Medical Officer's Guide to SA Rugby Match Day Medical Standards All Ages 2026

Normal school, club and community matches (including sevens at those levels) are Green level. SA Rugby's minimum is:

• One or two people trained in emergency field-side care (a trained first aider or a paramedic) per match, or per field in use;
• an ambulance and staff on standby, and access to emergency medical services;
• the Green sideline equipment: spinal board and harness, cervical collars and head blocks, the BokSmart Concussion Guide, and (except in certain disadvantaged communities) a SCAT tool and first aid bag;
• a medical tent or station;
• an emergency action plan presented to the referee before the game.

Where on-site EMS is used, it must be able to take a life-threatening head or neck injury to hospital without delay while keeping enough cover for play to continue. Every EMS resource on scene should run a spinal motion restriction drill before the games start.

All coaches and referees must be BokSmart certified. A doctor experienced in sports injuries is valuable but not required at Green level.

These requirements come on top of the Green minimum (Safety in the Playing Environment, December 2025):

The venue doctor, ideally sports medicine trained or experienced with sports injuries and trauma trained, oversees field-side care, runs the medical room, handles blood injuries and hospital referrals, and helps visiting team doctors. The match doctor's duties are set by the World Rugby handbook for internationals and by the participation agreement for domestic competitions.

SA Rugby's minimum sideline equipment, kept in the technical zone:

* In certain underprivileged or disadvantaged communities these cannot be treated as a requirement.

A typical first aid bag includes blunt scissors, surgical gloves, gauze swabs, a nasal pack, compression bandages (5, 7.5 and 10 cm), adhesive skin closures, elastic adhesive bandages, petroleum jelly, eyewash, antiseptic, triangular bandages, adhesive dressings and tape, ice packs, water and suture material.

The amount and type of equipment should match the qualifications of the staff using it.

From SA Rugby's Safety in the Playing Environment standards:

The treatment room or station should be used only for that purpose, be easy to reach from the field and for ambulances or a helicopter, and be central if several fields are in use.

A Gold or Gold+ medical room must have, among other things: lighting, a working telephone, hot and cold running water, a visible emergency action plan with contacts, two examination couches, a trauma board or stretcher, life-saving medication, suturing and blood injury equipment, a sharps container, BLS equipment (BP cuff, stethoscope, thermometer, glucometer, ENT set), ALS equipment including an AED, neurological examination equipment, splints, blankets, and a fridge or freezer with plenty of ice.

An emergency action plan (EAP) for a potential catastrophic injury must be in place before the game starts (Safety in the Playing Environment, December 2025).

• Responsibility: the home team management designs, implements and presents it. At Green-level (normal school, club and community) matches it must be presented to the referee before the game, and the referee must confirm the safety requirements and EAP are in place before allowing the match to start.
• Keep it current: it should be updated before every fixture, with changes to personnel and contact details marked and their availability confirmed.

It should set out:

• directions to the venue (GPS co-ordinates help), access and access control
• the facility layout, emergency vehicle access to the field, and where keys or other barriers are
• a list of emergency equipment and medication, and where it is kept
• roles of host and contracted emergency personnel
• who leads pitch management, medical room management, evacuation from the field and from the venue, and communication
• contacts: BokSmart Spineline 0800 678 678, emergency services, the nearest government and private hospitals and spinal unit, and family
• follow-up: a named person (the doctor at Gold and Gold+, the coach or manager at Green) keeps everyone informed until the player is with next of kin or team management

SA Rugby's Safety in the Playing Environment document (December 2025) requires, at every level, access to the World Rugby Heat Stress Index (HSI) calculator, a lightning warning system (telephone access to this information is enough) and telephone access.

Heat (World Rugby Heat and Air Quality Guidelines):

A suspended match (or training) may resume only when the HSI has been below 230 for at least 45 minutes, the forecast shows a low risk of HSI above 250 within 2 hours (match already started) or 3 hours (not yet started), and the match-day doctor confirms it is safe.

Lightning: no play should start when lightning is present in the immediate vicinity.

Water: if surface water is deep enough to realistically raise the risk of drowning, the game should not start; the decision rests with the referee.

Yes, if you are qualified medical staff and the referee has given permission, under the SARU Protocol for Medical Personnel Entering the Field of Play:

• Permission: the referee must give qualified medical staff permission to enter. This can be given beforehand (for example in the change room) or by stopping play and calling the medics on. If it has not been given, clear it with the referee before kick-off; it may not be unreasonably withheld.
• While play continues you must not interfere with play or endanger players or yourself, must watch where play is, and must not go on when doing so would compromise play or safety.
• 10 metre guide: if play moves to within about 10 m of the injured player and medical staff, the referee should stop play. Assistant referees should alert an unsighted referee.

Apart from players and qualified medical staff, no one may enter the playing area unless they are BokSmart certified and have shown proof of it to the referee or assistant referees.

The BokSmart Serious Injury Protocol puts a Responsible Person in charge. In order of seniority that is: sports physician, medical doctor, emergency care personnel, physiotherapist, biokineticist, rugby medic, first aider, coach, referee, manager. The club or school must have one at the field.

The Responsible Person (or the EMS provider, if present) must:

1. give appropriate on-site care, or have a suitably qualified person do so;
2. immediately call the BokSmart Spineline, 0800 678 678, which is linked to ER24;
3. make sure an ambulance or other emergency response is on its way (it need not be ER24 if another service is closer);
4. oversee transport to the nearest suitable hospital, chosen from the emergency action plan and the player's medical aid status;
5. record the injury details and the details of witnesses and anyone involved;
6. notify the next of kin (in a fatality, the police do this);
7. send the Serious Injury Report to the SICM within 48 hours.

On the field, the highest qualified medical person present takes charge of managing and evacuating the player.

Under the BokSmart Serious Injury Protocol, report serious concussion, head, neck or spine injuries that meet all three criteria:

1. potentially life-threatening;
2. potentially debilitating or disabling; and
3. the player is admitted to a hospital ward.

How: the Responsible Person (or the EMS provider) completes the Serious Injury Report form and emails it to the BokSmart Serious Injury Case Manager (SICM) within 48 hours of the event. The form and current contact details are on the BokSmart Serious Injury Protocol page on springboks.rugby.

The SICM number is not an emergency line. In an emergency call the BokSmart Spineline, 0800 678 678, first.

The SICM passes the report to SA Rugby's medical and rugby safety managers and the CEO of the provincial union, follows the player's care, and links the family to the Chris Burger Petro Jackson Players' Fund.

World Rugby Law 3.25: a player with a blood injury leaves the field and may be temporarily replaced. The player returns as soon as the bleeding is controlled and/or covered.

• If the player cannot return within 15 minutes (actual time, not playing time) of leaving the playing area, the replacement becomes permanent.
• In international matches the match-day doctor decides whether an injury is a blood injury needing a temporary replacement (Law 3.26).
• In HIA-approved matches, play cannot restart until the bleeding player has been temporarily replaced.

The Gold and Gold+ medical room standard requires equipment for managing blood injuries and lacerations, suturing equipment, protective clothing and a sharps container.

The SARU Concussion Regulations (3.1.2) say any player with a concussion or suspected concussion:

• must be immediately and permanently removed from training or the match ("Recognise and Remove"). A player can be concussed without losing consciousness;
• must be assessed by a medical practitioner or approved healthcare professional;
• must not return to training or play on the same day, and not until symptom free;
• must be monitored for red flags that need transfer to a medical facility.

Red flags (Appendix 2), refer immediately:

• headache that worsens, increasing drowsiness or deteriorating consciousness
• not recognising people or places, increasing confusion or irritability, unusual behaviour
• repeated vomiting, seizures or slurred speech
• one or both pupils enlarging
• severe neck pain, or weakness or numbness in the limbs

Outside World Rugby-approved elite adult matches, an off-field HIA screen must not be used to return the player to the field. The BokSmart Concussion Guide and a SCAT tool are part of the minimum sideline kit.

Under the SARU Concussion Regulations (effective January 2026), for all players with a suspected or confirmed concussion:

1. 24-48 hours of physical and cognitive rest (no exceptions).
2. Light exercise that does not significantly aggravate symptoms.
3. At least 2 weeks with no contact rugby, even if symptom free.
4. A graduated return to play (GRTP, or "Individualised Rehabilitation") programme. The player must be symptom free before the high-intensity stages (4, 5 and 6).
5. Medical clearance before the full-contact training stage.
6. Earliest return to a match: 21 days after the concussion.

Who does what (Appendix 1):

Exception: a player managed directly by an SA Rugby or World Rugby recognised Advanced Care Concussion Doctor (ACCD) may return before 21 days, but no sooner than 14 days. Extra caution applies to players under 19.

Only in elite adult matches and tournaments that World Rugby has approved in advance for the HIA (SARU Concussion Regulations, section 4). Approval needs, among other things, the Core Concussion Player Welfare Standards, an HIA review process and access to match video.

• At every other level, including club, school and U19 rugby, players must be managed with Recognise and Remove. An off-field HIA1 screen must not be used to decide whether a player can go back on.
• U19 players who qualify for an approved elite adult tournament (including approved U20 competitions) may be assessed under the HIA there.
• Only a registered medical doctor who has completed World Rugby's Medical Protocols for Match Day Medical Staff and Concussion Management for Elite Match Day Medical Staff modules may run the HIA.

Temporary replacement (Law 3.27): in an HIA-approved match the player must leave and be temporarily replaced, even if all replacements have been used, and play cannot restart until that happens. If the player has not returned 12 minutes (actual time) after leaving the playing area, the replacement becomes permanent.