CMRG makes George North recommendations

The Concussion Management Review Group (CMRG) has concluded its review into a head injury incident involving Northampton Saints’ George North.

North was injured in the 11th minute of the Aviva Premiership Rugby match between Leicester Tigers and Northampton Saints on Saturday 3rd December.

The CMRG’s view is that there was sufficient evidence to conclude not only from the video evidence but also George North’s history and risk stratification that he should not have returned to the field of play.

Northampton Saints medical team has accepted that North may have lost consciousness and therefore should not have returned to play.

The CMRG considered the welfare of North was always at the centre of Northampton’s actions, and does not consider that the medical team (or the club) failed to complete the HIA protocol nor intentionally ignored the player’s best interests.

In addition and although not a determining factor, the CMRG is aware that the player appears to have had no residual effects.

For the above reasons the CMRG will not be imposing any sanction against the club or any of its individuals as a result of this incident. 

Instead, the Group has made nine clear recommendations in its report, which is published in full here.

In making its recommendations the CMRG is aware that this is the first incident of its kind to be reported in the Aviva Premiership following the introduction of a new concussion management system this season.

'Thorough and rigorous review'

“This is the first review into a head injury incident we have seen following the introduction of the concussion management system this season in the Premiership," said Julian Morris, Independent Chairman of the Concussion Management Review Group.

"We wanted the review, which was primarily around the medical management and treatment of George North, to be thorough and rigorous to ensure that we fully understood the circumstances of this case.

“While the challenges in the consistent delivery of best practice in the on-field management of head injuries in professional sport are recognised, player welfare is paramount to the game of rugby.

“We believe that the clear recommendations put forward by this group will minimise the risk of incidents of this nature happening in the future, as well as providing ways to improve the systems and processes in place to protect the welfare of players.

“The Group notes the MyPlayXplay system, involving the use of PVRs, medical teams and modern technology is a valued addition to the concussion management of players during match day. All parties, from players to governing bodies, should continue to support its functioning and development as its aim is, player welfare.”

The CMGP was independently chaired by Dr Julian Morris and included RFU Director of Professional Rugby, Nigel Melville and Premiership Rugby’s Rugby Director Phil Winstanley.


The Concussion Management Review Group recommendations are:

  1.  George North follows the graduated return to play protocol to optimise his recovery.
  2. The pitch side video reviewer (PVR) should remain in their allocated seat;
  3. Wireless connectivity should be checked for those allocated seats;
  4. Consideration be given to the introduction of a ‘support PVR’ to ensure that the video feeds continue to be monitored and additional clips can be downloaded if the PVR is discussing matters with the medical team (e.g. over radio link) or the development of automatically downloaded clips of incidents;
  5. That at the forthcoming mid-season Premiership Club medical meetings, planned for February 2017, the reviewing and training team emphasise and re-enforce the necessity to review footage before starting the HIA assessment and the criteria in respect of permanent removal from the field of play;
  6. The team doctor must review the video footages for permanent removal criteria both before commencing and after completing the HIA assessment in the medical room (or designated HIA area);
  7. Irrespective of whether part of the HIA assessment has or has not been carried out on the pitch, the entire HIA must be completed again once in the medical room by the examining doctor;
  8. The maximum permitted time for an HIA process, in the Premiership in the 2016-17 season is 13 minutes. Given the importance of the HIA assessment in respect of player welfare the HIA should not be unduly shortened without clear reason;
  9. Hard wire live feeds should be reinstated to the medical/HIA rooms with recording and play back facility which would add resilience to the wireless MyPlayXplay system both in terms of functionality and also definition if, for any reason, there is an issue with the main (Wi-Fi) system.