What is HIA? Rugby’s Head Injury Assessment Explained

We explain the series of checks used in professional and Test rugby to determine whether or not a player is suffering from concussion – the Head Injury Assessment process

In rugby games you may have noticed that players who have had a blow to the head will be sent from the field for what is known as a Head Injury Assessment, or HIA.

So what is HIA? This is a series of checks used in elite rugby (at both professional and Test level) to determine whether or not an athlete is suffering from concussion and may or may not return to the field of play.

Dazed: A Uruguayan player receives treatment at the World Cup (Getty Images)

So how does the HIA system work? Here are the key points:

When there is a suspected incident of head impact by a player or players, this should be identified by match officials on the field, team doctors or independent match-day doctors who have access to video replays. If the independent match-day doctor decides an incident may have occurred, the player(s) involved must be removed, either permanently or for further assessment.
Players displaying obvious on-pitch signs of concussion must be immediately and permanently removed from play, without further assessment.
When not showing clear on-pitch symptoms or signs, players must undergo an off-field assessment consisting of a clinical evaluation by an attending doctor (the team doctor does this or they can delegate to the match-day doctor) who is aided by screening tools and video reviews. Players cannot return before ten minutes for assessment has elapsed. Players taken off for HIA can be replaced, and any replacement can take a kick.
After the match every player entered into the HIA protocol must undergo another evaluation within three hours. This is done using a check of symptoms, memory assessment and balance evaluation – compared with previous player baselines.
At 36-48 hours post-head impact event, the player(s) will be assessed again, going through a symptoms check-list, studying a player’s balance and using a cognitive assessment tool like CogSport or Impact.
Each union and/or competition must appoint trained HIA review processor(s) to look over the process used in every head injury event.
There will be a post-game video review process. Depending on the findings, the reviewer may recommend further education and training for the club or team medical personnel or recommend that the process moves to HIA review.
The HIA review group will formally investigate the incident and make recommendations for: further education and training for the club or team medics; a request to World Rugby’s HIA working group to consider a change to the process, education and/or training; or a referral to the appropriate disciplinary group to consider disciplinary action in line with competition rules.