This document summarizes a lesson on concussions and public policy. It discusses concussions as a major public health issue and outlines current concussion policies in Ontario, including Rowan's Law and PPM 158. It reviews research on the impact of these policies, specifically increased concussion reporting and identification in schools. However, it notes disconnects between research and policy implementation. It concludes by recommending continued concussion research, improved education, common data collection, and evaluation of policy impact to advance concussion prevention and management.

1. Concussions
&
Public Policy
Felicia Corrado & Megan McBride
July 2, 2021
MPHA 5P06 Policy and Practice
Topic: Mental Health

2. Lesson Format
25 mins
1. Lesson Video
5 mins
2. Infographic
25 mins
3. Assigned Readings
(2)
3 mins
4. Rowan’s Law Video
Optional
5. Discussion
Question & Videos

3. Learning
Objectives
1. Understand what concussions are and
their impact on health
2. Recognize concussions as a public health
issue
3. Gain an understanding of existing
concussion policies and practices
4. Explore the disconnects between the
available research and policy
5. Understand how we can use concussion
policy, practice, and research to improve
population health

4. Concussions
What are they and why are they a
public health issue?

5. Concussion Education

6. Impacts of Concussion “It took me very long to
understand what people
were saying. It took a
long time to process
things in my head and I
had to think really really
really hard.”
“If I wanted to do
something or achieve
something, I have always
been able to do it if I try
really hard. But I couldn't
so that was a step back. I
was pretty depressed.”

7. Concussions: A Public Health Threat
● Concussions are a major public health concern due to the large population at risk of
experiencing one and the limited diagnostic and treatment options available
● Concussion can have severe repercussions such as second impact syndrome (SIS)
which can be fatal
● Concussions are the most common form of head injury and represent a significant
burden of injury to Ontarians
Data Snapshot:
● 200,000 concussions annually in Canada (Brain Injury Canada, n.d.)
● 46,000 diagnosed concussions in children & youth aged 12-19 (Government of Canada,
2020)
● ED visits for concussions have significantly increased (Public Health Ontario [PHO], 2020)
○ 63.7 visits per 100,000 in 2003
○ 242.5 per 100,000 in 2018

8. Current
Concussion
Policy

9. Concussion Policy: A Provincial Context
● 2017: Canadian Concussion Guidelines completed & distributed representing the world’s first
national sports concussion guideline (Tater et al., 2019)
● Ontario is the world leader in concussion management and prevention
● Ontario is the first jurisdiction in Canada to pass concussion safety legislation
● Ontario concussion legislation: Rowan’s Law

10. Rowan’s Law
Named for Rowan Stringer, a high school rugby player from Ottawa, who died in the spring of 2013
from Second Impact Syndrome (SIS) - swelling of the brain caused by a subsequent injury that
occurred before a previous injury healed.
Enacted by the Ontario government in March 2018, making it mandatory to:
1) Ensure that athletes under 26 years of age, parents of athletes under 18, coaches, team trainers
and officials confirm every year that they have reviewed Ontario’s Concussion Awareness
Resources
2) Establish a Concussion Code of Conduct that sets out rules of behaviour to support concussion
prevention
3) Establish a Removal-from-Sport and Return-to-Sport protocol
(Government of Ontario, 2020)

11. PPM 158: School Board Policy on Concussion
● The Ministry of Education provides concussion policy direction through Program/Policy
Memorandum (PPM) 158
● To address concussion safety across school boards and school activities, PPM 158 requires
the development and maintenance of a school board concussion policy
1. The Ministry of Education updated the Concussion Policy PPM 158 for school boards in July
1, 2019 to be consistent with Rowan’s Law
2. Health and Physical Education curriculum in grades 1-12 have been revised to increase
concussion education in the classroom.
○ Students learn what concussions are, how to prevent them, how to detect them, and
what to do if they suspect a concussion has occurred.
(Ministry of Education, 2020)

12. Concussion
Policy
Evaluation
Research

13. School-Based Concussion Trends
Trends in Concussions at Ontario Schools Prior to and Subsequent to the
Introduction of a Concussion Policy (Matveev et al., 2018)
● Concussion studies are limited re: rates and proportions of concussions due to underreporting and
under-diagnosis
● 30% increase in the monthly rate of concussions presenting to the ED
● Proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016
● Percent of all diagnosed concussions occurring at schools increased throughout the study
reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium
(22%) or sports field (20%)
 The introduction of the PPM may have contributed to a general increase in concussion
awareness and an improvement in concussion identification at the school level in children
and youth aged 4–18

14. Informing
Practice
from
Research &
Policy

15. Disconnects from Research to Policy
● Even in places where legislation and policies exist to address concussion safety and ease
the return to learn transition, implementation remains problematic
● Revised and updated PPM 158 from the Education Act of Ontario, directs concussion
training and awareness to sports-related activities conducted by school boards in the
province rather than the full range of a concussed student's life in school.
○ Concussion training is only required for ‘relevant’
school staff
(Choudhoury et al., 2020)

16. Implications for Public Health Practitioners
Much of the current action on concussions in Canada pertains to concussion awareness and
identification, post-concussion management and guidelines for returning to school, work and
sports. This identifies a gap for public health organizations to focus on concussion prevention
(PHO, 2020)
● Based on Government of Canada’s Concussion: Sport and Recreation report (2020):
○ 1 in 2 have little or no knowledge
○ 1 in 4 do not know how concussion is treated
○ 15% can identify the best ways to treat concussion
○ 4 in 10 know how to find information and other resources

17. Moving Forward...
● Concussion awareness has increased dramatically in the last 10-15 years.
○ However, public opinion research by the Public Health Agency of Canada
indicates that there is still work to be done.
● A subcommittee on sport-related concussions in Canada submitted 13
recommendations to the Federal Government regarding considerations for ongoing
concussion development.
● If you’d like to review all 13 recommendations, here is a link to the report*:
https://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP10528875/hesa
rp24/hesarp24-e.pdf
*This is not part of the required readings for this lesson

18. Recommendation 1
Moving Forward: Federal Recommendations
Establish a common data collection system or process on concussions in sport.
Ensure a cultural shift on safety in sport.
Establish a Concussion Awareness Week to coincide with Rowan’s Law Day in
Ontario in September.
Recommendation 12
Recommendation 13

19. Moving Forward: Our Suggestions
for Next Steps
● Continued concussion research is required to assess the effectiveness of PPM 158 and
Rowan’s Law in terms of prevention of concussions and education.
● Concussion management strategies that include a dissemination and education strategy that
keep all stakeholders informed and engaged regarding the concussion management protocol
on a periodic basis.
○ To address the significant knowledge and awareness gaps regarding concussions
among parents, coaches, teachers, athletes as well as health care professionals.

20. Key Takeaways
● Concussions are a public health crisis; they’ are the most common form of head injury and
represent a significant burden of injury to Ontarians
● Concussion policies include Rowan’s Law & the subsequent amendment of the Education Act
PPM158
● Preliminary research illustrates PPM158 may have contributed to a general increase in
concussion awareness and an improvement in concussion identification at the school level in
children and youth aged 4–18
● We need to: improve concussion education, establish common concussion data collection
system, shift sport culture to that of safety, evaluate the impact of concussion policy, establish
dissemination strategies within concussion policy

21. References
Brain Injury Canada. (n.d.). Statistics on brain injury.
https://www.braininjurycanada.ca/en/statistics-brain-injury#Concussion
Casey, B., & Fonseca, P. (2019). Tackling the problem head-on: sports-related concussions in Canada. House of
Commons Canada. https://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP10528875/hesarp24/hesarp24-e.pdf
Choudhury, R., Kolstad, A., Prajapati, V., Samuel, G., & Yeates, K. O. (2020). Loss and recovery after concussion:
Adolescent patients give voice to their concussion experience. Health Expectations, 23(6), 1533-1542.
Government of Canada. (2020, October 21). Concussion: sport and recreation. Health.
https://www.canada.ca/en/public-health/services/diseases/concussion-sign-symptoms/sport-recreation.html#_Monitoring_concussion_in
Government of Ontario. (2020, May 9). Rowan’s Law: concussion safety.
https://www.ontario.ca/page/rowans-law-concussion-safety
Matveev, R., Sergio, L., Fraser-Thomas, J., & Macpherson, A. K. (2018).Trends in concussions at Ontario schools prior to and subsequent
to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016. BMC Public Health 18,
1324.. https://doi.org/10.1186/s12889-018-6232-9
Ministry of Education. (2020, January 31). Healthy schools: concussion safety. Government
of Ontario. http://www.edu.gov.on.ca/eng/healthyschools/concussion.html
Public Health Ontario. (2020). Evidence brief: risk factors for concussions.
https://www.publichealthontario.ca/-/media/documents/e/2021/evidence-brief-concussion-risk-factors.pdf?la=en
Tator, C., Starkes, J., Dolansky, G., Quet, J., Michaud, J., & Vassilyadi, M. (2019). Rowan's Rugby Fatality
Prompts Canada's First Concussion Legislation. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 46(3), 280–282.
https://doi.org/10.1017/cjn.2019.15
Wiebe, D. J., Comstock, R. D., & Nance, M. L. (2011). Concussion research: a public health
priority. Injury Prevention, 17(1), 69-70. doi: 10.1136/ip.2010.031211