Introduction of the 'Blue Card' Concussion Policy to Semi-Elite Australian Football: Medical Staff Experiences and Perceptions.

Background: The Western Australian Football League (WAFL) introduced a new umpire driven 'blue-card rule' for concussion, but its benefit to the sports medicine team is unknown.

Purpose: To determine the experiences and perceptions of medical staff within the 2022-2023 Men's and Women's WAFL competitions following the introduction of the 'blue-card rule'.

Study design: Cross-sectional study.

Method: An online survey was delivered through Qualtrics to all WAFL medical staff (doctors, physiotherapists, head trainers). The survey contained four sections (demographics, concussion knowledge, concussion exposure and blue-card perceptions) with closed and multiple-answer questions. Standard methods for reporting descriptive data were applied, including mean ± standard deviation (SD) and proportions (%). Between-group differences were assessed using chi-square tests, and significance was accepted at p <0.05.

Results: Response rate was 48% (n=7 doctors, n=12 physiotherapists, n=12 head trainers). Most staff (70%) did not agree that the 'blue-card rule' was a helpful concussion policy or should remain within the WAFL. Staff also felt umpires are not qualified to identify suspected concussions on-field (67%). Over two-thirds of medical staff feel the Football Commission needs to provide education about concussion policies before the commencement of each season. Only 33% of medical staff felt completely confident in delivering a sideline assessment, and 17% felt completely confident in their diagnostic capabilities. Relationships between medical and other staff were not substantially impacted by the 'blue-card rule'.

Conclusions: Medical staff within the WAFL reported the 'blue-card rule' as an ineffective concussion identification tool and did not support its continued use for future WAFL seasons. Staff suggested that the Football Commission needs to provide more education on concussion policies before the commencement of each season.

Level of evidence: 3.