Six Nations statement: Tomas Francis' concussion versus England

Six Nations officials have published their investigation into the concussion controversy over Wales prop Tomas Francis, who was allowed to play against England at Twickenham on February 26 despite a serious-looking head knock. He was then cleared by his country to start in the round four match versus France 13 days later.

The incident led to widespread criticism of the game’s authorities and even this Wednesday the Rugby International Players’ union reported that they voiced concerns to both World Rugby and the Six Nations over the way the hot topic concussion issue was being handled.

Six Nations have now published their findings and determined that Francis should have been immediately removed from play and should not have been permitted to return following his head injury assessment. However, the organisation added that it will not be taking any subsequent disciplinary action against the people who allowed Francis to return to play on in London.

What happens inside the brain during a concussion | Beyond 80 Knocked

What happens inside the brain during a concussion | Beyond 80 Knocked

Their statement read: “During the Guinness Six Nations match between England and Wales at Twickenham, Wales prop forward Tomas Francis was involved in making a tackle that resulted in a clash of heads.

“Francis temporarily left the field, as per head injury assessment (HIA) protocols, where he was assessed by the independent match day doctor before returning to the pitch. Following the conclusion of the match, and in accordance with the Six Nations Rugby HIA protocol and World Rugby’s relevant regulations, Six Nations Rugby referred the incident to an HIA review panel for further consideration.

“The areas to be determined by the HIA review panel: Were any criteria one (as listed in World Rugby’s HIA protocol here) indications present and missed, that would have led to the permanent removal of Francis from the field of play (rather than subject to temporary HIA)?

“And If findings concluded that Francis should have been immediately and permanently removed from the field, why that did not happen?

“In accordance with the Six Nations HIA protocol and World Rugby’s relevant regulations, the HIA review panel appointed to consider the incident comprised of Pamela Woodman (chair), Donal Courtney, Dr Martin Raftery (World Rugby), Dr Rod McLoughlin (independent), as well as Dr Simon Kemp (RFU) and Prabhat Mathema (WRU).

“The HIA review panel was responsible for reviewing the evidence available to them, including detailed statements from the Wales medical team and the independent match day doctor, who was on duty at the match, as well as a number of video clips of varying lengths, speeds and angles.

“The HIA review panel concluded that in this instance one or more criteria one indications had been present that should have resulted in Francis being immediately and permanently removed from play.

“As part of the review process, the panel found that a number of factors appeared to have contributed to the failure to identify these indications that ultimately led to Francis not being removed from the field of play. As such, a set of recommendations has been put forward by the panel, that warrants consideration.

“The panel highlighted that it had the benefit of time for review of the video footage and the other materials at length, without any match-day pressure, and also had access to more camera angles and clips than the match-day medical team.

“The HIA review panel made no recommendations in respect of disciplinary action against those involved in the relevant incident, and Six Nations Rugby Limited will not be taking any subsequent disciplinary action.

“While all but point g in the recommendations listed below are included within the World Rugby HIA process and supporting education modules, Six Nations will be working in collaboration with its unions and World Rugby to take appropriate action to reinforce and implement any steps to mitigate the risk of a similar instance occurring again.”

Recommendations Provided by The HIA Review Panel:
a. Video footage of an incident that has the potential to result in a concussive injury (potential HIA incident) should be viewed by the responsible doctor from (i) the incident in question to (ii) return to play of the player (or, if earlier, to when the player was removed from the pitch for an HIA). This is not a new recommendation, but it is worth reinforcing and restating.

b. For any potential HIA incident occurring in the first half, half time should be utilised by the responsible doctor(s) to (re-)review video footage of any potential HIA incident(s). Again, this is not a new recommendation but is worth reinforcing and restating.

c. As part of the training for video feed operators referred to in paragraph 7(d) (of the Six Nations 2022 head injury assessment and concussion protocol), the home union at whose ground the fixture is being played should ensure that they are aware of the need for video footage (and so any clips) of any potential HIA incident to cover the period from (i) the incident in question to (ii) return to play of the player (or, if earlier, to when the player was removed from the pitch for an HIA).

d. At least annually, the video services provider should ensure that their on-site technicians receive rugby union-specific training (which, if so required by World Rugby and may be developed by World Rugby in order to ensure consistency across competitions), including (but not limited to) training on the need for video footage (and so any clips) of any potential HIA incident to cover the period from (i) the incident in question to (ii) return to play of the player (or, if earlier, to when the player was removed from the pitch for an HIA).

e. At the pre-match medical meeting, the respective roles and responsibilities of the different medical personnel (including the medical room personnel, such as the medical room video Reviewer) should be agreed upon, including for a situation where more than one potential HIA incident and/or other injury require to be dealt with at or around the same time and any handover process as between medical personnel which may be required as a result.

f. If the match day doctor has primary responsibility for undertaking the off-field screen and, upon conclusion of an HIA, he/she assesses that the player may return to play, it should be considered if the process should be amended to include that the player is not to be permitted to return to play unless the team doctor of that player has also reviewed the video footage (as referred to in point a. above) and, based on the video footage review (as opposed to a direct clinical assessment of the player), is satisfied that there is no obvious reason why the player should not return to play.

g. Appropriate minimum standards for the size of screen(s) and number of screen(s) available pitch-side for video footage review should be set by the relevant competition or tournament organiser.

h. Where reasonably possible (based on the available infrastructure at the stadium in question), the medical/video room should not be accessed by anyone other than the medical team and any players who are undergoing an HIA or other medical treatment, except (where there is good reason for such access) with the express permission of a member of the medical team.

i. The calibration/training video interpretation session on the five-step video review process for a potential HIA incident, including case studies from unions/competitions for interpretation and discussion at the session, should be reinstated and undertaken on an annual basis.