NRL Media Release re Concussion

National Rugby League

National Rugby League Medical Officers have supported a strengthening of concussion guidelines as part of a review of procedures.

NRL Director of Football Operations, Mr Nathan McGuirk, initiated the review through Chief Medical Officer Ron Muratore in early March and which resulted in a phone hook-up with medical officers and leading Neurologist, Dr Richard Parkinson, last night.

The game’s existing concussion management procedures detailed in the Chief Medical Officer’s Handbook state that: “a player must not return to play until there is a full clinical and cognitive recovery.”

The Medical Officers have agreed that this should be amended to reflect the following:

* If after sideline/dressing room assessment by the Club Doctor the player is diagnosed with concussion he should not return to the field of play on the same day.

* If after sideline/dressing room assessment by the Club Doctor the player is not concussed or a diagnosis is uncertain he is free to return to play.

* If a player returns to the game he will be regularly re-evaluated by the Head Trainer.

“In recommending the change the doctors made it clear that concussion is a medical diagnosis and that it is easy to mistake symptoms,” Mr McGuirk said.

“The original focus of the review was to standardise testing procedures across all clubs and that is something that has also received support.”

All Club Medical Officers will be asked to adopt a modified SCAT 2 Testing procedure used in the NFL during the game.

All clubs will also adopt the ‘CogState’ testing system - a computer-based system that assists in both the diagnosis of and the tracking of concussive episodes.

Clubs have also been further reminded that the referee can stop play and allow an interchange at any time in the game that he believes a serious injury has occurred and that there is a need for the club medical officer to enter the field of play.

The NRL has  re-emphasised that the ‘ten man interchange’ rule was designed to accommodate injuries, including concussions and ‘blood-bins’, as well as tactical rotations.

“There was consideration at the time for having less interchanges but it was not felt that this would provide sufficient safeguards for players,” Mr McGuirk said.

Current guidelines applying to the initial on-field assessment by suitably qualified trainers in the management of concussion will remain:

* Maddock's Modified Questions
* Balance
* Cooperation

A player’s failure of any of these indicates the need for the player to be removed from the field for further assessment by the Club Medical Officer.

In all cases the Cog State testing system will be introduced across every club.

“It is important to understand that we are talking about a proper diagnosis and not simply the view of people looking on,” Chief Medical Officer Ron Muratore said today.

"Last week we had a player in Isaac Luke who was concussed and not allowed to return.

"We also had another player, Richard Fa’aoso, who was dazed but who after medical examination was not found to be suffering concussion.

"These are diagnoses that need to be made by a medical practitioner and in both cases the doctors have acted responsibly.

"The primary concern of the doctor is the welfare of the patient, which in this case is the player."

The medical officers also put the view that players under the age of eighteen should not be allowed to return unless an assessing doctor is confident that a concussion had not occurred.

They also expressed the strong view that any player who showed concussive symptoms such as dizziness, black-out or loss of memory in any match where a doctor was not present should be replaced immediately and should not play or train again until they had been medically assessed.


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