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Tournament medical facilities
Medical arrangements

1. Match Venue Medical Facilities

The following medical facilities will be available at the match venue on match days:

1.1 Players and Match Officials

An appropriate room or area for the use of players (from both participating teams) and
match officials (including referees and assistant referees) who are injured or ill. Such a facility will include:

  1. Resuscitation equipment, IV fluid and essential drugs;
  2. Oxygen and suction;
  3. Stiff neck collars;
  4. Standard stretcher, Jordan Frame, Spinal Board or Scoop stretcher;
  5. Readily available telephone with permanent listing of ambulance, rescue helicopter (where available) and local hospital;
  6. Adequate lighting including wall light for suturing;
  7. Sink and hand washing facilities;
  8. Facility for disposal of used needles, syringes and contaminated dressings; and
  9. Facility for sterilizing instruments.

Access to all such medical facilities will be such that there is unobstructed access for a stretcher from the field of play and ready access for an ambulance.

1.2 Dressing Rooms

A dressing room for each team participating in the match which will include reasonable access to:

  1. A physiotherapist table (upon request – see section 7.1.3)
  2. one ice bin; and
  3. Adequate disposal facilities for the disposal of used needles, syringes and contaminated dressings.

1.3 Physiotherapist table and additional ice bins

Participating teams who require a physiotherapist table and additional ice bins must notify the IRB by April 23, 2010. Teams that do not send a request will not be provided with tables and additional bins.

2. Medical History


Ensure that its Players are suitably fit to participate in the Tournament and that its Players comply in all respects with the medical requirements set out in the Participation Agreement.


Provide written confirmation / certification (see Appendix 1 in Section 15) to the Tournament Director at the Team Managers’ Meeting on May 15, 2010, completed not more than 7 days before departure to the Tournament, from a duly-qualified medical practitioner appointed by the Participating Union to the effect that each Team Member is in all respects mentally, physically and dentally fit to participate in the Tournament for the duration of the Tournament Term (subject to illness contracted or injury sustained during the Tournament). Where applicable this confirmation shall include those Players under the age of 18 who are proposed by their Union to play in the front row in the Tournament.


For the avoidance of doubt, it is the sole responsibility of the Participating Union to ensure that all Team Members are mentally, dentally and physically fit to attend and to participate in the Tournament and that only Team Members that are mentally, dentally and physically fit shall participate in any Match in the Tournament.


Be required to report any injuries sustained during the Tournament to the Match doctor or Tournament Medical Officer and abide by the Tournament Injury Surveillance Study.


Provide medical case notes relating to previous injuries / surgery.

3. Medical Fees and Costs

Costs of medical attention at a Match Venue will be borne by the Tournament. Any and all medical costs incurred away from the playing enclosures, including on a Match day, will be borne by the Participating Union.

The cost of treatment for Illness contracted or Injury sustained (including without limitation any dental treatment) by a Team Member at any time during the Tournament Term shall be paid by the Participating Union. Arrangements for medical attention and treatment are to be made only through the Team Liaison Officer. The Team Liaison Officer shall, at the conclusion of the Team's stay in the country of the Host Union, provide the Host Union with details of the Medical treatment provided and costs incurred.

In addition to the costs described above the Participating Union shall be responsible for strappings, bandages, mouth guards and similar items.

4. Medical Insurance

Medical expenses insurance, including medical repatriation, shall be taken up by the Participating Union to a minimum level of Stg£15,000 plus repatriation costs (if applicable) for each Team Member.

A copy of such insurance policy shall be provided to the Tournament Director by no later than

April 19, 2010.

The Participating Union is responsible for ensuring that its medical staff are properly qualified and insured to give medical treatment in the host country.

5. Team Doctor

All Team doctors should:

  1. be a Fully-registered medical practitioner.
  2. have completed General Professional Training (GPT) – with diploma e.g. R.C.G.P., M.R.C.P.I., F.R.C.S. etc.
  3. possess a post-graduate diploma M.Sc., PhD or equivalent in sports and exercise medicine.
  4. have undertaken training and experience in sports medicine (Team doctor with certification in on-field emergency-care).
  5. have undertaken Continuing Medical Education (C.M.E.) in sport and exercise medicine and emergency-care.

Team doctors and/or physiotherapists must be aware of any Players who require specialist medical care, e.g. diabetes, and be able to inform Match doctors as necessary.

Team doctors must ensure that Players are aware of the high risk associated with the use of recreational drugs such as cocaine, ecstasy and caffeine.

Players must be made aware of their duty of care to other Players in relation to skin conditions, such as Herpes Gladiatorum or scrum pox. This is a highly infective condition. A Player with this condition needs medical advice and

must not play

while the rash is present, as he is putting others at risk.

All participating Teams should bring with them a supply of various sizes of (or adjustable) neck collars for use if a Player is injured during training. Any Team requiring other specialized equipment must inform the Tournament Director well in advance.

Cardiac disorders causing sudden death in sport are numerous but one group, cardiomyopathy can be detected by ECG and echocardiography. The incidence of cardiomyopathy is 1 in 500. These investigations are justified. See Section 7.8 below.

All Players with concussion should be treated as per the adult protocol, which is justified in light of current published information. In accordance with World Rugby Regulation 10.1.2, all Players in this competition diagnosed with concussion will have to be examined by a neurological specialist before being allowed back to train or play.

6. Role of Medical Team in Case of Injury

The medical team will only attend to a Player who has been referred by the referee or the doctor of either Team. The Player is then under the responsibility of the Match doctor. This responsibility ends when the Match doctor considers that the Player is in a fit state to rejoin his Team which he may do either on the pitch or in the dressing rooms, but only once he has informed the Team doctor to which he belongs.

  1. All Players with serious injury, head, neck, back or lower limb injuries should be taken off the field by stretcher. No Player should hobble off the field with the help of a physiotherapist but should be taken off on a stretcher quickly and efficiently by agreed protocols.
  2. Match doctor will examine the Player off the pitch and will then decide to manage him in the medical room or transfer him to hospital.
  3. If transfer to hospital is decided then the Match doctor will send a medical person if necessary and certainly a member of the Player’s Team with the Player to hospital.
  4. Match doctor stays in contact with the ambulance and hospital to update the Player’s Team doctor and family.

7. Medical Protocol - Match Day Signals

The following hand signals are to be used across the whole Tournament by all personnel involved with the management of injuries to all competing Players.

• Call for the RESUSCITATION TEAM or for assistance with any suspected


• Call for assistance with

AIRWAY complications:

• Signal for

BLOOD injury

or management:

• Call for the


: - In the event of fractures, dislocations and severe soft tissue injuries (move hands up and down by your side)

8. Cardiac Questionnaire

Because of increasing awareness of sudden cardiac death in the young and especially in sport, worldwide research has been carried out in to the causes and management of these conditions (cardiomyopathies and channelopathies). This research suggests that significant cardiac abnormalities occur in 1 in 500 people and sudden cardiac death, in elite performance athletes has been reported.

The following procedures shall be implemented for the Tournament. All Participating Unions are required to comply.


The World Rugby cardiac questionnaire (this can be found in the downloadable PDF version of this document, accessible through the link at the top of the page) must be completed for every Player participating in the Tournament.


A physical examination of each Player for this purpose prior to the Tournament is also mandatory.


An electrocardiogram (ECG) is recommended.


If there is a positive response to symptoms or family history or abnormality on the ECG then an echocardiograph should be performed. The echocardiograph (ECHO) should be carried out and report on by a consultant cardiologist.

The questionnaire incorporates a disclaimer the components of which are considered to be of assistance in identifying and communicating issues relating to the completion of the questionnaire. It is a matter for your Participating Union to determine if you want to elaborate further or modify the disclaimer.

Each Participating Union is personally responsible for ensuring that the terms of this letter are complied with. Furthermore, and for the avoidance of doubt, Participating Unions are also reminded that it remains the sole responsibility of each Participating Union to ensure that all Team Members (excluding Team Officials) are medically, dentally and physically fit to attend and to participate in the Tournament and that only Team Members that are medically, dentally and physically fit shall participate in any Match in the Tournament. Nothing herein changes the medical responsibility requirements of each Participating Union for its Players.

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