Leading Canadian Health Organizations’ new recommendations call for concussion protocols

OTTAWA – New hard-hitting recommendations by the Canadian Concussion Collaborative call for an end to the haphazard approach to current concussion management for all sports and sporting events in Canada. The recommendations, outlined in the British Journal of Sports Medicine, are calling on all sport organizations and sport event organizers to implement a concussion management protocol.

The recommendations, supported by nine leading health and sport organizations that comprise the Canadian Concussion Collaborative (CCC), were developed in response to the growing health risk athletes face every time they step onto the field of play of a high-risk, contact sport, such as hockey, football, soccer or basketball.

“Concussion in sport is a public health problem and a major concern for those involved in high risk sports,” says Dr. Pierre Frémont, Chair of the CCC and Associate Professor, Faculty of Medicine, Université Laval.  “We know that when appropriate concussion management protocols are in place, the number of actual properly identified concussions increases five-fold. This occurs because coaches, parents, players and health care providers are properly educated on recognizing symptoms and knowing what to do. Without such a protocol, many concussions are going unnoticed and untreated and therefore, participants are at risk of longer term negative consequences.”

To galvanize action, the Collaborative published two key recommendations in the September issue of the British Journal of Sports Medicine.

The following two recommendations outline the key elements of an effective concussion management protocol and the important role a multi-disciplinary health team can play in helping manage concussions, particularly in high-risk sports:

1. Organizations responsible for operating, regulating or planning sport and sporting events with a risk of concussion should be required to have in place, and annually review, a concussion management protocol based on current best practices, customised for the specific sport and available resources.  Best practices include (but are not limited to) planning for education, knowing the steps to take should a concussion occur, and ensuring that all resources are current and accessible.

2. In situations where timely and sufficient availability of medical resources and/or trained and licenced health professionals qualified for concussion management are not available, health professionals from various disciplines should work together to improve concussion management outcomes by facilitating access to medical resources and relevant expertise where appropriate.

“When it comes to sports, we invest in safety elements for the fields, structures, lights, and change rooms and we buy equipment, but we also need everyone involved in sport to work together to develop safety policies to properly manage concussions, from prevention to return to play and beyond,” says Dr. Frémont. 

“Concussion can be a complex injury and there are a variety of healthcare professionals that can assist with its management and prevention,” says Dr. Kathryn Schneider, Researcher and Physiotherapist at University of Calgary’s Sport Injury Prevention Research Center.

Sport organizations aren’t equipped to prevent concussions

A recent survey paints a worrisome picture of sport organizations and their readiness to effectively deal with concussions. 

A poll of sport organizations (national and provincial sport organizations [NSO and PSOs], and clubs) who represent concussion-prone sports, found that only 41 per cent of 44 organizations surveyed had concussion management protocols in place.  Of the 14 NSOs and PSOs with a concussion protocol, only a few make it mandatory for their member organizations to have a concussion protocol in place. 

“No Canadian should engage in high contact sport, at school, on a competitive or recreational club, without a concussion management protocol in place,” says Dr. Charles Tator, member of the CCC and Professor in the Department of Surgery at the University of Toronto. “Our national and provincial sport bodies need to lead by example and develop these protocols together.”

According to three studies conducted over the last 10 years, most concussions, especially if they are identified early and managed properly, will resolve within seven to 10 days.  The implementation of concussion management protocols can contribute to the early identification and better management of concussion to help limit further brain damage.

All those involved in sport have a role to play

All stakeholders have a responsibility to support the development and implementation of concussion management protocol in sport.  The recommendations are meant to guide the following stakeholders in their commitment to implement a concussion management protocol:

Federal and provincial governments:
Governments, through their relevant ministries, should establish requirements through policies or legislation for concussion management in high-risk activities at all level of participation.

National and provincial sport organizations:
NSOs and PSOs, especially high-risk sports, should have concussion management policies in place.  NSOs can work with their PSOs and any member clubs to guide them through the process of developing/adapting provincial policies. PSOs should require member clubs to have a protocol in place in order to qualify as a member in good standing.

Community level clubs:
Even if it is not a requirement from their PSO, clubs should have a protocol in place which includes educating their coaches, parents, and players on each aspect of the protocol.

Schools/school boards:
Schools/school boards offering organized sports should develop and implement an integrated sport and academic concussion management protocol and develop and implement concussion management approaches for concussed students regardless of the context of injury or level of participation.

Parents:

• Parents should ask sports clubs / organizations about their concussion management protocols and think twice about letting their children engage in recreational, club-level or elite-level contact sport if there is no concussion protocol in place.
• Parents should understand their role as part of an effective concussion management protocol.

Coaches and trainers:

• Alongside parents, players and teachers, coaches and trainers should encourage their clubs / organizations to produce an organization-wide concussion management protocol.
• Coaches should look for educational opportunities to develop concussion related skills as they can play a central role in the early detection and safe management of concussions.
• Trainers should understand their role as part of an efficient concussion management protocol.

Health care system/professionals:

• Concussion experts have an important role to play in the development and adaptation of innovative and multidisciplinary concussion management approaches that will improve quality of care for concussed Canadians.
• Education efforts should continue to better prepare primary care and emergency resources for concussion management.

The Canadian Concussion Collaborative
The mission of the Canadian Concussion Collaborative is to create synergy between organizations concerned with concussions to improve education about concussions and the implementation of best practices for the prevention and management of concussions.

Members include: The Canadian Association of Emergency Physicians (CAEP), The Canadian Academy of Sport and Exercise Medicine (CASEM), The Canadian Centre for Ethics in Sports (CCES), The Canadian Medical Association (CMA), The Canadian Paediatric Society (CPS), The Canadian Physiotherapy Association (CPA), The College of Family Physicians of Canada (CFPC), The Ontario Medical Association Sport Medicine Section (OMA) and Parachute (includes the former ThinkFirst).

Available Resources:

• Recommendations for policy development regarding sport-related concussion prevention and management in Canada 
• The Canadian Concussion Collaborative (CCC) webpage (accessed Sep 2014).
• Guidelines for Pediatric Concussion
• Concussion Awareness Training Tool (CATT)

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About the Canadian Paediatric Society

The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,300 paediatricians, paediatric subspecialists and other child health professionals across Canada.