IRB: Health care at matches
The International Rugby Board has sent out the following instructions to unions and match day doctors and officials at Test matches.
Following the changes to Law 3 and Regulation 15 the following notes will assist in the practical application where a Match Day Doctor (MDD) is appointed to an international test match. This document has been produced for the benefit of; players, team management, team physicians, match officials (fourth and fifth officials in particular) and MDDs.
Blood
1. The definition of a blood injury that is allowed to access 15-minute temporary substitution is 'uncontrolled active bleeding'.
2. Practical definition provided in Match Day Doctor (MDD) Education Module
"Participants with uncontrolled active bleeding should be removed from the field of play if the bleeding cannot be stopped within 60 seconds or as soon as is practical. A temporary substitution is allowed for up to 15 minutes to allow medical staff to control the bleeding, cleanse the wound and cover the wound"
3. The MDD is the decision maker on access to 15-minute temporary substitution – Regulation 15.2.1.c – if no MDD this responsibility rests with Referee
4. Through the 4th official the MDD can recommend "the removal of contaminated clothing from a player on the field, at the next break in play".
5. Minor cuts and abrasions that do not have active bleeding should be cleansed and covered during scheduled breaks in play.
Pitch-side Suspected Concussion Assessment (PSCA)
• MDD has power to call for a PSCA
• MDD has power to call for a second PSCA on a player who has been cleared by a Team Doctor
• MDD has power to remove a player from further game participation as per Regulation 15.2.1 d. – If the nominated Match doctor gives his opinion that a Player should not continue playing on account of his injury, (whether such injury is a blood injury or otherwise) shall not be allowed to resume playing. The opinion of the nominated Match doctor shall be conveyed to the Player’s Union or its representative and it is then for that Union to decide whether or not a replacement shall be introduced.
• MDD has power to enforce permanent removal from play any player who has indications for permanent removal under the PSCA criteria.
Heat Guidelines
MDD must confirm IRB Heat Guidelines require implementation on days of extreme temperatures.
Game day interventions
1. Provision of dressing room fans if air conditioning not available.
2. Provision of side line shade if game played during the day when radiant heat (direct sunlight) is a contributing factor.
3. Strategic positioning of towels immersed in ICE water around the ground – behind goal posts and at junction of each quarter line and side line.
4. 2 minute break at the 20 minute mark of each half. The focus of this break should be threefold, a medical assessment of each athlete for signs of heat stress, cooling of athletes and re-hydration. It is suggested that cooling would be best achieved by immediately removing jersey and shoulder pads, application of ICE water to head ± body. Utilising sideline fans and shade (if game during day) would also be ideal. It should be noted that a 2 minute break has been recommended (as opposed to a 1 minute break) because the focus during this break is primarily medical assessment and cooling.
It should be noted that increasing access of water carriers to the field has not been recommended as it is felt that there are adequate breaks in the course of a game to allow water carrier access and player re-hydration.
