New Zealand Rugby to introduce blue cards to combat concussion

Reggie Goodes of the Hurricanes is assisted from the field after a concussion. Photo / Getty

New Zealand Rugby and all the Mitre 10 Cup provincial unions are upping the ante in a bid to better deal with on-field concussion in 2017.

With club rugby around the country having kicked off, or about to kick off, their seasons, referees in official adult rugby matches (18 and over) will be carrying a blue card along with their red and yellow. They will have the power to 'blue card' any player in the match they suspect of having been concussed. They have, in fact, always had that power to do so, but this will formalise that and take the battle against concussion to a new level.

Some may see this as putting more pressure on referees, but they will have to undergo training from a medical professional to be able to recognise the symptoms of concussion before they use the blue card.

The initiative was successfully trialled by Northland in 2014, a year in which 17 players were shown the blue card, including Jordan Kemp, who several months later died of a brain bleed after an on-field concussion. In 2013, Takapuna club player Willie Halaifonua died of a head injury following concussion.

After receiving a blue card, the player must leave the field of play and cannot return until they have completed a series of mandatory steps, including a three-week stand down (23 days for under 19s and 21 days for over 19s) from training and playing. That stand-down is a minimum, so a player may have longer out, but then must be cleared to return to play by a qualified medical professional with expertise in neurology.

Auckland Rugby Union match officials manager Smudge McNeilage is right behind the scheme, but does not want it couched in terms of the decision to remove a player being taken out of the hands of coaches and managers.

"It's quite the contrary. Referees should not be needing to do this if coaches and managers were doing their roles. This isn't a referees' initiative. Everyone needs to be aware of this. They think because we are holding a card, it is a referees' initiative," McNeilage says.

"So if the ref missed Bob being concussed, the coach or manager should be taking him off and putting him through the normal graduated return to play protocol (GRTP). They should not be saying 'Oh good, the ref missed that, we can play him next week.' That is not what we are about, and we don't want to see coaches sneaking players off before we blue card them. The issue is player safety. It's not about winners' medals. It's about team and safety and enjoyment."

Auckland has expanded the criteria to include schoolboy rugby, but with a caveat at this stage. There are around 190 fully affiliated, registered referees in the union, and all must undergo the training, which took place on March 6 and 13 and again next Monday (March 20) from Blues doctor Stephen Kara for recognising symptoms. If you have not attended one of those course nights, you will not be carrying a blue card, nor will you will have a blue card if you are a first year referee. That would be too much on your shoulders.

Is this creating more pressure on referees, many of whom, even at the amateur level, have to deal with new laws, interpretations and barracking from the sidelines?

"No, we always had this responsibility, the power to send a concussed player off," says McNeilage. "Unfortunately many of my referees did not do this, nor did coaches and managers, so this is highlighted to all of us."

He will not be directing his referees to err on the side of caution, even though there may be some subjectivity with a player who has taken a heavy blow as to whether he is concussed. They will need to trust their knowledge from the training and make the call.

"A blue card is probably more powerful than a red card. If Bob gets a blue card in the first minute of a quarter-final, he will be out for the semi and final as well," adds McNeilage.

He is hoping for buy-in from all teams and management, though some will surely try and beat the system.

"Some coaches are looking at ways around it and I'm shaking my head at this."

There will be "consequences" for any team who plays a blue-carded player before they have full clearance. In the event that a player wants to contest the blue card, there will be a very limited number of independent medical professionals with brain expertise who are approved by NZ Rugby. The only other way out of a blue card is obviously mistaken identity.

The concussion protocols around professional rugby do not apply in the community game, as one cannot always guarantee an independent doctor on site. The blue card will not apply to the professional game, including Mitre 10 Cup.

Three Heartland unions, including Poverty Bay, are also implementing the blue card scheme for 2017. NZ Rugby would like to see it expanded to all levels and 26 unions of the game in time.

"Implementing the blue card requires a collective effort. Referees need to be trained to better recognise the signs of concussion, coaches and players need to support the mandatory stand-down period, and local medical professionals need to help us record, track and report on the injury or suspected injury," says NZ Rugby head of community rugby Brent Anderson.

"We are very pleased at the response from our communities so far, people understand what we're trying to do and why it's important to put our players' health first. Our referees have stepped up, which is a reflection of their commitment too."

A blue-carded player must follow these steps to return to rugby:
• Rest until there are no on-going symptoms
• Complete the minimum stand-down period (21 days for adults, 23 days for under
19 players)
• Undertake the Graduated Return to Play Protocol (GRTP)
• Obtain medical clearance to return to play