A Blue Card for Rugby


“All Blacks Haka” by Sonya & Jason Hills from London, UK

Rugby is wildly popular in New Zealand, and that’s no news for anyone who follows sports.

It may be less appreciated how much medical research on rugby and other sports comes from the Land of the Long White Cloud.  The University of Otago in Dunedin, for instance,  conducts a good amount of research on sports medicine in general, and on concussions in particular.  Recently, the University hosted a conference entitled ‘Understanding sports concussion:  facts and fallacies.’

Our intrepid reporter from New Zealand, Dr. Hamish Osborne, is on the editorial board of CJSM and has previously done some guest blog posts when he was attending the annual ACSP conference in Australia.  He was one of the faculty at the Otago lecture and I asked him to share with us any of the important topics addressed .  What follows is the current breaking news on how NZ Rugby is managing concussions.  Thanks Hamish!


New Zealand Rugby Rolls out Concussion Blue Card (Dr. Hamish Osborne)

New Zealand rugby has approved the rollout of the “Blue Card” system to all levels of rugby in New Zealand with the exclusion of the professional programs.  Soccer has the yellow and red cards systems for misdemeanors. Rugby has a similar system for misdemeanors. The Blue Card will be shown to anybody who leaves the field or is required to leave the field for a suspected concussion.

Under the present rules of the game “an athlete with any symptoms following a head injury must be removed from playing or training. It is then recommended that a player is referred to a medical professional for diagnosis and guidance, even if the symptoms appear to have gone They must not return to activity until all symptoms have cleared.”The International Rugby Board (now known as ‘World Rugby’) regulation 10 New Zealand Domestic Law Safety Variation says that any player in New Zealand who has been concussed or suspected of being been concussed must follow IRB regulation 10 and the IRB concussion guidelines and clearance to return to play by a medical practitioner must always be obtained.2

Until now there has no been no paper trail to confirm that these rules are abided by. Last season the Blue Card system was successfully trialed3 in one of the New Zealand provinces and has now been approved for national roll out. This really doesn’t change any of the rules; rather the new system formalizes the process. When the referee displays the Blue Card the player will be asked to leave the field of play. The match referee and team coach will complete a report to the National Sporting Organisation. A letter from the National Sporting Organisation will be delivered to the club and the player confirming that the player has been stood down from playing rugby because of concussion.

Is recommended that they seek medical attention within 24 hours of the concussion episode. They must obtain medical clearance to resume contact training. They must produce a medical certificate to the National Sporting Organisation to resume playing. The National Sporting Organisation will require this to be received by 24-hours prior to the scheduled return to play. There will not be any grounds for the team to challenge the issuing of the Blue Card except for misidentification of a player.

The team will be sanctioned should they play a player who has not presented medical certification confirming to return to play.

This paperwork process required to leave and return to competitive rugby formalizes the guidelines outlined by the Zurich Consensus Statement4. While the consensus statement has previously resulted in guidelines by National Sporting Organisations and insurance systems such as the New Zealand no-fault Accident Compensation Corporation5, New Zealand rugby will soon require a paper trail with confirmation from a medical practitioner confirming that concussion symptoms have resolved and that neurological testing is normal and that the player is not complaining clinically of ongoing concussion symptoms.  It would be expected as a result of these changes by New Zealand’s national game (and current World Cup holders) that other sports follow suit.


Rugby has, arguably, led the charge in managing concussion in its sport.  World Rugby’s  ‘Recognise and Remove’ initiative is to be applauded.  And in South Africa–those great rivals of NZ rugby–the BokSmart program offers wonderful resources as well.

Thanks again,  Hamish!



  1. Rugby NZ. NZR Concussion Protocol 2014 Flyer. http://wwwnzruconz/social_responsibility/rugby_wellbeing – Concussion 2014.
  2. Rugby NZ. Small Black Rules 2012. http://wwwwcjrorgnz/Downloads/Small Black Rules 2012pdf 2012.
  3. Rugby NZ. Concussion Card Trial Review. http://wwwrefereesconz/wp-content/uploads/2014/10/Concussion-Card-Trial-Review-2014pdf 2014.
  4. McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport–the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med 2013;23:89-117.
  5. Corporation AC. ACC7018 Sport Concussion Guidelines. http://wwwaccconz/search-results/indexhtm?ssUserText=concussion 2015.

About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Deputy Editor for the Clinical Journal of Sport Medicine.

4 Responses to A Blue Card for Rugby

  1. rugbyscience says:

    Reblogged this on Rugby Science and commented:
    This will be interesting to follow…

  2. ian Turner says:

    In grass roots rugby, who will be authorised to sign a medical certificate for the return to contact training and play? will this be a requirement of the players own GP?

  3. Abi Page says:

    Reblogged this on abieleanor's Blog and commented:
    I looked into rugby players and body comp for my dissertation at under-grad and in the process of researching came across some scary research regarding concussion, I’m really glad to see steps like this being introduced to protect rugby players against concussion and the side effects.

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