The opening game of Ireland's tour of New Zealand has been overshadowed by a concussion row, after Ireland prop Jeremy Loughman was allowed to return to the field despite allegedly displaying clear concussion symptoms.
Loughman fell backwards while attempting to get to his feet following a collision in the opening minutes of Ireland's match against the Māori All Blacks on Wednesday.
World Rugby's concussion protocol dictates that players who display clear concussion symptoms are to be immediately removed from the field.
Instead, Loughman underwent a head injury assessment which he passed before returning 10 minutes later. Loughman was then replaced at half-time by Cian Healy, who went on to suffer a lower limb injury which has put the rest of his tour in doubt.
"[Loughman] actually passed his HIA with an independent doctor. We brought him off as a precaution," Andy Farrell, the Ireland head coach, said afterwards.
The decision to not remove Loughman immediately without an HIA was criticised by Progressive Rugby, the player welfare lobby group, who compared the incident to the concussion suffered by Tomas Francis playing for Wales against England during the Six Nations.
Francis was similarly removed for an HIA despite showing 'Criteria 1' indications that he had suffered a concussion, before returning to the field.
A subsequent HIA review panel concluded that "one or more 'Criteria 1' indications had been present" which should have resulted in Francis being immediately and permanently removed from play.
The incident involved Loughman follows World Rugby's announcement last week that players with a history of concussion or who fail off-field HIAs will be stood down for 12 days, with World Rugby's concussion protocol described as "gold standard, second to none and superior to most" by Professor Bob Cantu, a professor of neurology and neurosurgery who is part of World Rugby's Concussion Working Group.
Progressive Rugby added in a statement: "It is deeply alarming, just days after World Rugby's bold announcement of a 'gold standard' concussion protocol from 1st July, that a player clearly demonstrating signs of a traumatic brain injury has not been removed whilst in full glare of the media.
"Even under the current protocol, the safety of Ireland prop Jeremy Loughman demanded his immediate and permanent removal, but the process failed."
Former England scrum-half Kyran Bracken also criticised the handling of the incident, writing on Twitter: "Players lives at risk. @WorldRugby sort this s--- out or you won't have a game to govern!"
The Maori All Blacks went on to win 32-17 in Hamilton after scoring four first-half tries, with Ireland hit by injuries to Loughman, Healy, James Hume and Jimmy O'Brien which will test Farrell's 40-player squad with four more matches to come.
Iain Henderson has already been ruled out of the tour, while Rob Herring has been ruled out of the first Test against New Zealand this Saturday along with Mack Hansen, who has tested positive for Covid.