Welsh prop Tomas Francis should have been 'permanently' removed from England game after head injury

Welsh international Tomas Francis should not have been returned to the pitch after sustaining a head injury during Wales' Six Nations clash with England, a review has concluded.

Prop Francis was involved in a tackle that resulted in a clash of heads during the game at Twickenham on 26 February.

He temporarily left the field to be assessed by the match day doctor, who deemed him fit to play following completion of the Head Injury Assessment (HIA).

But the decision to send him back on - and to play him again in a subsequent match against France on 11 March - received widespread criticism.

The Six Nations HIA review concluded that Francis "should have been immediately and permanently removed from play".

It said this did not happen due to a number of factors, but it would not be taking any disciplinary action.

A statement from the panel read: "The panel highlighted that it had the benefit of time for review of the video footage and the other materials at length, without any match-day pressure, and also had access to more camera angles and clips than the match-day medical team.

"The HIA review panel made no recommendations in respect of disciplinary action against those involved in the relevant incident, and Six Nations Rugby Limited will not be taking any subsequent disciplinary action."

Former Welsh rugby international Alix Popham, who was diagnosed with early onset dementia, said it sends "a shocking message" and said "the protocols are not fit for purpose".

Popham suffered 100,000 sub-concussions over the course of his 14-year career.

"It's a bit of a joke really. It was clearly a concussion, he shouldn't have gone for a HIA, and to pass that just shows that the protocols are not fit for purpose and not putting the player's health first," he said.

"It's just shocking that this is still going on, and getting Tom Francis back on the pitch was all they wanted to do.

"For him to go back on after passing a HIA and putting him at risk - because we all know what happens with second impact syndrome and the devastating impacts that can have - I just can't understand it."

Second impact syndrome happens when the brain swells rapidly shortly after a person suffers a second concussion before symptoms from an earlier concussion have subsided.

Popham continued: "There have been a few deaths of younger players in schoolboy rugby where they've had a concussion, they've been looked at and they've gone back and had another impact to the head which has ultimately killed them.

"This is why if there's a possibility they've had a concussion they need to be pulled off and put the player first and not winning a game of rugby."

He described how Francis was let down by the staff around him.

"From having impact, you don't know where you are, you can see that evident in the clips that he was all over the shop, he couldn't get to his feet.

"But ultimately you trust the bubble around you and that's the support staff, and for them to say he's okay to go back on, you believe in that, but it's not the right decision.

"Also you've got to remember these guys and women are gladiators - they don't want to show any weakness or take a backward step - so this is where it needs to be taken out of their hands and protocols that are safe put in place."

Popham added that the incident is "very upsetting".

"I know concussions are going to happen in a contact sport, but once they do they need to be given the correct rest time and not played a week later.

"It's not just this instance with Tom Francis, it's happened in a couple of other games recently and that's on the biggest level with millions of eyes on the situation, so what's happening at club level, premiership level and further down?

"We need to show and set an example for everybody else to follow."

The Welsh Rugby Union said it "does not - and will not - compromise on player welfare", adding that it cooperated fully with the review.It said: "Our medical personnel are very experienced and we completely support all of their actions during the England v Wales Guinness Six Nations match, which were entirely appropriate and in accordance with all the relevant protocols.

"They were unsighted to the incident involving Tomas Francis in real time and, as had been agreed prior to the match, Francis was removed from the field of play to undertake his HIA with the independent match day doctor.

"This was duly performed and Francis was deemed fit to return to the field of play by the independent match day doctor following completion of the HIA.

"We are committed to continuing to work with Six Nations, World Rugby and other unions in respect of these matters."

A WRU spokesperson also added: “We are saddened by the accounts of former players and their families and appreciate that it is not easy to speak so candidly about their own personal circumstances.  We care about every member of the rugby family.

"We support World Rugby’s six-point plan to cement rugby as the most progressive sport on player welfare.  This commitment has former players at its heart but has also driven evidence-based moves to enhance player safety through science, technology, laws and research progression."