New rules on concussions in amateur sport come into effect July 1
Rowan’s Law mandates education, codes of conduct, removal from and return to sport protocols
Sports organizations in Ontario will soon be subject to new rules governing the prevention and management of concussions in amateur sport. Rowan’s Law (Concussion Safety), 2018, requires sports organizations to:
- ensure that athletes, parents of athletes under 18 years of age, coaches and officials confirm every year that they have reviewed the province’s concussion awareness resources (currently available in e-booklet format for ages 10 and under, ages 11 to 14, and ages 15 and up)
- establish a concussion code of conduct that sets out rules of behaviour supporting concussion prevention
- establish a removal from sport and return to sport protocol.
The first two rules take effect on July 1, 2019, while protocols for removal from and return to sport will take effect on July 1, 2020.
Rowan’s Law is named for Rowan Stringer, a 17-year-old high school student from Ottawa who sustained a concussion while playing rugby. Neither Rowan, nor her coaches or her parents realized that she had suffered an injury, so she continued to take the field. That same season, she received a second concussion, which also went undiagnosed, and then a third head injury, which proved fatal.
The groundbreaking legislation resulted from the coroner’s inquest into her death, which revealed that amateur sport in Ontario did not have the necessary practices and protocols for effectively managing concussions. It is the first law of its kind in Canada, where hospital emergency departments treat approximately 53,000 adults and 46,000 children for concussions every year, according to the Public Health Agency of Canada. Most of the concussions in children occur in sports and recreation activities, with the highest proportion coming from ice hockey, rugby, and ringette.
A concussion is a brain injury caused by any blow to the head, face, or neck. It can also be caused by a blow to the body that causes the brain to move around inside the skull. It can happen to anyone, anywhere, and in all kinds of settings. It’s not necessary to black out to get a concussion—in fact, 95 per cent of concussions do not cause a loss of consciousness, writes Dr. Charles Taylor, Emeritus Scientist with the Krembil Research Institute, in “Concussions and their consequences: current diagnosis, management and prevention” for the Canadian Medical Association Journal” (CMAJ).
People who have suffered one concussion are more susceptible to sustaining additional concussions, from which it can take longer to recover. Repeat concussions can cause the brain to swell and lead to permanent brain damage, severe disability, or death.
Signs of a concussion include:
- physical symptoms – headache, pressure in the head, dizziness, nausea or vomiting, blurred vision, sensitivity to light or sound, ringing in the ears, balance problems, tired or low energy, drowsiness, “not feeling right”
- cognitive symptoms – not thinking clearly, slower thinking, feeling confused, problems concentrating and remembering
- sleep-related symptoms – having a hard time falling asleep, sleeping more than usual
- emotional symptoms – easily upset or angered, depression, sadness, nervousness or anxiousness.
Severe symptoms that should be treated as an emergency include neck pain or tenderness, double vision, weakness or tingling in the arms or legs, severe or increasing headache, seizure or convulsion, loss of consciousness, vomiting more than once, as well as increasing restlessness, agitation or aggression, and confusion.
There is no definitive lab test or scan (such as a CT-scan or MRI) for identifying a concussion, notes Dr. Taylor his CMAJ article. He adds that there only needs to be one persistent symptom, and only a physician or nurse can diagnose a concussion after a medical exam, ideally within a few hours of injury.
The most effective way to treat a concussion is rest from both physical and cognitive activities. That means taking a break from play (including screen time), work, or school before gradually returning to normal activities. Most people get better in one to four weeks but it may take longer for children. Sometimes recovery takes months or years, and long-term problems like headaches, neck pain, or vision problems can persist. There may be lasting changes in the brain leading to memory loss, problems concentrating, or depression.
It’s important to be patient, because resuming normal activities and exercise too soon can make symptoms worse or extend the recovery period. The province’s concussion resources include guidelines that detail a graduated return to sport, highlighting the aim, activities and goals of each step. Athletes must receive medical clearance before returning to unrestricted practice or competition.
The resources also recommend five key ways to reduce the risk of sports concussions:
- ensuring athletes use sports equipment that is in good condition
- ensuring athletes wear equipment that fits properly
- ensuring athletes respect the rules of the sport
- committing to the sport organization’s concussion code of conduct and ensuring athletes do too
- promoting a safe and comfortable environment for everyone to report injuries and make sure that everyone understands the risks of not speaking up.
Rowan’s Law’s focus on preventing, identifying and treating concussions makes Ontario as a national leader in preventing and managing concussions in amateur sport. However, sports organizations, coaches, parents and athletes should be aware of potential liability risks.
The law applies to “certain sports organizations” which “could include a person or entity that carries out a for profit or otherwise prescribed activity, municipalities, universities, colleges of applied arts and technology, and other post-secondary institutions.” Sports organizations may not realize that the legislation applies to them, or how far the rules extend within an organization. Would it include a fundraising volunteer, for example, or an administrator?
It’s critical, then, to make sure that sports organizations, coaches, athletes and parents are aware of Ronan’s Law. The province’s concussion resources should be reviewed annually, and sports organizations should develop concussion codes of conduct and a removal from sport and return to sport protocol that are consistent with the province’s guidelines.