Great steps have recently been taken in Ontario's schools to manage concussions among students. The rest of Canada should take notice and follow suit to keep our kids safe.
On Jan. 30, 2015, Ontario will become the only province to have an organized plan to deal with concussions that occur at school. It's called the Policy/Program Memorandum No. 158 School Board Policies on Concussion (PPM 158) of the Ontario Ministry of Education, and I am proud to have contributed to its formation.
A considerable number of concussions in kids and adolescents occur at school. Exact numbers are difficult to come by, but it's estimated that about 25 per cent of concussions occur among children aged six to 18. In provinces the size of Ontario, the number would be in the tens of thousands. So it's imperative to try to reduce the number of concussions at school and expertly manage those that occur.
Under PPM 158, all 72 school boards in Ontario will be required to have concussion programs in place to educate parents, students, teachers and coaches about concussions and policies to manage them. I applaud the province for this initiative and the fact that it is catching up to other jurisdictions on dealing with this problem.
Various countries have taken steps to deal with concussions in schoolchildren. Most U.S. states have enacted so-called concussion legislation. It may surprise you, as it did me, that there are laws to manage this type of brain injury. In general, these laws make it mandatory for schools and athletic organizations that offer sports for children and adolescents up to about age 18 to have programs to prevent concussions; strategies to educate parents, teachers, students and coaches about concussion; and strategies to manage those that occur.
The most important features are removal of the student from the game or practice when a concussion is suspected, and clear guidelines that every concussed athlete or student should be examined by a physician or other health-care professional. Notice that the rules do not put the responsibility for diagnosing concussion on teachers, only the awareness and suspicion that the participant may have been concussed. The actual diagnosis is left to a medical expert.
That's all we're asking of schools and teachers – awareness and action. The rest should be left to medical professionals.
Most concussion laws also include "return to play" requirements for students – guidelines on how to safely allow a concussed student to start playing sports again, and then to monitor his or her progression to full play. Some legislation goes further and includes recommendations and guidelines about when and how to return a student to school after a concussion. Ontario's new policy covers these tough issues, so essential for the management of concussed kids.
Research indicates that during adolescence, the brain is most susceptible to trauma – making it even more important that we deal effectively with prevention and management of concussion in schools. Ideally, the principles in Ontario's policy will also become the norm for dealing with concussions that occur outside school, especially in collision sports such as hockey and football.
Throughout most of the United States, concussion legislation covers organized sports both in and out of schools. Fortunately, organizations such as Hockey Canada and Football Canada have begun to make their own systems for concussion management.
To my knowledge, no Canadian province or territory has plans to enact concussion legislation, but Ontario's PPM 158 is a good first step. And which is better – concussion legislation or a policy such as Ontario's? The answer is not yet known. The Canadian Sports Concussion Project at Toronto Western Hospital is researching this question, but it will be a few years before we have answers.
Meanwhile, amid growing recognition of the effects of concussion in the developing brain, I hope that some form of concussion policy or legislation will be present in all provinces and territories in the next few years. There is no reason to wait. A great model will soon exist in Ontario, ready for adoption by the rest of Canada.
Dr. Charles Tator is a neurosurgeon at the Krembil Neuroscience Centre of Toronto Western Hospital and the research lead for the Canadian Sports Concussion Project which is studying the long-term effects of concussions. He is also the founder of ThinkFirst, now part of Parachute Canada, a national non-profit organization dedicated to the prevention of brain and spinal cord injuries.