Rugby's Head Injury Assessment: Twelve Minutes, and Three Tests Over Two Days

Absolute time, not playing time

The HIA window is twelve minutes, and the qualifier is the important part: absolute time, beginning when the player leaves the field.

Football has adopted only half of the same solution — see football’s concussion substitutes.

Rugby stops its clock constantly — for scrums, injuries, television replays. If the HIA ran on playing time, twelve minutes could stretch to twenty-five of real time, and the sport would face an obvious temptation: a team a player short has an incentive for the assessment to take as long as possible.

Using absolute time removes that. The clock runs regardless of what the match is doing, so nobody gains from delay.

The temporary substitution is the mechanism

The protocol only works because rugby allows a temporary replacement during the assessment.

Without it, a doctor deciding whether to remove a player for evaluation would also be deciding to play a man short for the duration — a cost that would inevitably influence the decision, however conscientious the doctor.

The temporary substitution makes the assessment free to the team. That is a deliberate piece of design: remove the competitive penalty and you remove the pressure not to check.

Compare cycling’s 3km rule, which removes the competitive reason to take risks in a bunch sprint. Both rules work by deleting an incentive rather than by asking people to ignore one.

Failing it ends the match

If the player fails HIA1, the replacement becomes permanent and they take no further part.

There is no appeal, no second look, and no discretion for the coach. The assessment is a gate, not an opinion to be weighed against the state of the game.

That absoluteness matters more than the test’s sensitivity. A protocol with an override would be overridden.

It continues after the match

Concussion does not resolve on a match schedule, and the protocol acknowledges that.

HIA2 is conducted within three hours of the match. HIA3 follows between 36 and 48 hours after the injury.

So a player who passed the pitchside assessment is still assessed twice more. The twelve-minute test is explicitly treated as insufficient on its own — it is a screen for removing players immediately, not a clearance.

That is an unusually honest design. Most sports build a test and then rely on it; rugby built one and then wrote down that it cannot be trusted alone.

Graduated return, and a doctor who is not yours

Return to play is graduated, each stage lasting a minimum of 24 hours from the time of injury. Stages progress only if the player remains symptom-free.

And crucially, return decisions must be discussed with the Independent Match Day Doctor — someone not employed by the team.

That independence is the structural safeguard. A team doctor faces pressures a wholly independent one does not, however professional they are, and the protocol addresses this by requiring a second party rather than by trusting the first.

It is the same reasoning as race walking requiring three different judges to card an athlete and taekwondo requiring two of three judges to confirm a turn. Where a judgement carries pressure, sport makes it plural.

More on player welfare and governance is in how sport is run.