Introduction

Welcome to our latest newsletter.  We hope that you’ve been enjoying the Rugby World Cup action from France.  The tournament is now in its middle phase, and has so far showcased some exceptional performances and a huge array of medical support that we hope, naturally, does not make the headlings.  This newsletter, however, is dedicated to expanding a little on that medical support and provision.  First, we explore the inner workings of the HIA video review system that operates with one goal on match-days: To make sure that no player who experiences a concussion plays on after the head impact.  Second, we hear from Dr Emmanuel Reboursiere, the Tournament Medical Director, who explains some of the infrastructure and numbers behind the medical provision.  Finally, we wanted to share with you the agenda for our annual Medical Commission Conference, and also invite you to consider attending, either in-person or online for part of it.  A World Cup brings the rugby world together, and it is no different for the medical and research specialists involved in the sport, and we are very much looking forward to our conference in Bordeaux, and hope you’ll join us.  The details are below.

Inside the HIA video system review process on Match days

This is what the HIA video control room looks like at the #rwc2023. This station is run by two technical operators, who sit with a match day video doctor (MDVD), who has access to on-demand footage from any one of the 22 Hawkeye operated cameras at the game.

During the match, the main match day doctor (MDD) is positioned on the sideline, also accompanied by a technical operator from Hawkeye, so that the MDD also has access to the same footage on an iPad.

Both doctors and the Hawkeye operators continuously look for any signs of head impact with the potential to cause a concussion, and that may have been missed by the team doctors. When the MDVD sees such an event, it is relayed to the MDD for examination.  If the incident is seen live or on video by the MDD, they have the ability to alert the team doctors of both teams about the case, and they can look at the footage together, before deciding whether to have the player removed either permanently, or for an off-field screen. The team doctors and MDDs can also make this call themselves. 

When a player is identified as needing an off-field screen, the player leaves the field, accompanied by the MDD and one of their own medical staff (this is all discussed before the match).  They first review the footage in this video control room, which is usually located immediately off to one side as the player leaves the field. That video review can either suggest the permanent removal of the player (if they have a so-called Criteria 1 sign), or it is the first step in doing the HIA1 screen, a test that examines symptoms, balance and cognitive function. That’s done in another quieter room, and takes at least 12 minutes, with the result determining if the player returns to play, or is substituted permanently. 

Then after the match, all the confirmed HIA1 cases and all other “bookmarked” head impact events (the ones that were spotted, but not removed from play after examination by the MDDs and Team Doctors) are downloaded to a folder for review, which is a process done by the MDVD and a Hawkeye assistant.  This is done to identify any players who may have experienced significant impacts and who may present with symptoms or indications of concussion later, and who then require an HIA2. 

Also, 520ccc.com double-check check the cases, both for assurance of appropriate removal vs non-removal, and for documentation purposes.  The cases and numbers are cross referenced against two separate systems, one of which also has the detailed screening test results, to ensure accuracy. 

Tournament Medical provision

Naturally, the match-day medical services are a strong focal point of player welfare, and use the above-mentioned Match Day Doctors who work in collaboration with Team doctors to ensure that fast, accurate and clinically sound decisions are made during play.  But even beyond this, the medical infrastructure of the RWC is enormous, with literally hundreds of doctors on duty through France for the duration of the tournament, so that no medical need is left unattended.  The Tournament Medical Director, Dr Emmanuel Reboursiere, talked us through the details of who is involved, how the MDDs in particular were prepared, and what some of the significant challenges in setting up the medical service provision were.

MCC in Bordeaux

As we mentioned in our previous newsletter, October also brings with it our annual Medical Commission Conference. This year, it happens in Bordeaux, to coincide with the 2023 Rugby World Cup. The first part of the meeting aimed at the Chief Medical Officers and practitioners within our Member Unions, while a second part, in collaboration with the Rugby Science Network, is open up to all researchers and clinicians with an interest in rugby research science.  The MCC has always been a highlight of our year, an opportunity to share ideas, findings and decisions, and perhaps more importantly, to plan ahead and forge new and stronger research and medical relationships. 

We have recently moved part of this meeting online, too, and if you are unable to join us in one of the world’s most famous wine-producing regions, there will be an option for you to dial in no matter where in the world you are. The agenda and registration is available HERE

So, there is much to look forward to, and we are excited to tell you about it, and then to hear from you as a community that shares player welfare interests and objectives. Once again, please share this newsletter as widely as you can, feel free to engage with us, and we look forward to our shared journey.
 

Enjoy the Rugby World Cup

Prof Éanna Falvey