Bashing heads over concussion

Facilities for video reviews of suspected concussion at pitch-side and in team medical rooms are to be mandatory at the Rugby World Cup.

The move is part of a bid to prevent a repeat of the incident during the England-Wales Six Nations game on Friday in which George North was allowed to return to play despite appearing to be knocked out.

It is understood that official match-day doctors, who are independent of teams, will also be appointed during the tournament - to be held in England in September and October - to alert medics to suspected concussions.

Details of the heightened protocols emerged on Sunday night after World Rugby, the sport's governing body, called for a full report from the Welsh Rugby Union on whether the correct concussion procedures were followed in the handling of North.

The player had already passed a mandatory head injury assessment after receiving an accidental boot to the head from Dave Attwood, when he clashed heads with Richard Hibbard, his Wales teammate, midway through the second half. Video replays appeared to show that he immediately lost consciousness but was allowed to return to play.

The head injury assessment allows team doctors 10 minutes to assess a player off the field, but World Rugby directives state that any player even suspected of losing consciousness should be removed immediately from play.

Medics for the Welsh team were treating another player when North sustained his second head blow and, according to the Welsh Rugby Union, the second incident was not seen at the time. Although North had "no signs and symptoms", they treated him as concussed after studying video footage.

For Barry O'Driscoll, who resigned as chief medical adviser at the International Rugby Board (IRB, the precursor to World Rugby) over its attitude to concussion, the incident was just another example of medical concerns being overridden by on-field considerations.

"I am afraid it is very difficult to come to any other conclusion than that it is not the state of the player's brain, but the state of the game, that is determining a lot of these cases," O'Driscoll said.

"If George North had been in a boxing ring the fight would have been stopped. He was out cold.

"What has happened is that World Rugby has got itself in an awful mess by creating two categories of concussion: a suspected concussion, where you must come off and stay off, and a potential concussion, where you can come back on. It is nonsense."

The presence of independent medics had not provided the safety net that many hoped.

"These doctors should not be appointed by World Rugby or the home nations," said O'Driscoll. "The appointments need to be made by an independent medical organisation otherwise there is the potential for a conflict of interest."