DEALING WITH INJURIES A Guide for Rugby Referees

KEEPING THE GAME SAFE M. Bruce Carter, MD December 4, 2007

Good Samaritans with Whistles  Duty of Care?  Level of expertise/training  Help may be refused  Implied consent  Don’t stop once you start  No obligation to incur risk

Pre-existing Arrangements  Ask ahead of time  Assume anyone responding to an injury is qualified (until further notice)  Cell phones are everywhere

Primum non nocere  Don’t make it worse  Don’t let someone else make it worse  This includes the injured person

What is Serious?  Bleeding  Inordinate pain – blow the whistle  Unexplained sensations  Life or limb  Obvious deformity  Loss of consciousness

Stabilize the Situation  Whistle  Full attention  Eliminate further danger  Minimize movement of affected part/person  ‘Neutral’ position  Comfort, hydration, shade/warmth

Call For Help  Qualified folks on scene  If you think about it – activate the EMS

If In Doubt – Don’t  Don’t move an injured person if it might make them worse  Don’t take any action for which you have no good reason

The ABCs  Airway  Breathing  Circulation  Disability/Damage (neurological), Depth of Consciousness  Everything Else

Head Injuries  This is how rugby players die  Bloody noses, black eyes, dangerous tackles, scrums and ‘normal’ tackles  Fortunately, this allows for preventive care

Guidance from the IRB  “A player who is suffering definite concussion should not participate in any match or training session for a period of at least three weeks in any match or training session for a period of at least three weeks from the time of injury, and then only subject to being cleared by from the time of injury, and then only subject to being cleared by a proper neurological examination.” a proper neurological examination.”

Concussion Defined  A period of altered consciousness in response to a head injury  What the IRB calls ‘definite concussion’ is what physicians call a Grade 3 concussion

The Key Question - PEARL  HOW DID YOU GET TO THE GAME TODAY?

Grades of Concussion  Grade 1: ‘Bell rung’ – NO LOSS OF CONSCIOUSNESS – back to normal within 5 minutes  Grade 2: NO LOSS OF CONSCIOUSNESS – Not back to normal, feels ‘off’, after 5 minutes  Grade 3: ANY loss of consciousness

Treatment for Grade 1  Back to normal within 5 minutes  Rest and observation for 15 minutes  No further symptoms: okay to participate  Second Grade 1 = Grade 3

Treatment for Grade 2  Still not completely back to normal after 5 minutes  No further strenuous activity for 1 week, subject to professional examination and clearance

Treatment for Grade 3  This is what the IRB refers to as ‘definite concussion’  “I think I was out for a second” – no further activity. IRB Guidance applies – 3 weeks’ rest, professional evaluation  Unconscious for more than one or two minutes – activate EMS  Seizure activity – activate EMS

Preventive Treatment  Do not let concussed players continue to play  Inform coaches/teammates/friends/family of your concerns and recommendations  Rugby players look out for their mates better than they do for themselves

SUMMARY  RUGBY IS ONLY A GAME  Safety is part of our charge  You care or you wouldn’t be there  You’re intelligent or you wouldn’t be there  The Law and the law are on your side  Ask for help and trust the helpers  “Preserve the fighting strength”