DEALING WITH DEALING WITH INJURIESINJURIESA Guide for Rugby RefereesA Guide for Rugby Referees

KEEPING THE KEEPING THE GAME SAFEGAME SAFEM. Bruce Carter, MDM. Bruce Carter, MD

December 4, 2007December 4, 2007

Good Samaritans with Good Samaritans with WhistlesWhistles

Duty of Care? Duty of Care? Level of expertise/trainingLevel of expertise/training Help may be refusedHelp may be refused Implied consent Implied consent Don’t stop once you startDon’t stop once you start No obligation to incur riskNo obligation to incur risk

Pre-existing Pre-existing ArrangementsArrangements

Ask ahead of timeAsk ahead of time Assume anyone responding to an injury Assume anyone responding to an injury

is qualified (until further notice)is qualified (until further notice) Cell phones are everywhereCell phones are everywhere

Primum non nocere Primum non nocere

Don’t make it worseDon’t make it worse Don’t let someone else make it worseDon’t let someone else make it worse This includes the injured personThis includes the injured person

What is Serious?What is Serious?

BleedingBleeding Inordinate pain – blow the whistleInordinate pain – blow the whistle Unexplained sensationsUnexplained sensations Life or limbLife or limb Obvious deformityObvious deformity Loss of consciousnessLoss of consciousness

Stabilize the SituationStabilize the Situation

WhistleWhistle Full attentionFull attention Eliminate further dangerEliminate further danger Minimize movement of affected Minimize movement of affected

part/personpart/person ‘‘Neutral’ positionNeutral’ position Comfort, hydration, shade/warmthComfort, hydration, shade/warmth

Call For HelpCall For Help

Qualified folks on sceneQualified folks on scene If you think about it – activate the EMSIf you think about it – activate the EMS

If In Doubt – Don’tIf In Doubt – Don’t

Don’t move an injured person if it might Don’t move an injured person if it might make them worsemake them worse

Don’t take any action for which you have Don’t take any action for which you have no good reasonno good reason

The ABCsThe ABCs

AirwayAirway BreathingBreathing CirculationCirculation Disability/Damage (neurological), Depth Disability/Damage (neurological), Depth

of Consciousnessof Consciousness Everything ElseEverything Else

Head InjuriesHead Injuries

This is how rugby players dieThis is how rugby players die Bloody noses, black eyes, dangerous Bloody noses, black eyes, dangerous

tackles, scrums and ‘normal’ tacklestackles, scrums and ‘normal’ tackles Fortunately, this allows for preventive Fortunately, this allows for preventive

carecare

Guidance from the IRBGuidance from the IRB

““A player who is suffering definite A player who is suffering definite concussion should not participate concussion should not participate

in any match or training session for a in any match or training session for a period of at least three weeks period of at least three weeks

from the time of injury, and then only from the time of injury, and then only subject to being cleared by subject to being cleared by

a proper neurological examination.”a proper neurological examination.”

Concussion DefinedConcussion Defined

A period of altered consciousness in A period of altered consciousness in response to a head injuryresponse to a head injury

What the IRB calls ‘definite concussion’ What the IRB calls ‘definite concussion’ is what physicians call a Grade 3 is what physicians call a Grade 3 concussionconcussion

The Key Question - PEARLThe Key Question - PEARL

HOW DID YOU GET TO THE HOW DID YOU GET TO THE GAME TODAY?GAME TODAY?

Grades of ConcussionGrades of Concussionwww.aan.com

Grade 1: ‘Bell rung’ – NO LOSS OF Grade 1: ‘Bell rung’ – NO LOSS OF CONSCIOUSNESS – back to normal CONSCIOUSNESS – back to normal within 5 minuteswithin 5 minutes

Grade 2: NO LOSS OF Grade 2: NO LOSS OF CONSCIOUSNESS – Not back to CONSCIOUSNESS – Not back to normal, feels ‘off’, after 5 minutes normal, feels ‘off’, after 5 minutes

Grade 3: ANY loss of consciousnessGrade 3: ANY loss of consciousness

Treatment for Grade 1Treatment for Grade 1

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

Treatment for Grade 2Treatment for Grade 2

Still not completely back to normal after 5 Still not completely back to normal after 5 minutesminutes

No further strenuous activity for 1 week, No further strenuous activity for 1 week, subject to professional examination and subject to professional examination and clearanceclearance

Treatment for Grade 3Treatment for Grade 3

This is what the IRB refers to as ‘definite This is what the IRB refers to as ‘definite concussion’concussion’

““I think I was out for a second” – no I think I was out for a second” – no further activity. IRB Guidance applies – 3 further activity. IRB Guidance applies – 3 weeks’ rest, professional evaluationweeks’ rest, professional evaluation

Unconscious for more than one or two Unconscious for more than one or two minutes – activate EMSminutes – activate EMS

Seizure activity – activate EMSSeizure activity – activate EMS

Preventive TreatmentPreventive Treatment

Do not let concussed players continue to Do not let concussed players continue to playplay

Inform coaches/teammates/friends/family Inform coaches/teammates/friends/family of your concerns and recommendationsof your concerns and recommendations

Rugby players look out for their mates Rugby players look out for their mates better than they do for themselvesbetter than they do for themselves

SUMMARYSUMMARY

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