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The Blue-Card Rule in Australian Football: Is It Effective for Concussion Management?

Mar 10, 2025 | By Dr. Jennifer Hunnicutt

Concussion management in contact sports is an ongoing challenge. Sports leagues worldwide are constantly searching for ways to improve player safety.

In the Western Australian Football League (WAFL), a new “blue-card rule” was introduced to allow umpires to remove players from the field if they suspected a concussion.

But is this rule actually helping medical staff to manage concussions?

A new study has revealed that WAFL medical staff overwhelmingly do not support the rule, raising questions about its effectiveness. Let’s dive in and review!

What is the Blue-Card Rule?

The blue-card rule was implemented in WAFL but is not a standard across all levels of Australian football. The rule allows umpires to stop play and send a player off the field for a mandatory 15-minute medical evaluation if they suspect a concussion. During this time, a medical professional performs a concussion assessment following standard WAFL guidelines.

While similar approaches have been used in the rugby union, little research has been done on how medical professionals perceive the rule’s effectiveness in actual game-day situations.

The Research Study

A research team conducted a survey of 31 medical staff members, including doctors, physiotherapists, and head trainers in men’s and women’s leagues of WAFL. The study aimed to understand whether medical professionals found the rule useful in concussion identification. The study also explored the need for further concussion education.

Key Findings: What Did Medical Staff Think?

Lack of Support for the Blue-Card Rule – Over 70% of medical staff surveyed did not believe that the rule was helpful in identifying concussions or assisting them in making a diagnosis. Many (67%) felt that umpires were not qualified to assess concussion symptoms, leading to potential misjudgments on the field.
Need for More Concussion Education – Only 33% of medical staff felt completely confident in conducting sideline concussion assessments. These findings suggest that medical staff in the WAFL would benefit from more targeted concussion education and training before each season begins.
Players Returning to Play Prematurely – Despite the rule’s intent to enhance player safety, 69% of players returned to play during the same game even after being flagged by the blue card. Alarmingly, 44% of those who returned to play were removed a second time within the same game.

The Bigger Picture: Lessons for Other Contact Sports

The findings from this study extend beyond Australian football. Many contact sports, including ice hockey, soccer, and American football, face similar challenges in balancing player safety, medical decision-making, and in-game rules.

Key takeaways that could inform concussion policy in other sports:

Umpires, referees, and officials may not be best suited to assess concussions—more reliance on medical staff could be necessary.
Players returning too soon after a suspected concussion remains a major issue and needs to be addressed across all contact sports.
Preseason concussion education for all stakeholders (medical staff, referees, coaches, and players) is essential for improving concussion management.

Final Thoughts

This study raises important concerns about the blue-card rule in the WAFL. While well-intentioned, it appears not to be an effective tool for helping medical teams diagnose concussions, according to this research study.

As sports organizations continue to refine their concussion protocols, studies like this provide valuable insight into what works, what doesn’t, an where improvements can be made to better protect athletes.

References

Msando JR, Cowen G, Harris SA, Kirkham T, Murphy MC. Introduction of the ‘Blue Card’ Concussion Policy to Semi-Elite Australian Football: Medical Staff Experiences and Perceptions. Int J Sports Phys Ther. 2024 Dec 2;19(12):1569-1580. doi: 10.26603/001c.125794. PMID: 39628782; PMCID: PMC11611476.

About the Author

Dr. Jennifer Hunnicutt is a licensed athletic trainer with a PhD in Health and Rehabilitation Science, who has worked with all types of athletes, including professionals and Olympians. She has held prominent research positions at Emory Sports Medicine and the NBA Hawks Center in Atlanta, GA, as well as serving on the national network of healthcare providers for U.S. Figure Skating. Now the owner of Hunnicutt Writing and Consulting, LLC, Dr. Hunnicutt collaborates with global institutions, spearheading innovation and research among professionals and businesses in Sports Medicine and Orthopedics. Learn more at www.drhunnicutt.com