"That's a blue for you": Referee experiences managing concussion injury risk in Canadian amateur rugby


Concerns around athlete safety continue to grow and sport-related concussion (SRC) has emerged as a crisis facing all levels of rugby competition. To address these concerns, a Blue Card rule has been introduced in various levels of amateur rugby competition in Ontario in accordance with Rowan's Law recommendations. This enables a referee to remove an athlete with a suspected SRC from play and initiates an injury management process preventing a return to play without medical clearance. However, little is known about the experiences of referees in managing SRC and their decision to use strategies such as the Blue Card. This qualitative study explored the subjective experiences of 19 (74% male, average age = 40) rugby referees recruited using maximum variation sampling for experience level. Semi-structured interviews were conducted, and three themes developed from semantic and latent codes following the procedures of reflexive thematic analysis. First, referees operated within a network of responsibility, where other members within the rugby community may be brought in to support the decision-making process. Second, role coherence influenced referees' decisions to use risk management strategies such as the Blue Card. Last, referees described varying engagement in critical praxis regarding the broader management of injury risk. This research provides novel insight into the use of referees as gatekeepers to, and facilitators of, risk management via the Blue Card process and contributes to the collective knowledge on the use of rule changes for managing injury risk in sport.

Acknowledgments: Rugby Canada, Rugby Ontario, Sport Information Resource Centre (SIRC)