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YEAR IN REVIEW 2015 WORLD RUGBY 85HIA PRINCIPLESAny clear or suspected signs or symptoms of concussion MUST result in immediate and permanent player removalIf the signs or symptoms of concussion are unclear then a player can be removed for an HIA, which is a 10-minute off-field assessment – the HIA does not diagnose concussion; it identifies a suspected concussionIf a player is suspected of concussion following a pitch-side assessment supported by the HIA they are removed permanently from the matchAny player who undertakes an HIA (irrespective of the result) must undertake a further clinical assessment supported by the SCAT 3 immediate-ly after the match and again at 36-48 hours – it is during this period that the diagnosis occursAny player with a concussion must undertake a supervised graduated return to play protocol to manage safe return to competition KEY HIA FINDINGSLess than 12 per cent of players with a confirmed concussion remained on the field following their injury. Prior to the HIA, 56 per cent of concussed players returned to play following their injuryThe HIA process (temporary substitution, pitch-side tool plus follow up process) is playing a predominant role in changing culture in the sport towards concussion and is a major factor behind increased reported concussion rates in the elite gameThese Player Welfare Standards were a significant step forward for medicine at Rugby World Cup 2015 and are being adopted by all major World Rugby events and other major rugby events worldwide.HIA adopted into Law In August, World Rugby adopted temporary substitution for head injuries at the elite level into Law 3.10, further underscoring the governing body’s commitment to evidence-based research driving player welfare enhancements for players at all levels of the sport. World Rugby’s number one priority is player welfare and any clear signs or symptoms of concussion or suspected concussion – at all levels of the game – must result in the immediate and permanent removal of players from the playing or training environment as highlighted within the organisation’s #RecogniseAndRemove education campaign. At the elite level of the game an HIA (Head Injury Assessment) is used only when it is unclear if the player has a suspected concussion. The temporary substitution time period is proving successful in assisting medical staff to assess and make an informed decision regarding the removal of players when suspected concussion is not clear. The entire process includes strict side-line assessment based on the best available evidence and rigid follow-up procedures. PERCENTAGE OF PLAYERS RETURNING TO THE FIELD AND LATER DETERMINED TO BE CONCUSSED12%0%56%Before HIAAfter HIARWC 2015 PLAYER WELFARE | RUGBY BUILDS CHARACTER