New federal concussion guidelines are a step forward but what will impact be without enforcement?

New federal concussion guidelines are a step forward but what will impact be without enforcement?

By Dave Korzinski, Research Associate

On July 28, the federal government, in partnership with Parachute Canada, a non-profit organization founded to educate Canadians about minimizing preventable injuries, released its first “Canadian Guideline on Concussion in Sport”.

The document – a guide for athletes, parents, coaches, officials, teachers, trainers, and licensed healthcare professionals – is designed to explain the proper protocol if and when an amateur athlete appears to have sustained a head injury.

Given how likely to hide injuries young athletes have been proven to be, this is an important step toward their protection. The absence of a protocol in schools, for example, has been blamed for the deaths of young athletes, including both 13-year-old football player Zachary Lystedt in the United States and 17-year-old rugby player Rowan Stringer in Canada. Both athletes succumbed to second-impact syndrome after a first – undiagnosed – concussion was followed by another in a short period of time.

When the Angus Reid Institute studied the issue last year, we noted a growing awareness among parents, who were much more likely to have taken their child to see a doctor for a concussion than they were to have seen a doctor themselves for the same injury:

Alongside this growing awareness, however, is an apparent call for more involvement from government. More than eight-in-ten Canadians (83%) said concussions were “very serious”, and in need of more attention from policymakers. It appears that some attention is now being paid, but whether it makes an impact is yet to be seen.

A policy guide Canadians welcome

The Parachute report contains seven guidelines for stakeholders, focusing on areas such as education, assessment, care, and readiness to return to play, with the goal of creating a consistent approach for amateur sports organizations and school districts across the country. Parents and educators – many of whom are skeptical of the judgement of youth sports organizers – will welcome many of the elements included in the guidelines.

In fact, more than half of Canadians told ARI that “too many” parents (57%) and coaches (58%) would allow a child under their care to return to play too soon after a concussion.

Further, seven-in-ten Canadians (72%) say they would support requiring a certified trainer or health professional to be present for all organized youth games. Guideline four suggests just this.

Even greater support is found for guideline number five – “return-to-play” policy (also known as “return-to-sport”). This strategy is designed to help athletes gradually increase activity, with markers for progress in place, so they can return to their school and sport activities in a safe manner. Nine-in-ten Canadians (92%) said they supported this type of measure.

Will guidelines be sufficient without enforcement?

So, what’s missing? An enforcement mechanism. When the Angus Reid Institute asked, two-thirds of Canadians (65%) said their provincial government needed to get involved in regulating these procedures to better protect young athletes.

Each policy option canvassed in the poll was presented as being “required,” rather than offered as best practice or recommendation. Nine-in-ten Canadians (92%) say they support it being a “requirement” that coaches be educated on concussion as a condition of their coaching eligibility. The same goes for requiring young athletes to receive medical clearance to return to their sport. Nine-in-ten (92%) say this should be obligatory.

The question is, how successful can concussion policies be without a mechanism for punishment of those who do not follow the guidelines? To date, no government in Canada has a policy with a punitive framework in place. Two provincial governments have gone further than the federal government, but perhaps not as far as is needed.

Last June, Ontario became the first province to adopt concussion rules for youth sports when legislators passed Rowan’s Law. This, after high school rugby player Rowan Stringer died from a second concussion the day after her first. “Nothing can stop me!” she texted her friend the night before her death. But the Ontario legislation only mandates an advisory committee to make recommendations based on the findings of the inquest after Stringer’s death. What would enforcement action look like if the same incident were to happen again? It’s not clear.

Manitoba’s legislature introduced the Concussion in Youth Sport Act in May of this year. If passed, it will ‘require’ return-to-play protocols in all provincial sport organizations and schools, as well as annual training for coaches on concussions. Each organization must submit its own return-to-play policy to Sport Manitoba Inc. for review, and if judged insufficient, will have a specified time frame to amend its policy. Here as well, according to Rochelle Squires, the minister responsible for sport, no penalties for non-compliance have been put forth.

While proponents, including former NHL star Eric Lindros, continue to call for more action, no other province has a youth sport concussion policy in place. The appetite for greater legislative efforts appears to exist among Canadians, but to this point, action has been either absent or incomplete.


Editors’ note: The stories in this Analysis section are opinion pieces. They reflect the views of their authors, not those of the Angus Reid Institute as an organization.