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‘Brain Bin’ with Temporary Replacement – Clarification from IRB

irb-top-bannerThere seems to be some confusion about the use of a “Brain Bin” and I would like to help clear some of it up. The ‘Brain Bin’ is not endorsed by USA Rugby, and it is not recommended by the IRB for anything but Elite international play. It should not be used except at this level of play.

Reference: http://usarugby.org/concussions/irb


– The article viewable at the above website brings us all up to date. The article clearly states this procedure is in a TRIAL state for only INTERNATIONAL ELITE rugby. It is not policy. USA Rugby has not made any official endorsement of this trial and has not made any change in our policy.
– When used in international elite play, the only way a player can be returned to play is for a MEDICAL DOCTOR to administer a pitch side assessment that includes the Maddocks Questions (cognition), a balance assessment and a ‘symptoms and signs’ assessment. If the PHYSICIAN clears the player, the PHYSICIAN takes full responsibility for the medically cleared to play decision. The MW situation is much different: it is rare for us to have a ‘team physician’ on the sideline, and if they are present, most do not know what tests to administer nor realize the risk they are taking with ‘clearing’ an athlete. To repeat policy: Only a physician can clear an athlete to return to play. For a referee to take on this responsibility on the advice of other than a physician puts that referee in a huge risk zone.

IRB Regulation 10 continues to apply:
Regulation 10 features a two-pronged approach to protect players at both the elite and community levels. Where concussion is diagnosed, a player must be removed from the field of play and not return to play or train on the same day and must be guided through a dedicated return to play protocol.

All players with suspected concussion where there is no appropriately qualified person is present to diagnose concussion must be removed from the field of play and not return to play or train on the same day and should be reviewed by an appropriately qualified person and then should complete the graduated return to play protocol described in the IRB Concussion Guidelines

Summary. We all want fewer injuries, especially head injuries. Removing a player from play if there is any doubt is the safest way to realize that. A gradual return to play based on qualified medical assessments is the current policy and any decision to return to play is out of the referee’s hands. Until we get clearance from the IRB and USA Rugby on a policy change, we should not allow any time for a pitch side assessment for a questionable concussion in non-international elite games. That player comes off; period.

Please forward this to fellow referees and coaches.

Harry Laws, MD
IRB Medical Educator