Operational Rules


Section E13: Medical Standards

CONTENTS

i.          Disclaimer

NOTE ON SCOPE OF MEDICAL STANDARDS

NOTE ON TERMINOLOGY

SECTION A       MEDICAL PERSONNEL

A1        Medical Staff Registration with RFL

A2        Medical Staff at Matches

A3        Medical Staff at Training

A4        Super League Club Doctor Duties

A5        Emergency Medical Staffing Situations

A6        Match Officials

A7        Match Day Rules Relating to Medical Staff

A8        Medical & First Aid Provision for Spectators

A9        Immediate Medical Management on the Field of Play (IMMOFP)

A10      RFL CPD Programme

A11      Travel to France

SECTION B       INFORMATION & DATA

B1        Recording Injuries

B2        Sharing Information

B3        Sharing Information – Dual Registered Players

B4        RFL/SL Injury Audit

B5        Reporting Death or Serious Injury

B6        MERLIN Medical Database

SECTION C       MEDICAL EQUIPMENT & FACILITIES

C1        Mandatory Medical Equipment (MME)

C2        Duplicate Equipment

C3        Match Commissioners’ Checks

C4        Additional Recommended Equipment

C5        Mandatory Medical Equipment in France

C6        BOC Oxygen Contract

C7        Clinical Waste Disposal

C8        Dressings & Strapping

C9        Facility Standards

C10      Training Guidelines

SECTION D       ANTI-DOPING

D1        UK Anti-Doping

D2        Supplements

D3        Creatine – Status in France

D4        Testing – Blood &/or Urine

D5        Anti-Doping Education

D6        Declaration of Use

D7        Prohibited Substances

D8        Pseudoephedrine

D9        Methylhexaneamine

D10      Platelet Derived Preparations

D11      Therapeutic Use Exemptions

D12      Glucocorticosteroids

D13      Beta-2 Agonists

D14      Hay Fever

D15      General

D16      Centres for Asthma Tests

D17      Intravenous Infusions

D18      2015 Monitoring Programme

SECTION E       RFL MEDICAL POLICIES

E1        Blood Borne Infectious Diseases – Guidelines

E2        Blood Borne Infectious Diseases – Regulations

E3        Concussion & Management of Head Injuries

E4        CogSport

E5        Cardiac Screening

E6        RFL Safeguarding Policy

E7        Turning Players Over on the Field of Play

E8        Protective & Other Equipment

E9        Hot Weather Code

E10      Mental Health/Counselling Services

E11      Mental Health First Aid

E12      Insomnia

E13      Social & Non Prescribed Prescription Drugs Social & Non-Prescribed Prescription Drugs Policy

CONTACTS

i. Disclaimer

The RFL has taken every care to ensure that the content of this booklet is current and correct at the time of going to print and it has been produced in good faith. However the RFL cannot guarantee its correctness and completeness and no responsibility is taken for any errors or omissions.

The information provided in this booklet has been provided to assist those working in the medical profession within Rugby League. It is not a substitute for the RFL Operational Rules as published from time to time by the RFL which in the case of any conflict take precedence over this document. The medical information contained is a minimum standard. It is not a substitute for medical and clinical best practice. The RFL does not warrant that information provided will meet the health or medical requirements of each individual case. Medical practitioners should use their knowledge and experience to ensure that they fulfil their duty of care to a player.

 

NOTE ON SCOPE OF MEDICAL STANDARDS

The Medical Standards is a RFL Policy which binding on all Persons Subject to the Operational Rules as set out in Section A1 and C2 of the RFL Operational Rules.

All Club Medical Staff are bound by these Standards and are expected to be fully conversant with the contents of these Standards.  Failure to comply with Mandatory elements of this Policy constitutes misconduct under section D1 of the Operational Rules. 

NOTE ON TERMINOLOGY

In these Medical Standards the following terminology is used next to each sub heading e.g. A1, B2 and applies to the whole of that sub heading e.g. A1.1, A1.a etc.

MANDATORY - required under the RFL Operational Rules and failure to comply constitutes Misconduct.

BEST PRACTICE - recommended for all clubs subject to resources available.

FOR INFORMATION ONLY - no action required.

E13:1 SECTION A
Medical Personnel
A1 MEDICAL STAFF REGISTRATION WITH THE RFL - MANDATORY
All Medical Staff working (or volunteering) at Clubs who are, or may be, involved in giving treatment or advice to Players within a professional Club environment must be registered with the RFL on the appropriate form.
A2 Medical Staff attendance at matches -
For all matches the Doctor is to be present in the dressing room area for at least one hour prior to kick off and to remain for at least 30 minutes following the end of the match. Prior to leaving the Doctor must check with the away team physio (if the team does not have a Doctor present) to confirm that his/her services are not required before leaving the dressing room area.
A2a RFL Operational Rules
All Medical Personnel working at matches must be registered as set out in Section C2 of the RFL Operational Rules including doctors who provide emergency cover.
A2b SUPER LEAGUE REQUIREMENTS – HOME & AWAY GAMES
The Mandatory Requirement is:
- Doctor (Qualified, registered with GMC and practicing with current IMMOFP qualification)
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
. A2c CHAMPIONSHIP & LEAGUE 1 REQUIREMENTS HOME GAMES
The Mandatory Requirement is:
- Doctor (Qualified, registered with GMC and practicing with current IMMOFP qualification)
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
A2d CHAMPIONSHIP REQUIREMENTS AWAY GAMES - Championship Clubs ranked in positions 1-4 for Central Distributions and Championship Clubs playing in the Super 8s
The Mandatory Requirement is:
- Doctor (Qualified, registered with GMC and practicing with current IMMOFP qualification).
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
A2e CHAMPIONSHIP CLUBS RANKED 5-12 for Central Distributions & LEAGUE 1 REQUIREMENTS AWAY GAMES
The Mandatory Requirement is:
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
A2f ACADEMY, U19s, RESERVES AND SCHOLARSHIP REQUIREMENTS
For home games:-
- Doctor (Qualified, registered with GMC and practicing with current IMMOFP qualification).
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
For away games:-
- Physiotherapist (CSP and HCPC registered with a degree in physiotherapy and current IMMOFP qualification)
NB Please note that Clubs MAY NOT use paramedics to replace doctors at any level in the professional game.
A3 Medical Staff at Training - BEST PRACTICE
The RFL recommend that club Physiotherapists are present at all training sessions and particularly those that involve contact. If a Physio is not present then a first aider with an up to date recognised first aid (not emergency first aid) qualification is a minimum requirement. The RFL recommends BFAS as an appropriate qualification which can be booked through RL Learning.
A4 SUPER LEAGUE CLUB DOCTOR DUTIES - MANDATORY
Super League Club Doctor’s should carry out the following duties.















        • Ensure that an IMMOFP-qualified doctor is present at all Super League home and away fixtures

























        • Ensure that an IMMOFP-qualified doctor is present at all Academy and Scholarship home fixtures

























        • Ensure that mandatory medical equipment is available at all home and away Super League games and all home Academy and Scholarship games

























        • Be responsible for ensuring that all mandatory medical equipment is stocked, in date and in good working order

























        • Be available to players and coaching staff for medical advice at times outside of match days, and ideally attend at least one training session per week to provide medical advice and/or treatment to players

























        • Keep contemporaneous records of treatments given and interventions made during matches and at training sessions

























        • Provide players with medications required to treat common illnesses and injuries

























        • Provide all First Team, Academy and Scholarship players with the opportunity to attend annual pre-season medical screening as set out in the Screening section of these Standards

























        • Ensure, in conjunction with the head physiotherapist, that coaching staff are appropriately trained to assist with emergency scenarios such as spinal boarding

























        • Comply with these Medical Standards

























        • Ensure other club medical staff and club coaching staff are aware of RFL (and other relevant) medical policies and understand the importance of compliance

























        • Co-operate with the RFL Welfare department regarding reporting of serious injuries and concussions

























        • Facilitate referrals for players to secondary/tertiary care where appropriate including mental health providers

























        • Keep up-to-date with knowledge and skills required for working with elite athletes, including attendance at RFL CPD events when possible

















A5 Emergency Medical Staffing Situations – FOR INFORMATION ONLY
In an emergency when a Doctor or Physiotherapist cannot cover a game through unforeseen circumstances, and an IMMOFP qualified replacement cannot be found, a non-IMMOFP qualified doctor or physiotherapist can be used on a one-off basis with the permission of the RFL Operations department. This person can only work once in a season before an IMMOFP application is required. (In these circumstances the Medical Practitioner can carry out Concussion Assessments as set out in E3).
The RFL has established an on-line database that will enable Club personnel to go directly to an IMMOFP qualified practitioner in the event that they need medical cover for a game.
All of the staff on this database are IMMOFP registered, and the database will be updated by the RFL following every IMMOFP course. In the event that you require a Doctor or Physio to cover one of your games, please use this Reserve list to make direct contact with those medics who have confirmed that they are willing to provide cover. Clubs are to agree fees and expenses with reserve medical staff. Anyone using this list is bound by the Data Protection Act and may only use the information for the purpose above and is not entitled to share that information in any manner.
The details to access the database are: www.therfl.co.uk/resources/downloads/medic_reserve_lists
The username and password are available from Gavin Wild gavin.wild@rfl.uk.com (0113 237 5023).
A6 Match Officials - MANDATORY
Should a Match Official require medical treatment then the home club medical team should provide this promptly and in emergency situations without waiting for a request. All medical personnel are obliged to treat Match Officials and failure to do so is Misconduct.
A7 Match Day Rules Relating to Medical Staff - MANDATORY
Doctors and Physiotherapists must wear the distinctive coloured tops as set out in the RFL Operational Rules and abide by the following procedures:
A7a PHYSIOTHERAPIST
- Must wear an orange t-shirt.
- Is allowed unlimited access to the playing field to render assistance to injured players.
- Must go directly to the player concerned and in instances of severe injury may indicate to the referee that the game should be stopped.
- Is not allowed to pass on messages at any time.
- Must enter and leave the field as quickly as possible (i.e. running).
- Are not allowed to be involved in the on-field interchange process save that when he/she goes onto treat a player he/she can bring that player off i.e. escort him to the touch line - he/she cannot have any further involvement in the interchange process.

A7b DOCTOR
- Must wear a red t-shirt.
- Enter the field of play when he/she is medically required to do so using his/her medical judgement.

A7c GENERAL
- The Doctor and Physiotherapist shall enter the pitch only from the designated technical area or bench and shall return to that area after coming from the pitch. They shall not be permitted to station themselves around the pitch and shall be subject at all times to the control of the Match Commissioner and Match Officials.
- The Doctor and Physiotherapist shall ensure that they refrain from involving themselves in any conflict between players and shall ensure that they refrain from making comments to opposition players
- Persons entering the field of play should also refrain from making comments to match officials about their performance or decisions.
- Medical staff should arrive at the game no later than one hour prior to kick-off.
- None of the persons entitled to enter the field of play shall carry any electronic device with them on to the field of play or do any other thing which interferes or may interfere with play in the Match.
- Doctors need to be aware of their Duty of Care to players with regards to allowing a potentially seriously injured player to travel home unaccompanied following an away match.

A7d POSITION OF MEDICAL STAFF DURING GAME
Doctors and Physiotherapists must be located within the bench area.
A8 Medical & First Aid Provision FOR Spectators – FOR INFORMATION ONLY
In addition to the above medical personnel (present for the treatment of players and officials) clubs should ensure that they fully understand and are aware of their obligations under the provision of their safety certificate and the Green Guide (Guide to Safety at Sports Grounds) regarding medical staff for spectators, e.g. crowd doctors, first aiders, first aid room, ambulance etc.
Recommended training for crowd doctors is Pre-Hospital Emergency Care Course (PHEC) and the Major Incidents Medical Management & Support Course (MIMMS) or equivalent relevant experience. The Ground Safety Officer is responsible for this provision.
A9 Immediate Medical Management on the Field of Play (IMMOFP©) - MANDATORY
The requirement to hold a current IMMOFP qualification is mandatory to those medical personnel entering the field of play. These persons must be qualified as set out in the RFL Operational Rules i.e. a currently registered practicing medical practitioner or a Chartered and State registered Physiotherapist with a degree in physiotherapy.
Medical personnel applying for their first IMMOFP course will be required to submit a photocopy of their degree certificate, GMC or HCPC and CSP certificate with their application. Existing staff may be asked to supply this (if not already on record) on subsequent applications. All HCPC renewals will also be requested for physiotherapists.
Once qualified, the IMMOFP qualification is valid for two years. Medical staff who have an expired IMMOFP qualification have two months from the date of expiry to renew their qualification or until the first available course if there are no courses available within this time frame or they will be prohibited from entering the field of play.
Individuals should check their certificate for the expiry date. The RFL will send out reminders to remind individuals of the expiry date of their IMMOFP qualification and to advise on the dates of forthcoming courses. However keeping the qualification up to date and booking on a course in time is a personal responsibility for medical staff.
New personnel have three months to successfully complete an IMMOFP course, or until the first available course if there are no courses available within this time frame.
IMMOFP courses are in demand therefore please book well in advance to obtain a place on a course to suit renewal needs.
A9a EXAMINATION AND IMMOFP PROCEDURES
Payment must be received a minimum of 6 weeks in advance of the course date to guarantee a place. The RFL reserves the right to fill the place if payment is not received within this time frame.
The course manual will be sent out only on receipt of payment in full.
Cancellations up to 4 weeks before the course will be refunded in full, minus the cost of the manual (£30). Cancellations within 4 weeks of the course date will not be refunded unless a replacement candidate can be found in which case a refund will be made minus the cost of the manual (£30) and £20 late cancellation fee.
Candidates are required to read the manual before the course and complete the pre-course multiple choice paper.
The pre-course multiple choice paper will be sent out to candidates four weeks before the course date and is required to be returned to Gavin Wild in the RFL Operations Department, Red Hall no later than one week before the course commences. Failure to return the paper within this timeframe will result in the candidate being marked zero for this element of the course.
This multiple choice paper is part of the IMMOFP assessment procedure and is worth 5% of the overall mark.
The RFL, strongly advise, that candidates should not be attending a course immediately preceding a weekend fixture where they are scheduled to provide medical cover as candidates who fail to pass may not enter the field at that fixture.
Where a candidate has to attend a course immediately prior to the weekend of a game he/she is scheduled to cover, arrangements must be made with the Club concerned to have an appropriately qualified member of the medical team available to take the candidates place should they fail to pass the course.
Please bear in mind that the course finishes between 16:00 and 17:00 on Friday afternoon therefore candidates who pass may find it difficult to attend fixtures due to be played that evening.
Candidates, who fail the course, will not be able to enter the field of play until such time as a pass is achieved. The RFL Operations Department will inform the relevant Club of the failure on the Friday evening of the second day of the course. Any breaches will be referred to the Compliance Department.
A9b COURSE ELEMENTS
Candidates are assessed on five elements of the course according to an objective marking criteria, with an overall pass mark of 75% needed to pass the course. The assessment will compromise the following:




Element Marks Allocated How this will be assessed
Pre-course MCQ 5% of overall mark 30 question MCQ paper
On-course workstation 10% of overall mark On-going, on-course assessment. Candidates will be assessed by instructors delivering the workstations with respect to their practical engagement in the learning tasks undertaken.
Practical Scenario exam 30% of overall mark Objective marking criteria for professional performance within the practical scenario
CPR exam 35% of overall mark Objective marking criteria for professional performance within the practical scenario
Theory paper 5% of overall mark 50 question MCQ paper





There is an overall pass mark for the course, which has been set at 75% (of all accrued element scores). Any candidate who does not achieve the overall required mark across all elements will be deemed to have failed the course. In this instance, they will no longer be able to run on the field of play until such times as they have attended and passed another IMMOFP course.
A9c IMMOFP RE-SIT PROCEDURES
Any candidate who does not achieve the overall required mark across all elements will be deemed to have failed the course. In this instance, they will no longer be able to run on the field of play until such time as they have attended and passed another IMMOFP course. This is in line with industry best-practice, where any medical course that has elements of ongoing assessment is deemed not to be suitable for re-sit opportunities for individual elements of the course.
A9d COURSE FEES
RFL affiliated members £350 per candidate and £600 for non RFL affiliated candidates.
A9e COURSE DATES FOR 2015
All courses will be held at the The Mend-A-Hose Jungle, Wheldon Road, Castleford, WF10 2SD.
- Thursday 29 & Friday 30 January 2015
- Wednesday 25 & Thursday 26 February 2015
- Thursday 19 & Friday 20 March 2015
- Thursday 16 & Friday 17 April 2015
- Thursday 21 & Friday 22 May 2015
- Thursday 18 & Friday 19 June 2015
- Wednesday 22 & Thursday 23 July 2015
- Wednesday 9 & Thursday 10 September 2015
- Wednesday 14 & Thursday 15 October 2015
- Thursday 12 & Friday 13 November 2015

For all enquiries relating to IMMOFP courses, please contact Tim White, RFL Competitions Officer, on tim.white@rfl.uk.com or phone 0113 237 5528.
A9f NON COMPLIANCE OF IMMOFP REGULATIONS
Clubs will be reported to the RFL Compliance Department should medical staff enter the field of play without the appropriate qualification.
A9g RECOGNITION OF OTHER RELEVANT COURSES
Any Doctor or Physio who has successfully completed a Level II FPHC RCSEd course (ICIS, AREA, SCRUMCAPS, EMMiITS, EVENT MED BHA) will, on receipt of relevant documentation, be entitled to receive a dispensation of 12 months before they have to complete IMMOFP.
Written permission should be sought and proof of completion of the RFU course must be provided.
A10 RFL CPD PROGRAMME – BEST PRACTICE
Medical staff are expected to attend the RFL’s CPD programme. The programme covers issues particularly relevant to RFL policies and to the treatment of injuries commonly suffered within rugby league.In 2015 three are planned with provisional dates in March, June and September. It is highly recommended that colleagues (whatever your level of Club) attend at least two of these events every season.
A11 Travel to France – FOR INFORMATION ONLY
A11a MANDATORY MEDICAL EQUIPMENT IN FRANCE
Please see section C5 for details of the set of RFL Mandatory Medical Equipment that is stored in France for visiting teams to use.
A11b LEGAL ISSUES
The GMC advises that doctors should consult their own Medical Defence Union to advise them of the legal implications of travelling to France with a Rugby League team and any obligations under French law.
However please be advised of the GMC’s Good Medical practice guidance booklet which states:
paragraph 9 “In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide” ; and
paragraph 33 “You must have adequate insurance or professional indemnity to cover all aspects of your practice that is not covered by an employer’s scheme.”
The GMC would expect should a medical emergency arise, with a member of your own team, the French team, a Match Official or a spectator, that a Doctor would provide appropriate medical care. The nature and extent of the care will depend on the circumstances and the level of professional competence.
A11c FOREIGN DOCTORS PRACTISING WITH TEAMS VISITING THE UK
The General Medical Council introduced in 2007 an amendment to the Medical Act to enable overseas doctors to practise medicine in the UK under a provision entitled ‘special purpose’ registration. Special purpose registration was introduced for those doctors who intended to be in the United Kingdom temporarily for the purposes of providing particular medical services exclusively to persons who are not nationals of the United Kingdom.
EU doctors are able to seek registration under a separate process with the GMC as there is an entitlement to such registration for EU doctors to provide services on a temporary and occasional basis (EU doctors should contact the GMC - see below).
In short, where a doctor is required to undertake work in the UK that involves clinical practice (for example, diagnosis, assessment or treatment of a medical nature) he or she must be registered with a license to practice through the GMC.
There is a team in place at the GMC who will support Doctors/ Unions through the application process. Should you have any GMC enquiries please contact Steph Styles SStyles@gmc-uk.org or 00 44 (0)161 923 6656.
SECTION B
Information & Data
B1 Recording Injuries - MANDATORY
Medical staff should make a note of any Player who has been injured in the match in any way whatsoever and retain such notes in line with the GMC recommendations. For the avoidance of doubt, the notes shall remain subject to the rules of medical confidentiality save as set out in the standard Player Contract or as required by the RFL Operational Rules or the Injury Audit or as required by the Concussion Regulations contained in these Medical Standards or in the cases of Blood Borne Diseases as set out in sections E1 and E2.
B2 Sharing Information - mandatory
In the case of matches where the Away Team Doctor is not attending (Championship 1, Academy, U20s, U23s or Scholarship) it is the responsibility of the player’s Club Doctor or Physiotherapist to provide the Home Team Doctor with the details on the day of the special requirements of any of their players and to provide the Home Team Doctor with that special medication/equipment on game day. This is not relevant to Super League and Championship First Grade teams as Doctors are required to travel to away matches.
B3 Sharing Information - Dual Registered Players - MANDATORY
As would be expected under good medical professional standards, Club medical staff at both Clubs must liaise and share information as appropriate to ensure the best care for the player.
B4 RFL INJURY AUDIT - mandatory
The RFL Injury Audit run in conjunction with the University of Bolton is fully operational and co-operation is a mandatory requirement for Super League and Championship Clubs ranked in positions 1-4 for Central Distributions (for 2015 Bradford Bulls, London Broncos, Leigh Centurions & Featherstone Rovers).
Complete and reliable recording of injuries sustained by players is central to future interrogation of the player - performance delivery in clubs and country for audit & development purposes. The number, type and severity of particular injuries, the circumstances of their aetiology, including the prevailing weather conditions, relationship to training or playing and the time during a session or game at which they occur are essential parameters for evaluation. In addition, correlation with fatigue, impact and training intensity will facilitate understanding of these factors in injury causation and adaptation of training patterns and match preparation accordingly. Those injuries found to be most common would then be the subject of standard investigation, management and treatment utilising a care pathway approach thereby ensuring consistency, reliability and quality in their management.
Colleagues are reminded of their professional obligations with respect to medical record keeping. Clear, contemporaneous record keeping will underpin the Club’s clinical governance arrangements and it is expected the Club medical staff will undertake an audit of a specific aspect of injury management as part of their continuing professional development
B5 Reporting Death or Serious Injury - MANDATORY
When a player has died or suffers a life threatening or catastrophic injury the RFL should be notified immediately using the emergency numbers provided below: -
The information does not necessarily need to be provided by a Doctor and the information required does not breach any medical confidentiality issues.

B5a RFL CONTACTS
- Emma Rosewarne 07850 483736
- Kelly Barrett – 07739 819750



Please make sure the RFL has the name of the player, where possible contact details for the player’s family and any initial prognosis.
The RFL will:
- Inform the Benevolent Fund who will provide moral and financial support to the player and his family.
- Handle any enquiries from the media.
- Inform the RFL’s insurance brokers where relevant.

B6 MERLIN Medical Database - BEST PRACTICE
The RFL have commissioned a web-based medical database (known as MERLIN) which is available for club medical staff to use to manage medical information within Super League clubs and to aid communication between medical colleagues in a club environment. Although the system is web-based it can still be used off-line. Four licenses are provided to clubs free of charge. This system will also assist clubs in ensuring that they are meeting the requirements relating to clinical governance. Any queries should be directed to Dean Hardman in the RFL Operations department.
SECTION C.
Medical Equipment & Facilities
C1 MANDATORY MEDICAL EQUIPMENT (MME) - MANDATORY
The RFL have produced a list of equipment which must be present at all games. The home Club is responsible for ensuring that all the Mandatory Medical Equipment (MME) is present in the dressing room area at least one hour before kick-off.
In Super League and Championship Clubs ranked in positions 1-4 for Central Distributions (for 2015 Bradford Bulls, London Broncos, Leigh Centurions & Featherstone Rovers) the away Club must also travel with a set of MME. The only exception is when travelling to play Catalans Dragons where the club may use the RFL MME kept in France for this purpose.
Championship medical staff should travel with the equipment they require and not rely solely on the home team equipment.
The RFL strongly recommend that all medical staff also carry with them the items they deem necessary to fulfil their role and do not rely on the home team or someone else to provide. Please ensure that all locum cover staff are aware of what equipment will be present and what additional equipment they will require to cover a game i.e. non mandatory equipment.
Where a curtain-raiser is played on the same day clubs should ensure that there is a set of MME available for each game (working on the assumption that equipment for the first game may not be available for the second).
Match Commissioners will carry out checks on MME at matches. See Section C3 for further details.
Where an away team player requires the use of a piece of equipment which is then taken away (e.g. to hospital), it is the responsibility of the away team to retrieve or replace the item.
C1a FULL LIST OF MANDATORY MEDICAL EQUIPMENT
1. Spinal Board and/or Scoop Stretcher and Trained Stretcher Bearers.
A Spinal Board and/or Scoop Stretcher with full complement of body straps or spider straps and head straps with head Immobiliser plus appropriately trained stretcher bearers (those trained by the club medical staff to adequately and safely, under the direction of the club medical staff, transfer a player onto the stretcher and remove him from the field of play). It is recommended that clubs carry both spinal board and scoop stretcher thereby providing resilience for all possible medical eventualities.
2. Cervical Stiff Neck Collar(s)
An assortment of collars will be available to fit every player within the club (extrication collar). Soft neck collars are not suitable. Medical staff may wish to size players for collars preseason to ensure they have collars sufficient to fit all players and all neck types.
3. Splints
For immobilisation of the limbs. Preferably box splints, which are hygienic, stored flat and ready to use (these come in full and half sizes for upper and lower limb). Alternatively the SAM splints or vacuum splints can be used.
4. Airways, Masks etc
- Oropharyngeal airway [assorted sizes]
- Nasopharyngeal airway [assorted sizes]
- Pocket Mask (1 way valve)
- Self-Inflating Valve mask

The fully equipped and annually serviced Oxygen kit bag from BOC will have some of the above contents supplied. Please compliment these accordingly.
5. Automated External Defibrillator (AED)
AEDs are now mandatory at all levels of the game. The AED should be present pitch side at all levels and be available solely for player use i.e. in addition to AEDs used for the benefit of spectators etc.
Please note if you carry an AED with a monitor, then you are required to carry, in addition to the above, the appropriate medication to deal with each potential outcome that might occur.

6. Portable Suction
Hand held or powered - must be suitable for pitch side use.
7. Oxygen
Life line pro kit, includes variable flow rate oxygen, bag valve mask capable of delivering 97% oxygen, non -re-breathing mask capable of delivering 80% oxygen, standard oxygen mask with attachable nebulizer chamber encased in a purpose made carrier with 10ml syringe and two OP airways. Supplied & serviced yearly direct to the club from BOC.
8. Drug Box - further details below
Emergency drug box to be available at all games at all levels, to be utilised by both teams. It is the responsibility of Home team Doctor to update and maintain the drug box at the club. Regular checks of the contents of the drug box are essential as some items have relatively short shelf lives.
- Adrenaline 1:1000 1ml vial
- 2 vials of Hydrocortisone 100mg for IV administration (200mg dose)
- Chlorpheniramine (Piriton) 10mg in 1ml vial for IV/IM use
- 10mls water for injection
- Diazepam injection (emulsion)0.5%, 5 mg/ml, 2 ml ampoule
- Salbutamol UDV (Unit Dose Vial) 5mg per 2mls (to be nebulised using oxygen unit with mask and chamber supplied in BOC oxygen unit).
- 300mg Aspirin - oral. [antiplatelet effect for use in Myocardial Infarctions]
- Please note Aspirin should NOT be given to players under the age of 16 years, unless specifically on the advice of a doctor. This is due to a risk of Reye’s syndrome, a rare condition that causes brain swelling and damage to the Liver.
- IV fluids 500ml sodium chloride 0.9%
- IV giving set (ensure IV infusion set)
- One of each - green, white and brown venflon
- Green/Blue/Orange needles (3 of each) xii)1ml, 2ml, 5ml, 10ml syringes (2 of each)

All mandatory drugs must be in-date at all times and replaced as soon as is practicable after use.
Medical personnel should carry any additional medication considered necessary to cover all eventualities, together with any medication required for players with known allergies or medical conditions or illnesses.
It is the responsibility of the Visiting Team to ensure that any medication or equipment required by their own players is brought with them to a game for a player with a known allergy, condition or illness.
9. Foil Blanket and Ambulance Blanket
For protection against hypothermia. To keep players warm if unable to remove from field of play until emergency services arrive.
10. Sharp’s Bin and Clinical Waste Bag
A sharp’s bin and a yellow clinical waste bag should be present in the treatment room and on match days in the home and away dressing rooms. This is for the safe and correct disposal of sharps and clinical waste. This is the responsibility of the Home Team to provide at all levels. See section C7 for further details on clinical waste disposal.

11. Bleach Solution Disposable Gloves & Other Personal Protective Equipment
The recommended spray container with 15mls of standard washing-up liquid and 32mls of standard household bleach must be present on the touchline and in both dressing rooms for use on game days and present at during training for use by medical and kit-room staff. This is the responsibility of the Home Team to provide at all levels. This should be made fresh for every session. In addition disposable gloves must be readily available for use with this solution and all clinical waste.
Medical staff should also ensure that any Personal Protective Equipment deemed necessary for player medical care is available.
C1b HIGHLY RECOMMENDED BUT NOT MANDATORY EQUIPMENT - BEST PRACTICE
12. Entonox
A self-administered system of pain relief delivering a 50% nitrous oxide and 50% oxygen analgesic gas.
13. Emergency Cricothyrotomy Device and/or needle Cricothyroidotomy equipment
Provides a quick method to provide and emergency airway with minimal bleeding in an extreme emergency in the presence of severe oro-facial injury when an airway cannot be maintained & your patient is rapidly deteriorating.
14. Crutches
Adjustable with adequate ferrules
15. Penlight Torch
A high quality light to aid diagnosis following a Head Injury
16. Scoop Stretcher
Preferably a thermoplastic scoop that allows both ‘lift and carry.’
C2 Duplicate Equipment - MANDATORY
If a Club has more than one team playing at separate venues on the same day, duplicate equipment will be required. When scheduling fixtures, Clubs must take into account the availability of medical personnel and equipment.
C3 Match Commissioner Checks – for information only
Match Commissioners will carry out checks on all medical equipment at games. Should any of the Mandatory Medical Equipment not be present, the Match Commissioner will order the kick-off to be delayed until the piece of equipment is present. Should it not be possible to locate a piece of essential equipment, the Match Commissioner has the power to postpone or abandon a game. This is a last resort and should be avoided by the appropriate planning, checking and management of medical kit.
C4 Additional Recommended Equipment for Medical Staff attending a game - BEST PRACTICE
Some of the resuscitation equipment below is only recommended for those medics who are competent in its use. It is up to each individual to act within their own clinical competence and professional training.

- Various ET tubes
- Laryngoscope
- Stethoscope
- Sphygmomanometer
- Various needles, syringes – in addition to those in drug box
- Adrenalin 1:10,000 plus additional 1:1000 or epipen (in addition to the adrenalin in the Drug Box)
- Suture Kit (dressing pack, normal saline irrigation sachets, toothed forceps, suture holder, scissors plus suture materials). Should be present at every game and all medics ready to stitch as required at any point throughout a game.
- Eye irrigation materials - Fluorescin Drops, saline irrigation, Chloramphericol ointment/drops, Eye pad & tape.
- Emergency cricothyroidotomy kit - as per recommended equipment list
- Anti-inflammatories (tablets/IM)
- Painkillers (check WADA Prohibited List) [tablets & IM]
- Anti-emetics
- Anti-fungals
- Antibiotics (various)
- Medipreps
- Gauze swabs
- Scissors
- Inhalers - Salbutamol (nebulised now in drug box)
- Jelly Babies/Lucozade tablets

Any other equipment that a doctor considers necessary to carry out their duties
Additionally all medics should have:
- Effective means of communication with emergency services.
- Sound knowledge of additional medical persons at ground.
- Detailed knowledge of treatment room facilities.

C5 Mandatory Medical Equipment in France - MANDATORY
The RFL provide a full set of Mandatory Medical Equipment (MME) and some supporting training equipment for the use of the visiting team in Perpignan.
In Perpignan the equipment is stored with the coach company and should be on the bus when the team is collected from the airport. Medical staff should check the equipment on arrival and inform the RFL immediately of any issues.
Please leave this equipment in the condition in which you would wish to find it. If you use any of the disposable items or damage anything or find that any equipment is missing it is MANDATORY that the RFL Match Commissioner is informed immediately. The Match Commissioner will report to the RFL Operations Department so that replacements can be provided. Remember that the medical staff for the next team visiting France rely on your assistance in this regard and failure to comply may result in a match in France being postponed
C6 BOC Oxygen Contract - MANDATORY
BOC supply Oxygen to all clubs through the central contract. This standardisation of kit allows medical staff to be familiar with the units in every club. Should an emergency ensue where more than one cylinder is required, no time is lost to familiarisation with a new unit. BOC will also contact Clubs direct to arrange to service the unit(s) already with the Club.

C7 Clinical Waste Disposal - MANDATORY
Clinical waste disposal at clubs is a Health and Safety procedure and is a Club responsibility. The presence of the sharps bin and clinical waste bags is not sufficient: an adequate disposal system that meets H&S regulations is also required.
Sharp’s Bins and Yellow Clinical Waste bags are part of the RFL Mandatory Medical Equipment to be present at every game. It is the home Club’s responsibility to provide disposal facilities for both teams. Clubs should not have to travel home with their soiled clinical waste and sharps. A visiting team who finds that they have no clinical waste disposal facilities should inform the Match Commissioner immediately.
For those medical staff assisting their clubs with clinical waste disposal via their own practices and hospitals, please be aware of the guidance on traveling with clinical waste in cars. This can be obtained from the local authority.
Under no circumstances should clinical waste be thrown into the general refuse bins.
C8 Dressings & Strapping - MANDATORY
Please be aware of your duty of care to other members of staff at the Club such as ground staff and cleaning staff who may come into contact with blood stained dressings and strapping post game/training.
These staff should be trained in procedures to handle such items and understand the risks involved and should be provided with adequate bleach solution as per regulations and disposable gloves.
C9 Facility Standards - MANDATORY
Clubs must have a separate treatment room close to both teams’ dressing rooms. This room is for the sole use of players and match officials only and not for the treatment of members of the public. A separate first aid room should be provided for members of the public and equipped as set out in the Green Guide.
C10 Training Guidelines - BEST PRACTICE
It is important that Clubs do not compromise on safety in training sessions so Clubs should carry out a risk assessment regarding training sessions but as a minimum should consider the following issues:
- As a minimum an appropriate first aider (with current national certificate) is present at all training sessions with access to appropriate equipment.
- Emergency protocols to cover possible scenarios which may occur during a training session.
- Access to hot and cold running water.
- Ambulance access to the training area.
- Access to a fully charged mobile phone or a landline.
- Mandatory Medical Equipment is present, along with personnel who are trained in the use of the equipment. If using training facility equipment to compliment mandatory equipment, e.g. defibrillator, Club staff should ensure that they know its location, have access at all times, and have personnel present who are trained in its use.

The RFL recommend that club Physiotherapists are present at training sessions see A2 above.

SECTION D
Anti-Doping
NB There are significant changes to the WADA Code which take effect from 1 January 2015. The UKAD Advisor course will make sure that you are aware of the changes see D5b below.
If you have any questions regarding any aspect of anti-doping, please contact Dean Hardman on 0113 237 5041 or on email on dean.hardman@rfl.uk.com .
D1 UK Anti-Doping – FOR INFORMATION ONLY
UK Anti-Doping (UKAD) is responsible for all anti-doping in the UK.
D2 Supplements - BEST PRACTICE
The RFL policy on supplements is to assess the need and assess the risk. No guarantees can be made regarding the composition of supplements and whether or not they contain prohibited substances. Strict Liability applies in all doping cases and contaminated supplements will not be a valid defence for a player who provides a positive sample. However, clubs and players should attempt to minimise the risk by only using supplements from manufacturers who have robust quality control measures in place. There are organisations available who can test supplements and reputable manufacturers will use these services. One such example is Informed Sport www.informed-sport.com
D3 Creatine - status in France – FOR INFORMATION ONLY
The RFL have confirmed with UKAD that Creatine is not illegal in France for consumption of less than 3g per day for less than 4 weeks.
D4 Testing - Blood &/or Urine – for information only
Under the provisions of the RFL anti-doping regulations, blood and/or urine samples can be collected. On some occasions, it may be one or the other, and in other cases it could be both. Blood tests will be conducted by a suitably qualified phlebotomist and 8ml will be taken, with appropriate rest periods before and after enforced. The only valid reason to refuse a blood test would be due to health reasons such as haemophilia, and appropriate medical evidence would obviously need to be provided to substantiate any refusal. If a refusal cannot be substantiated then the player will be charged with an Anti-Doping Rule Violation for refusing a test.
D5 ANTI DOPING EDUCATION – MANDATORY
D5.1 100%ME PLAYER EDUCATION
100%ME is the player-centred education programme developed by UKAD and the RFL. Clubs are bound by the RFL Operational Rules to deliver a 100%ME session to all players in the club on an annual basis. From 2014 it is compulsory for all professional players at each club to have a 100% ME education session taken by a UKAD Educator. The RFL will distribute names and contact numbers for UKAD Educators who have an understanding of Rugby League. Clubs are responsible for paying the fee which is fixed by UKAD. However the RFL will pay the Educator direct and deduct fees from distributions.
D5.2 100% me Advisor
From 2014 it is mandatory for club doctors, physios and conditioners to have completed UKAD’s online 100% ME Advisor course to ensure that they are up to date with regards to the current anti-doping rules. There are no entry requirements for this programme. Training is via an on-line e-learning programme with an assessment at the end. Advisors remain accredited via an annual assessment. Visit www.ukad.org.uk/learningzone for the Advisor training. Please note you will need to be registered to access this course. To do this you will need to register on our website at www.ukad.org.uk/account/register . If you are already registered, you may log in with your current username and password. FYI it is also compulsory for Player Welfare Managers and Heads of Youth to complete this course.
D6 Declarations of Use – FOR INFORMATION ONLY
As of 1st January 2011 the Declaration of Use process was abolished.
D7 Prohibited Substances - Checking Medication - mandatory
For an immediate answer to an enquiry about the status of a substance for use in Rugby League log on to the Global Drug Reference Online (GlobalDRO) - www.globaldro.com. GlobalDRO allows you to search for the status of a licensed medication that can be purchased in the UK and also allows you to search for the status of generic ingredients that can be found in foreign products, which may contain different ingredients to similar brands in the UK.
As always, the RFL recommend checking any prescribed medication to ensure that it does not contain banned substances; if it does, a Therapeutic Use Exemption (TUE) will be necessary and this must be completed before taking the substance.
Please note supplements cannot be checked using the GlobalDRO system as they are not licensed medications.
D8 Pseudoephedrine – FOR INFORMATION ONLY
Pseudoephedrine was added to the WADA Prohibited List as of 1st January 2010. This means that any player who provides a sample containing Pseudoephedrine is likely to face a sanction. Pseudoephedrine is commonly found in cold remedies so players must be careful which remedies they take when they have a cold. A Player should consult club medical staff before taking any cold remedies. Many cold remedies do not contain Pseudoephedrine and these are often more effective. Therapeutic Use Exemptions will not be granted for cold remedies containing Pseudoephedrine.
Over-using Pseudoephedrine can lead to:
- Fast, pounding or uneven heartbeat
- Increased blood pressure
- Severe dizziness
- Easy bruising and bleeding Flu-like symptoms; chills, fevers, aches
- Anxiety and restlessness
- Unusual weakness

D9 Methylhexaneamine – for information only
Methylhexaneamine has been found in a number of supplements recently and is a Prohibited Substance and as such could carry a sanction for any player who provides a sample containing it.
Methylhexaneamine is commonly referred to by a number of alternative names including, but not limited to, forthan, forthane, floradrene, geranamine, dimethylamylamine, DMAA, dimethylpentylamine, 1,3-dimethylamylamine, geranium oil or geranium extract. Please note that not all of these synonyms appear on www.globalDRO.com .
The type of supplements that are more likely to contain Methylhexaneamine are those supplements which are designed to increase energy or aid weight loss. There is no guarantee that supplements are drug free, and the RFL and UK Anti-Doping recommend that any player who is considering the use of a supplement assess the risks in doing so.
Due to health concerns, the MHRA made it illegal in August 2012 to sell products containing Methylhexaneamine. The reasons given by MHRA were that it “has been linked to suspected adverse drug reactions worldwide, ranging from shortness of breath to heart attacks. It has also been linked to at least one fatality.” The full MHRA press release can be found at http://www.mhra.gov.uk/NewsCentre/Pressreleases/ CON180711. Medical staff and players should be aware that some less reputable companies continue selling products containing Methylhexaneamine.
D10 Platelet Derived Preparations (Platelet Rich Plasma) – FOR INFORMATION ONLY
Platelet-derived preparations have been removed from the Prohibited List after consideration of the lack of any current evidence concerning the use of these methods for purposes of performance enhancement notwithstanding that these preparations contain growth factors. Despite the presence of some growth factors, current studies on PRP do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect. Note that individual growth factors are still prohibited when given separately as purified substances as described in the Prohibited List.
D11 Therapeutic Use Exemptions - Changes for 2015 – FOR INFORMATION ONLY
The 2015 WADA Code has not significantly changed the TUE process, however there have been some minor changes.
D12 Glucocorticosteroids – FOR INFORMATION ONLY
The use of Glucocorticosteroids administered via inhalation (e.g. Beclomethasone or Budesonide) or a non-systemic route does not require a TUE or a Declaration of Use. Non-systemic routes means intra-articular, peri-articular, peri-tendinous, epidural and intra-dermal injection.
Players still need to declare the use of Glucocorticosteroids on the Sample Collection Form when tested.
Glucocorticosteroids administered via a systemic route (i.e. orally, rectally, intravenous or intra-muscular) still require a full TUE.
Topical preparations (e.g. eye drops, nasal sprays, creams and ointments) containing Glucocorticosteroids are not prohibited and therefore do not require a TUE.
D13a Beta-2 Agonists - Salbutamol, Salmeterol and formoterol – for information only
Salbutamol, Salmeterol and Formoterol do not require a Therapeutic Use Exemption (TUE) or a Declaration of Use.
Appropriate use of these inhalers with good administration technique is essential as there are specified levels of salbutamol and formoterol a player can take above which an adverse analytical finding will be declared. The limits are a maximum of 1600 micrograms over 24 hours for Salbutamol and a maximum of 54 micrograms over 24 hours for Formoterol. The presence in urine of Salbutamol in excess of 1000 mg/ml or Formoterol in excess of 30 mg/ml is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic inhaled dose up to the maximum indicated above.
Poor administration technique or poorly controlled asthma are recognized as possible contributory factors to such abnormal urine findings. However, such a result will lead to an Anti-Doping Rule Violation hearing following which sanctions, including a suspension of up to two years, may be applied. It is therefore essential that all medical staff pay due diligence to ensuring optimal administration technique and optimum control of asthma in their playing staffs.
D13b BETA-2 AGONISTS - ALL OTHER BETA 2-AGONISTS OTHER THAN SALBUTAMOL, SALMETEROL AND FORMOTEROL – FOR INFORMATION ONLY
All other Beta-2 Agonists (e.g. Terbutaline) still require a TUE application and the supporting evidence.
TUE applications for Beta-2 Agonists (e.g. Terbutaline) require:
- Comprehensive Medical History
- Clinical Review
- Objective Spirometry assessment at rest and following a challenge
- Lung function test:
- Bronchodilator Challenge
- Bronchoprovocation Challenge

A clinical suspicion report should only be submitted if clinical suspicion persists and can be evidenced after Bronchodilator and Bronchoprovocation has delivered negative results.
It is essential that the TUE Beta-2 Agonist Guidance document is consulted to obtain full details of these requirements so that the correct evidence is submitted with TUE applications.
Also, please note that there is a specific TUE application form for those Beta-2 Agonists which require TUEs. Applications on regular TUE forms will not be accepted. These documents can be downloaded from the RFL website or obtained by contacting the RFL Operations department.
In order to control the number of players having to undertake lung function testing, the RFL, in conjunction with UKAD, have decided that only the first team squads from Super League clubs will have to complete proactive TUEs for those Beta-2 Agonists which require TUEs. (ALL Beta-2 agonists OTHER THAN Salbutamol, Salmeterol and Formoterol) Proactive TUEs means that these must be granted before these players take the medication.
All other players (non- first team squad Super League players, Championship , League One, Academy, Reserve & Scholarship players) must complete TUEs for Beta-2 Agonists (i.e. FOR ALL Beta 2 agonists OTHER THAN Salbutamol, Salmeterol and Formoterol) retroactively, i.e. once they are tested they have 10 days to submit the TUE application.
However, we would recommend that any player currently using ANY Beta-2 Agonist speaks to his Doctor to ascertain if he really needs to use it, as it may be the case that a player was given an inhaler as a preventative measure but does not actually have asthma.
If a player needs a TUE as outlined above but after testing cannot meet the criteria, the player needs to have a discussion with the Doctor to find out why they have been prescribed asthma medication. If clinical suspicion of asthma or any other respiratory problem is still present then this must be recorded in a Clinical Suspicion Report as this can be used to support a TUE application if the criteria are not met, although it is not a guarantee that the TUE will be granted. If an application for a TUE is rejected, there is a TUE Appeals Committee to whom an appeal can be made. If this appeal is rejected then the player may be charged with an Anti-Doping Rule Violation. Therefore medical staff need to take all reasonable steps to ensure that players who require Beta-2 Agonists do meet the criteria for being granted a TUE.
D13c BETA-2 AGONISTS AND INHALED CORTICOSTEROIDS SUMMARY - MANDATORY
Players have a responsibility to ensure that they take appropriate action when prescribed any inhaled medication. The table below details the action to take:




Medication Action Required
Salbutamol None*
Salmeterol None
Formoterol None*
Terebutaline TUE
Corticosteroids None





*Refer to D13a regarding the upper limits for Salbutamol and Formoterol.
Objective medical evidence will have to be provided to obtain a TUE. Details are on the TUE form and Club medical staff need to be fully aware of this process. If specific advice is needed please contact the RFL or UKAD.
D14 Hay Fever - mandatory
UK Anti-Doping receives Therapeutic Use Exemption requests for the one-off use of intramuscular corticosteroid injections to treat hay fever. Applications must be submitted in advance of treatment and be supported by medical evidence to justify therapeutic use.
Required supporting evidence:
1. Description of symptoms to confirm diagnosis
Provide details of when the hay fever started; the symptoms experienced; the severity of these symptoms; the effect on performance; and symptoms suffered in previous years.
2. Medical history documented
Provide details of any known allergens or allergic history. Submit results of immunological investigations such as skin prick tests or specific IgE to confirm these details.
3. Confirmation that reasonable therapeutic alternatives have been trialled
Provide details of the permitted oral, nasal and/or ophthalmic medications that have been trialled for at least 2 weeks including names, doses, dates, duration and the effect of the treatment.
4. Specialist referral
A specialist opinion (i.e. ENT, immunologist or respiratory) is required to support the proposed treatment request. The specialist will need to give a reasoned opinion in view of the British Society for Allergy and Clinical Immunology (BSACI) guidelines and NHS Clinical Knowledge Summaries (CKS) on hay fever.
BSACI and CKS guidelines do not recommend the use of intramuscular corticosteroid injections to relieve hay fever symptoms. These guidelines consider the risk-benefit profile of intramuscular corticosteroid injections to be poor in comparison with other treatments available.
Please note that in severe uncontrolled cases where symptom control is critical (e.g. imminent competition), an emergency TUE application for a single short course of oral prednisolone will be considered without specialist opinion. Supporting evidence points 1, 2 and 3 above must be covered in such applications. Thereafter, applications will require specialist opinion to support any further proposed courses of oral prednisolone. Please contact tue@ukad.org.uk for further information.
D15 General - MANDATORY
All other Prohibited Substances will require a full TUE (completed proactively) if prescribed for a legitimate medical condition. TUE applications are reviewed by a panel of independent physicians known as UKAD’s TUE Committee.
TUE applications should be sent direct to UKAD in an envelope marked
“Private & Confidential” to:
TUE, UKAD, Fleetbank House, 2-6 Salisbury Square, London, EC4Y 8AE
or emailed to tue@ukad.org.uk
D16 Centres for asthma tests to provide evidence for TUE applications – FOR INFORMATION ONLY
Brunel University - Middlesex - Professor Alison McConnell 01895 266480 alison.mcconnell@brunel.ac.uk
Bronchodilator. £80 approx. @ Brunel or club (subject to 7 minimum tests and travel costs)
Northumbria University - Newcastle - Les Ansley les.ansley@unn.ac.uk 07999 418 119
Eucapnic hyperventilation (EVH) test. £150 approx (although discounted rates may be available for block bookings) @ club. Can also do EVH testing at clubs based in the London area.
Olympic Medical Institute - Harrow, London
Offer full diagnosis, assessment and management of breathing problems. Medical staff referrals only to Nick Fellows on 020 8423 7203 or nick.fellows@boa.org.uk
D17 Intravenous Infusions - mandatory
Regardless of the ingredient or brand, intravenous infusions are prohibited at all times except in the management of surgical procedures, medical emergencies or clinical investigations.
This is to prohibit hemodilution and overhydration as well as the administration of Prohibited substances by means of intravenous infusion.
An intravenous infusion is defined as the delivery of fluids through a vein using a needle or similar device.
The following legitimate medical uses of intravenous infusions are not prohibited:
- Emergency intervention including resuscitation;
- Blood replacement as a consequence of blood loss;
- Surgical procedures;
- Administration of drugs and fluids when other routes of administration are not available (e.g. intractable vomiting) in accordance with good medical practice, exclusive of exercise induced dehydration.

Injections with a simple syringe are not prohibited as a method if the injected substance is not prohibited and if the volume does not exceed 50 ml.
D18 2015 Monitoring Program (Including nicotine) – FOR INFORMATION ONLY
In order to detect potential patterns of abuse, nicotine is currently on WADA’s Monitoring Program. It is not WADA’s intention to target smokers, rather to monitor the effects nicotine can have on performance when taken in oral tobacco products such as snus.
Nictoine is one of several stimulants included in the Monitoring Program, along with the narcotics hydrocone, mitragynine and tramadol. Out-of-competition use of glucocorticosteroids is also included.

SECTION E.
RFL Medical Policies
E1 Blood Borne Infectious Diseases - Guidelines - MANDATORY
This section should be read in conjunction with the relevant Operational Rules relating to Blood Borne Diseases Section E7.1.
Medical, coaching and/or playing staff who fail to comply with these Guidelines may be referred to the RFL Compliance Department for disciplinary action.
The aim of the guidelines below is to prevent the spread of disease via infected blood and other bodily fluids. The guidelines cover the following:
- Matches and Training - Bleeding Injuries
- Team Areas
- Blood contamination
- Equipment Guidelines
- On and Off Field Treatment of Bleeding Wounds
- Hepatitis B Vaccination

E1a MATCHES & TRAINING - BLEEDING INJURIES
It is the players’ responsibility to report all wounds and injuries in a timely manner, and their responsibility to wear appropriate protective equipment.
If a player suffers a cut at training or during the course of a match, the player(s) must leave the field as soon as practicable and the following procedures will apply:
a) During Matches
In the presence of a clearly visible amount of blood on a player’s jersey or other clothing or on a wound dressing or padding applied to any body part, the Player must leave the field of play for the jersey/dressing to be changed before he can be allowed to return to play to avoid the risk of transfer of infection.
Blood Bin Procedure – FAILURE TO COMPLY CONSTITUTES MISCONDUCT
The following procedure will apply in all cases where a Player is bleeding on his person, clothing or equipment has been contaminated by blood
If the Referee notices a bleeding or blood contaminated Player he will immediately stop play and call ‘time-out’ and signal to the Physio to attend to the Player.
The Physio will immediately enter the field of play to assess whether the Player can be quickly treated on the field or whether he will require treatment off the field.
If the Physio advises that the Player can be treated on the field, the Referee will instruct the player to drop out behind play for that purpose and the match will immediately recommence.
If the Physio advises the Referee that he will have to treat the Player off the field, the match will not restart until the player has left the field. The Player may be interchanged, or alternatively the team can elect to temporarily play on with 12 players. (Note: other than for the initial assessment, the match will not be held up while the bleeding player receives treatment or is interchanged).
If the Referee stops play twice for the same player and the same wound, the Player must be taken from the field for treatment and either interchanged or the team may elect to play on with 12 players until the bleeding player returns.
If a bleeding player has left the field for treatment and is not interchanged, he may return to the field of play at any time provided he does so from an on-side position. If the bleeding Player has been interchanged, he may only return to the field through the interchange official as a normal interchange player.
A bleeding player returning to the field of play who has not been interchanged, is not to be regarded as a replacement/interchange player and therefore may take a kick for goal. Conversely, a bleeding player returning to the field of play who has been interchanged may not take a kick for goal at that time.
Stitching
Any Player who is bleeding and requires treatment by way of either stitches, stapling or otherwise, must be taken to the team dressing room or medical room so this procedure can be conducted out of the view of the general public. After the treatment the wound must be bandaged or covered to protect the injury and to eliminate the risk of further bleeding and to prevent