by Tom Billups, C.S.C.S.

Over the past four years in this column, we have discussed several changes within the game. Many of these changes originated from the 2004 International Rugby Board’s Conference on the Playing of the Game, which was held in Auckland, New Zealand. It was during this conference, which included all twenty head coaches from the 2003 Rugby World Cup, that attendees were challenged to formulate law changes in an attempt to increase the amount of “ball in play” time. Outside of the “ball in play” proposals that have already been put into law, there is one proposal change from that 2004 conference that might soon be implemented by the IRB. In this column offering, we will discuss the possible introduction of a “medical bin” and the positive effects it would have on the game.

Player welfare has been a major consideration since the beginning of the decade and has influenced not only how the game is currently governed, but also the number of matches top players participate in. Recent law changes have increased the number of substitutes, including the use of temporary blood replacement substitution, which has increased player safety considerably. The “blood bin” law requires that a player who has an open wound or is bleeding must temporarily be replaced, leaving the field to receive medical attention. The player in the “blood bin” has up to fifteen minutes to return to the field before the substitution becomes permanent. The proposal of expanding the existing blood bin to include all medical injuries would be good for the players. The need for a medical bin is highlighted by the disparity that currently exists between being allowed up to fifteen minutes to evaluate and repair a scalp laceration and only being allowed an “injury minute” on the field (unless you choose to play shorthanded) to diagnose more serious injuries such as whether or not a player has suffered a concussion. A concussion or other non-blood injuries deserve just as much medical attention as blood, they are just as serious if not more so, and likewise deserve the same assessment window.

The IRB is preparing to announce strict protocols around head injuries, including concussions, soon. It is possible that the international governing body may introduce a “medical bin” allowing the referee to send a player off, temporarily, for further medical evaluation.

This was an issue during the recent Six Nations Championship when an English player was clearly concussed but not removed by the team physiotherapist. In this match, the referee is heard via his microphone saying, “I want him off” but was powerless to do anything more than that. A “medical bin” would allow for either the team medical staff, or match referee, to remove a player from the field for further medical evaluation without being immediately ruled out for the remainder of the match. This potential law change would dramatically lessen the pressure on medical staff to make a rapid injury assessment and subsequent decision regarding whether it is safe for a player to carry on during an injury stoppage.

Detractors have concerns about a medical bin being abused as occasionally has happened with the blood bin. Nowhere was this abuse of the player welfare law more blatant than at my old club Harlequins in London, but I think lessons have been learned. All stakeholder, players and coaches alike, are responsible for upholding the integrity of the laws, including a possible medical bin. I think the creation of a ten-minute medical bin would allow for a team’s medical staff to make a better, more comprehensive evaluation regarding whether or not a player should be allowed to play on.

As with the current blood bin, I believe there must be a restrictive use of a medical bin, but as the saying goes, “better safe than sorry”. Specifically, employing a medical bin at the age grade and collegiate levels would allow a player who, initially really frightened that a significant injury incurred, would be allowed more time to be assessed and potentially right themselves without being permanently replaced.

Over the past decade, many law changes have been made to improve the quality of the game as a viewable product, and also make it safer for the athletes to play. I hope that the medical bin is considered as another step in this direction.
 

Tom Billups began his rugby career in 1984 and has spent time as a player in New Zealand (Bay of Plenty), the U.S. (The Old Blues), England (London Harlequins), and Wales (Pontypridd) for domestic teams as well as representing the U.S.A. at international tournaments with the Eagles. After hanging up his boots, Billups got into coaching leading the Eagles and now with University of California – Berkeley. Read the entire bio of Tom Billups as well as Billups first column My Rugby Path and then check out what Billups is saying about the game of rugby in The Billups Column on Rugby Rugby.