Blue card: referees’ perspectives of a rugby union concussion recognition and management programme

Objective The Northland (New Zealand) Rugby Union developed an innovative concussion recognition and management programme (Blue Card) as part of its player welfare responsibilities for club (community) players. The referee is empowered to issue a Blue Card (BC) to any player they suspect of being concussed, thus removing them from the game. The purpose of this descriptive study was to investigate the referees’ perspectives on having this added responsibility, and whether this detracted from their enjoyment of refereeing. Design Cross-sectional survey. Setting Northland Rugby Union headquarters Participants Twenty-one amateur male referees who officiated in club-level rugby matches covered by the Northland Rugby Union Blue (NRUBC) programme during the 2014 season volunteered to participate. Outcome measures Custom-designed survey instrument using both open and closed questions. Main results The referees had between 2 and 35 (mean=12.1) seasons of refereeing experience with 81% (17/21) claiming a good or average knowledge of concussion. The majority (20/21) reported that they had sufficient training for their expanded role. Two thirds (14/21) of the respondents did not think that the additional responsibility impacted on their refereeing satisfaction. Over the season nine (9) BCs were issued by 7 of the participating referees, with 5 indicating that they were “very confident” in their decision. Conclusions The referees indicated that they were well prepared to handle the added responsibility as on-field concussion gatekeepers, and this role did not detract from their enjoyment of refereeing the game. Additional insight into how the NRUBC programme is received by players, teammates and their families, needs investigation. Competing interests S.J Sullivan, A Gray and P Handcock: None. K Collins was involved in the development of the Northland Blue Card Programme but was not involved in the data analysis. None.