INTRODUCTION

As from September 1, 2015, the following terminology will be used by World Rugby when describing medical positions at World Rugby Tournaments. This terminology will be used for consistency in Host Union Agreements (HUA) and also Terms of Participation (ToP) documents which are the legal documents used by World Rugby to outline service expectations and responsibilities at Tournaments.

World Rugby recognises that differences in Tournament medical coverage exists and that financial and medical restrictions on Host Union will also influence services supplied during a Tournament but this terminology should be applicable to all World Rugby Tournaments. It is also acknowledged that one doctor may be responsible for more than one position outlined in this document.

The different medical terms include:

1. Tournament Medical Manager
2. Match Day Doctor
3. Immediate Care Lead
4. Tournament Team Doctor – specifically applies to SWS Tournaments
5. Immediate Care Team

Also outlined in this document are minimum medical standards that should be applied by Host Unions.

MEDICAL TEAM TERMINOLOGY

The following terminology should be adopted for consistency across all World Rugby and Elite Tournaments:

Tournament Medical Manager (TMM)

• This person is ultimately responsible for the planning, co-ordination and governance of medical services provided by tournament medical staff to players, officials and team management during the Tournament (both at the venue and at team hotels).
• The person appointed to this position must have a medical or healthcare professional qualification and should have experience working at an international Tournament or Competition.
• He/she may or may not personally deliver medical services in the other roles listed below (Match Day Doctor and / or Immediate Care Lead) unless appropriately qualified and World Rugby accredited.
• The name and contact details of the holder of this role must be made clear to participating teams in advance of the tournament.

Match Day Doctor (MDD)

• This person is responsible for decisions on Match Day regarding replacement for blood and head injury.
• This person must be a medical practitioner and have completed the World Rugby's on-line education modules - Concussion Management for Elite Level Match Day Medical Staff and Medical Protocols for Match Day Medical Staff. If this person is providing any on-field care or there is no Immediate Care Lead this person must also have completed the Level 2 ICIR accreditation (or an approved equivalence).
• Ideally in elite Tournaments this role should be separate from the Immediate Care Lead and where practical be independent of country and team.
• In Tournaments where the provision of medical staff is limited the Immediate Care Lead and the Match Day Doctor may be the same person. This role or combined role may also be held by the Tournament Medical Manager (TMM) if the TMM is appropriately qualified.
• This name and contact details of the holder of this role is typically made clear to participating teams before game day.

Immediate Care Lead

• This person is responsible for coordinating and providing on-field game day immediate medical care services and onward referral to secondary care if appropriate at the Tournament.
• The person(s) covering this position must be a medical practitioner and as a minimum have a Level 2 ICIR or equivalent accreditation.
• This role may be held by the Tournament Medical Manager if they are a medical practitioner.
• The name and contact details of the holder of this role is typically made clear to participating teams before game day.

World Rugby Tournament Team Doctor

• This person provides team doctor services during Sevens World Series Tournaments to all teams, away from the match/tournament. They can also provide off-field game day support if requested by the Team Physiotherapists.
• It is expected that The Tournament Team Doctor will liaise with the Immediate Care Lead regarding the appropriate follow up of injured/ill players once they depart the tournament medical facilities.
• The name and contact details of the holder of this role must be made clear to participating teams in advance of the tournament.

Immediate Care Team

• The TMM must provide a list (not specific names) of all other available medical and paramedical staff (including the pitch retrieval team) providing on and off-field medical services at the game/tournament.

MINIMUM GAME DAY MEDICAL COVERAGE

ADULT PROFESSIONAL RUGBY MATCHES

Ideally, as a minimum, a Health Care Professional with experience, skills in immediate pitch side care and skills in managing sports injuries should be present at all adult professional Rugby matches.

ELITE WORLD RUGBY TOURNAMENTS

The minimum game day medical coverage should be:

• Team Doctors or Tournament Team Doctor
• One other medical practitioner providing services as both Match Day Doctor and Immediate Care Lead.
• Ambulance stationed at the ground* for emergency transfer of injured players to designated hospitals or trauma centres. The ambulance must be capable of providing advanced life support services and spinal evacuation services. The location of this ambulance must be provided to each Team Doctor.

*It is recognised that the legislation in some host countries prohibits the availability of an ambulance at sporting stadia and in these circumstances emergency services capable of providing advanced life support services and spinal evacuation services must be available at the ground.

As a guide to minimum standards at elite World Rugby Tournaments, the following capabilities must be covered by attending staff at matches. These requirements may be provided by an attending ambulance or pitch side specialist coverage:

• Airways Management - ability to intubate + Oxygen & suction available
• Cardiac resuscitation - defibrillator + emergency drugs
• Spinal injury evacuation equipment and management (suitable for player weighing 150 kg)
• Volume replacement - IV fluids plus cannulas & giving sets
• Analgesic Control - narcotics including entonox or equivalent
• Limb stabilization splints - upper & lower limb splints
• Nebulizer + ventolin

Note: All equipment MUST be functional with disposable supplies within their use by dates.

MINIMUM NON-GAME DAY MEDICAL COVERAGE FOR ELITE WORLD RUGBY TOURNAMENTS

The Tournament Medical Manager (TMM) must provide to all teams prior to the Tournament, the name and contact details of the following:

• Doctor responsible for providing non-match day medical support including prescriptions, general medical consultation coordination and priority radiology access.
• Dentist
• Physio supply company (tapes, braces etc)
• Medical and surgical supply company
• Oxygen supply company
• Massage services
• Closest hospital to hotel and training grounds
• Closest swimming pool to hotel and training grounds

PAYMENT AND DOCUMENTATION

Insurance: All treatment provided away from the game will need to be paid for at the time of care. Players and Management will need to pay at the time of consultation and claim through their own insurance companies at a later date.

Passport Details: A list of passport names and numbers may be required by hospitals. It is recommended that managers have these available when accessing hospital and medical treatment.

EMERGENCY MEDICAL EQUIPMENT – STADIUM MEDICAL ROOM FOR ELITE WORLD RUGBY TOURNAMENTS

The following is a guide for elite Tournament and Competition matches

• Long (Spinal) Board or Split long board (EXL Scoop) with Head Immobiliser
• Cervical collar stiff - 1 medium, 1 large
• Oxygen - to include variable flow rate oxygen, bag valve mask, non re-breathing mask, and purpose made carrier
• Pocket mask with one way valve
• IVI Fluids - Normal Saline 1 litre - 2 bags / Crystalloid 1 litre + IVI Giving sets – 2
• IVI cannula 21 g x 5, 19 g x 5
• Crutches with handles
• Round ended scissors for removal of tape
• AED with manual override and monitor
• Disposable suture kits with equipment minimum 10
• Suture material - 3/0 and 5/0 - minimum 10 of each
• Xylocaine 2%
• Non sterile gloves - Large
• Splints (For immobilisation of the upper and lower limbs).
• Stethoscope and Sphygmomanometer
• Crutches with handles
• Entonox with patient self-administration system (if available within country)
• Pethidine injection (100 mg / ml)
• Morphine injections 15 mg / ml

FEATURES & FIXTURES OF MEDICAL ROOM - MINIMUM

• Stretcher access from field and to ambulance
• Power point
• Wall light or portable lamp
• Running water or full water container
• Soap or hand wash
• Towels x 6
• Examination beds x 2 - fixed or portable
• Chair x 1 (minimum) / Mirror - fixed or portable
• Emergency phone number - local hospital / ambulance service
• Blankets x 4
• Sharps bin
• Medical waste bin and bags (for blood stained items)

Non-Medical Equipment

• Bag of ICE (5 kg) in Esky per day
• Plastic bags for ICE

HOTEL MEDICAL SUPPLIES

It is recommended in Sevens World Series Tournaments that Host Unions provide the Tournament Team Doctor with the Stadium Emergency Medical Equipment kit for use in the Hotel during the week leading into a Match or Tournament. This equipment should be retrieved by the Match Day Medical Staff the night prior to the match or on the morning of the match. This equipment should supplement the medical equipment and supplies brought by visiting medical staff and would provide for most non-match medical emergencies.

This Stadium Emergency Medical Equipment kit is developed recognizing that most Team Doctors or Tournament Team Doctors have their own supplies that would include but not be limited to the following.

ELITE WORLD RUGBY TOURNAMENTS

RECOMMENDED MINIMUM RECOVERY STANDARDS – STADIUM

• Post-Match ice cold water therapy
• Post-Match nutrition
• Private post-match stretching area

RECOMMENDED MINIMUM RECOVERY STANDARDS – HOTEL

At least one of following recovery modalities must be available at the hotel and be capable of use by multiple teams

• Access to ice cold water therapy
• Access to massage
• Adequate gym facilities
• Swimming pool on premise or within walking distance – a list of local pools should be provided to the teams with these pools in either close proximity to the hotel or training fields
• Adequate nutrition

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