A 15-year-old school student suffered serious neck injuries while participating in a rugby game as part of Saturday sport at a Queensland school. The school is liaising with Rugby Australia, the Queensland Rugby Union and the Great Public School Association of Queensland (GPS) to review medical and match day procedures, and support initiatives to review the safety of rugby players.

The Injury and the Response

The student was reportedly playing on the wing during the 15Bs match, which was being played on school grounds. While diving at speed to score a try, he was tackled by two other players and injured his neck. The student was treated by a doctor and nurse on the field, before paramedics arrived and took him to hospital.

This was the fourth injury requiring hospitalisation in the last month as part of a GPS rugby union competition. While all the cases were different, the cluster of injuries is considered to be of particular concern to Rugby Australia. Rugby Australia CEO Raelene Castle has stated that the organisation will undertake a review of the sport regarding how the health and safety of players is ensured. Any improvement outcomes established during the inquiry into the incidents will be rolled out nationally.

Many stakeholders have called for changes to school competition rules in response to this cluster of incidents, including former Wallaby and Spinal Life Australia ambassador Tim Horan. Horan expressed support for a certificate system for school-aged players who play in front row positions. Under Horan’s proposed system, Certificate 1 players could only pack a scrum during training, with a Certificate 2 (which teaches how to pack a scrum) required for participation in competitive games.

However Dr Rafe, from Sports Medicine Australia, has stated that an additional credentialing system for players would not be of assistance. Ball-handling sports were considered to be relatively safe, with changes to scrum rules having assisted in the reduction of injury rates; catastrophic injuries such as those experienced in the past month were highly unusual.

Rugby Injury Statistics

According to the Australian Rugby Union's most recent annual report, 271,922 people participated in rugby in 2017 (playing five or more structured sessions), with a further 205,109 experiencing rugby through a school, club, camp or event environment. The frequency of rugby injuries has been the subject of extensive study, with three research projects conducted at the University of New South Wales in order to identify injury patterns and understand the factors contributing to particular kinds of injuries. Rugby Australia reported the key findings as follows:

• tackles accounted for the largest proportion of injury (46.6%) across all levels of play, with being tackled the most common cause of injury
• overexertion is the leading cause of ‘noncontact’ injury, such as hamstring strains
• cases of spinal cord injury are rare
• the shoulder, lower leg and head/neck/face are the most commonly injured body regions
• the incidence of injury increases with age and level of play
• in junior and youth rugby union, most injuries were caused by impact (falling, tackling or during a scrum) and were of minor severity or constitute a ‘typical childhood injury’ (this term was not defined).

Sports Medicine Australia states that rugby injuries are decreasing on average albeit based on data from 2000 to 2006. This data shows that average injuries fell from 36.2 per 1000 hours in 2000 to 29 in 2006. However, information is limited regarding current injury rates in Australia. A recent study of injuries in school-level rugby union in Queensland found the overall injury rate to be lower on average, with 23.7 per 1000 hours played during the 2017 season.

It is important to consider the rugby injury statistics in context to understand how the likelihood and consequence of injury relates to other activity areas, such as swimming and motor sports. Dr Rafe reflected that equestrian activities were far and above the most dangerous when it came to catastrophic spinal injuries based on participation rates; recent research by the Australian Institute of Health and Welfare partially corroborates this statement. This research indicated that equestrian activities had the highest reliable participation-based rate of spinal injury for females, at 140 per 100,000 participants (with gymnastics and trampolining the second highest). However, for males, the highest participation-based rate was for wheeled motor sports, at 258 cases per 100,000 participants. Equestrian had the second highest rate, slightly higher than the rate for rugby.

Risk Management in the Sporting Context

From a risk management perspective, focus has historically been placed on contact sports such as rugby due to the heightened risk of concussion within the context of tackling. The risk of a poorly executed tackle is greater than many risks inherent in other sports, with a potential consequence being death or paralysis.

In managing the risk for all sports, schools and other organisations are required to identify the risks present in the activity, assess the likelihood and consequence of those risks occurring, then evaluate the risks to determine the controls that need to be in place. While rugby and equestrian activities have a greater likelihood of injury, there are various other factors which need to be considered in a risk assessment, including the activity level, the age, number and characteristics of students involved, and the conditions at the activity venue. If contractors or external providers are used, such as third party referees, coaches and umpires, this will affect the risk assessment for the activity.

Rugby is ultimately one of many activities that may be considered to have a heightened risk associated with them which can form part of a sporting curriculum for a school, including:

• contact sports with a heightened risk of collisions and concussions
• aquatic activities which involve swimming or proximity to water with a heightened risk of drowning and environmental injuries
• strenuous physical activities, presenting a heightened risk of sprains, pulled muscles and other overuse injuries
• adventure or outdoor education activities, which have greater environmental risks.

How Should Schools Respond to these Recent Rugby Injuries?

As has been demonstrated by these recent incidents, it is a difficult time for a school community when a student suffers a serious injury. While the rugby injury rate in schools is far lower than at the elite level, injuries can and do occur in any sport, whether they are contact or non-contact. With students involved in sporting activities every single week, it is inevitable that students will be injured, sometimes quite seriously – refer to our previous School Governance articles here and here. As a result, balancing duty of care obligations while providing the best educational experience possible for students is a difficult exercise for schools and their employees and volunteers.

A school seeking to minimise the risk and impact of a sporting injury should develop activity risk management procedures for assessing sporting risks and risk controls to prevent and treat injuries. Common controls include:

• activity selection procedures – only allow students to participate in sports that are suitable for their age and ability
• student briefings – ensure students are aware of the risks prior to participation
• implementing supervision strategies and codes of conduct
• warm-up and cool-down regimes for training and competition
• ensuring there are sufficient staff in attendance with first aid and CPR training
• safety inspections of sports fields, activity equipment and protective gear
• conducting due diligence on venues to assess the suitability of the location, and on coaches, referees and umpires to confirm their qualifications, skills and experience.

Responding to and treating student injury clearly depends on the seriousness of the incident. Response procedures should include:

• immediate treatment or medical referral, including conducting a concussion assessment for head injuries
• maintaining supervision of the injured student and other participants
• contacting parents/carers, the school, or medical centres for injury treatment
• preparing accurate incident reports and records.

By having an effective sports safety framework in place, a school can balance the risks presented by sporting activities such as rugby against the benefits to students’ education and development.