Managing rugby injuries

Posted on 3 July 2016

Emergency care on and off the rugby field is essential to the health and safety of players. Dr Jann Killops, sports doctor and manager of Mediclinic’s events department, gives an inside look at what’s involved.

Dr Killops works as the clinical lead on Mediclinic’s major sporting events. Mediclinic and the South African Rugby Union (SARU) have a very close, collaborative relationship, and together with their subsidiary ER24, Mediclinic’s medical team regularly assists at rugby matches.

‘Because we have organisational alignment, we give clinical guidance at times and at others we actively take a field hospital to the sporting event,’ Dr Killops explains. ‘Our flagship event was the HSBC Sevens series at the end of 2015. There was field-side medical care and we had an on-site field hospital for the players. We anticipated the kind of injuries we’d see and planned for the appropriate doctors and specialists we would refer patients to. We also had sports physicians and emergency physicians for intermediary care at the event. Players were therefore managed optimally from field-side to discharge.’

Working together
Our international and regional rugby teams generally have their own physiotherapists and sometimes their own team doctors, says Dr Killops. ‘We work very closely with their existing medical infrastructure to ensure we’re informed about existing injuries players might have so we can anticipate issues should they arise. Often at the event the team’s physio will be at the patient’s side and can provide a 360-degree view of the player – who they are, how they train, how they performed on the day, what injuries they’re carrying – so we can really give expert care.’

Specialised training

The Mediclinic medical team undergoes specialised medical training to work with rugby players. ‘There are specific Rugby Union protocols that we have to adhere to,’ Dr Killops explains, ‘so we make sure all of our staff are current and competent – from the paramedics who respond on the field to the doctors and even the specialist doctors. We make sure that they’re aware of the guidelines. Generally, in our department, staff are qualified either in sports medicine or emergency medicine.’

Chain of care
During a rugby match there is a chain of specialised medical support. Dr Killops talks us through it:
– On the field, ER24 or relevant paramedics provide expert care in terms of the immediate management of sporting injuries. They address demobilisation, immediate management of bleeding, and so on, in accordance with SARU and world rugby protocols.
– From there, patients go to the on-site medical facility, staffed by emergency and sports physicians. These doctors decide whether they can treat the patient immediately and put him back on the field, otherwise they refer patients appropriately and according to SARU’s medical governance. For example, if a player has a head injury he can’t go back onto the field – the player’s safety and long-term future is paramount.
– The on-site team liaises extensively with the Mediclinic specialist network, so if there’s something that puts the patient at risk and that can’t be fully managed on-site, they’ll go to hospital. This is usually if patients need an X-ray, if they have a big laceration, if there’s concern about a head injury, if they need a scan, have a bad dislocation, and so on. Whenever a specialist is needed, the player is sent to hospital.

Back to the field
For players to be cleared to play after recovering from a head injury, concussion or spinal cord injury, SCAT3, a standardised tool for evaluating injured athletes, is applied.

‘This a complex and specific physical and mental assessment tool that looks at the ability to balance, motor skills, reasoning and memory,’ Dr Killops explains. ‘The return to play is graded. Players first need complete rest and recovery. When they’re feeling better and have passed the SCAT3, they can start doing low-intensity exercise, increasing exponentially until they’re ready to return to full contact play, which can take up to four weeks. We do the initial evaluation and give guidance to the team’s medical staff.’

Published in Prime

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