Six Nations concussion rules explained: What are HIA and GRTP?

To help protect player health and welfare, law changes and medical protocols have been put in place by World Rugby to spot and treat injuries more efficiently, lengthen recovery time and also increase disciplinary sanctions for players who undertake tackles which are deemed dangerous.

RadioTimes.com has rounded up all the key information you need to know about the Head Injury Assessment (HIA) and Return to Play protocols.

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Concussion and the Six Nations

Tackles and collisions in the sport can result in players becoming injured and concussed through direct force to the head, or through a blow to a part of the body which causes rapid movement of both the head and brain, for example whiplash.

Due to the severity of head injuries, match officials are now taking a zero tolerance approach to acts of foul play such as head on head collisions, high tackles, and dangerous clean-outs – in both reckless and accidental situations.

Following Tomas Francis being deemed fit to continue play in Wales’s defeat to England in the 2022 Six Nations – after the prop was clearly staggering around the field following a clash with team-mate Owen Watkin – head injury assessments will no doubt be paramount for officials in this year's competition.

What is the Head Injury Assessment (HIA) protocol?

To help protect player welfare and assist with the identification and diagnosis of head injuries with the potential of concussion, World Rugby implemented the three-stage Head Injury Assessment (HIA) protocol in 2015, following a successful global trial.

Firstly, when a player has suffered a head injury with any suspected signs or potential for concussion, players will be temporarily substituted from the field (cannot return before 12 minutes) and sent for a HIA.

This consists of a series of checks including balance evaluation, signs/symptoms, and memory assessment. If a player fails this off-field assessment, they are permanently removed from play.

In cases where players display obvious on-pitch signs of concussion, they are immediately and permanently removed.

Post-game, players who undergo HIA are required to complete an early medical evaluation within three hours to assess clinical progress using a sport concussion assessment tool (SCAT5). This helps assist with early diagnosis of concussion.

Players are assessed again following 36-48 hours of post-head impact, to determine progress and help assist in late diagnosis of concussion, once again using a SCAT5 and the addition of a computer neuro-cognitive tool.

World Rugby’s Graduated Return to Play (GRTP) Protocol explained

Last year, World Rugby announced fresh Graduated Return to Play (GRTP) rules that have been implemented since July 2022 to ensure players are safely able to play following an injury.

The organisation has implemented an individualised approach to concussion, acknowledging some players with a concussion history and those who report higher severity scores during an assessment 36 hours after the injury may be at risk of a prolonged recovery.

The majority of players with a concussion history or particularly severe symptoms are likely to be ruled out of playing their next game to allow more time to fully recover.

Players must sit out of action for a minimum of seven days before being allowed to play again, though players in the higher risk category are ruled out for a minimum of 12 days – with scope for an even longer absence.

Regardless of severity, all players will see an independent concussion consultant before being cleared to return.

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