the scenes, and they both passed the testing so they’re allowed to play on.” Francis shouldn’t have had the opportunity. It’s not the first time he has been involved in an incident like this. Last year the former Dragons forward Adam Hughes, who retired because of brain injury, said he had given Francis “a bit of a telling off” about an incident in Wales’s match against Ireland, when Francis was hit in the head by Peter O’Mahony, but played on without having an HIA. “But it’s not him I should be telling off,“ Hughes said, ”it’s the physios, referees, and independents [doctors].”
Progressive Rugby’s letter says “we consider the above incident demonstrates a clear flagrant breach of HIA protocol that potentially puts both the short-term and long-term health of an elite athlete at risk. It is our major concern that the public has observed that in Rugby Union individuals have incurred brain injury and been permitted to continue to play. Until satisfactory explanations are provided, we remain unable to accept World Rugby’s assertion that player welfare is the game’s number one priority.”
They also point out that they are still waiting for the results of similar failures during England’s match against Italy on February 13, and England U20s match two days earlier.
A World Rugby spokesman said the Six Nations will be obliged to review the Francis incident, and confirmed they are still looking at the two others mentioned by Progressive Rugby. They also had their Chief Medical Officer run a “dedicated education top-up” with all the match officials involved in the tournament.
