Minister’s Year Five Progress Report on Rowan’s Law (Concussion Safety), 2018

Minister’s message

I have attended sporting events across Ontario over the past year and observed first-hand the impact of Rowan’s Law.

Posters at provincial championships have promoted Rowan’s Law, raising awareness of concussion safety among athletes, parents, coaches, officials and volunteers. As one example, organizers of the 2023 IIHF Women’s World Hockey Championships in Brampton prominently displayed the Rowan’s Law “Hit. Stop. Sit.” advertisement in the CAA Centre, reminding both fans and participants of concussion protocols.

The last Wednesday in September has been designated as Rowan’s Law Day. Schools, hospitals and sport organizations hold annual events to raise awareness about concussion safety. Iconic Ontario landmarks such as the CN Tower, Niagara Falls and the Big Nickel are lit up in purple — Rowan’s favourite colour — in honour of her memory. These are all part of the ongoing campaign to raise awareness among Ontarians of the importance of concussion safety.

My ministry has added to its existing efforts by now prioritizing concussion data collection, surveillance and analysis. We are working with our colleagues at the Ministry of Health to examine readily available concussion data sources that could be publicly reported. My ministry is also working with provincial sport organizations to determine how they can best collect and report their own concussion data as it may provide insights on how we prevent concussions in sport. Concussion data collection and surveillance is complex, and we continue to make progress in this area.

As we mark the sixth annual Rowan’s Law Day, I reflect on, and am encouraged by, how much has been accomplished. Almost all 21 recommendations of the Rowan’s Law Advisory Committee are on-track to be implemented by March 2024. This is a significant achievement, one that would not have been possible without the Rowan’s Law Advisory Committee and the Rowan’s Law Concussion Working Group. Thank you to the members of these bodies for the significant time and effort that you have contributed towards realizing the implementation of Rowan’s Law. I also want to recognize the many contributions of community partners, non-government organizations (NGOs) and Ontario’s sport organizations.

Eleven of the 13 provinces and territories are implementing an annual concussion week or day during the last week of September in coordination with Rowan’s Law Day. This significant accomplishment signals the move towards a national harmonized approach to sport and recreation concussion prevention and awareness. This progress is a result of the ongoing collaborative efforts of the Federal-Provincial/Territorial (F-P/T) table responsible for sport, physical activity and recreation. At the February 2023 Conference of F-P/T Ministers in Prince Edward Island, I reiterated Ontario’s commitment to work in partnership with our federal, provincial and territorial counterparts to continue to make sport and recreation concussion prevention, awareness, detection and management a priority for the table.

I am confident that by working together, we can ensure that athletes in Ontario and across Canada can participate, train and compete in a safe, inclusive and welcoming sport environment.

The Honourable Neil Lumsden
Minister of Tourism, Culture and Sport

Rowan’s Law background

Rowan’s Law (Concussion Safety), 2018 (“Rowan’s Law”, “the Act”) is landmark legislation, the first and only of its kind in Canada.

Thanks to the hard work, determination and dedication of Rowan Stringer’s family, the Rowan’s Law Advisory Committee, countless sport organizations, schools, coaches, volunteers and administrators, Ontario is now a world leader in concussion prevention, awareness, detection and management.

Rowan’s Law has changed the culture of sport in Ontario. Every athlete is safer because players, students, coaches, officials, team trainers, educators, spectators, and families better understand the vital role they play in recognizing the signs and symptoms of a concussion and reducing the pressure to continue playing with a head injury.

Since September 2017, the Government of Ontario has worked to address the 21 Recommended Actions brought forward by the Rowan’s Law Advisory Committee in response to the Rowan Stringer Coroner’s Inquest Jury Recommendations.

Implementation of Rowan’s Law

Year one

September 2018 to September 2019

11 recommendations implemented:

• July 1, 2019: sections of the Act and Regulation came into force: mandatory education (for example, concussion awareness resources), codes of conduct, proclamation of annual Rowan’s Law Day (in force March 7, 2018) and minister’s progress reports (in force September 25, 2019); related amendments to the Education Act proclaimed (Recommendation #1)
• Evaluation of Policy and Program Memorandum (PPM) 158 in schools (Recommendation #4)
• Codes of conduct (Recommendation #5)
• Annual concussion training for coaches (Recommendation #8)
• Coach’s tool kit (Recommendation #11)
• Teacher candidate exposure to concussion awareness (Recommendation #12)
• Concussion website (Recommendation #13)
• Sustained marketing and awareness campaign (Recommendation #14)
• Annual concussion awareness education event in schools (in PPM 158) (Recommendation #16)
• Established mandatory concussion education for relevant school staff (in PPM 158) (Recommendation #17)
• Creation of Concussion Partners Committee (Concussion Working Group) (Recommendation #21)

Year two

September 2019 to September 2020

Two recommendations implemented:

• Updated Policy and Program Memorandum (PPM) 158 for school boards (tied to amendments made to the Education Act as part of Recommendation #1)
• Developed concussion education modules for students for delivery in schools (Recommendation #15)

Year three

September 2020 to September 2022 (extended due to COVID‑19 pandemic)

Five recommendations implemented:

• January 1, 2022: remaining sections of the Act and Regulation pertaining to removal-from-sport & return-to-sport are expected to come into force (Recommendation #1)
• Field of Play Inspection Guidelines for sport organizations (Recommendation #6)
• Concussion spotter tool for higher risk sports (Recommendation #7)
• Confirmed existing codes should be used when submitting claims to OHIP (Recommendation #10)
• Enhanced professional development for health care professionals (Recommendation #18)

Year four

September 2022 to September 2023

Three recommendations in progress:

• Ministry of Health to collate and share concussion incidence data annually (Recommendation #2)
• Amateur sport delivery partners should collect and report concussion incidence data (Recommendation #3)
• Investment in electronic data collection/sharing tool about incidents at field of play (Recommendation #9)

Ongoing:

• Work with Federal-Provincial/Territorial (F-P/T) partners towards achieving a national harmonized approach to concussions in school/non-school environments (Recommendation #19)
• Work with Indigenous partners to support goals of increased safe participation in amateur sport and concussion management (Recommendation #20)

To date, Ontario has completed 18 of the 21 recommendations put forward by the Rowan’s Law Advisory Committee and the remaining 3 recommendations are currently in progress.

Recommendations in progress

The remaining three recommendations related to concussion data collection and analysis are in progress:

Ministry of Health (MOH) to collate and share concussion incidence data annually (Recommendation #2)

The Ministry of Health is continuing to explore options on how to utilize existing data (for example, data from emergency departments and health care visits) and national surveys to support the development of a public report on concussion incidence in Ontario. Further work is required to determine any limitations of using the data.

Amateur sport delivery partners should collect and report concussion incidence data (Recommendation #3) and investment in electronic data collection/sharing tool about incidents at field of play (Recommendation #9)

MTCS is working with higher-risk provincial and multi-sport organizations (PSOs/MSOs) to acquire their own electronic data collection tool to report concussion data to the ministry and plans to implement this program in 2023 – 2024.

Year four achievement highlights

Sport concussion prevention, awareness, detection and management across Canada

Ontario is the leading jurisdiction in the country in concussion safety and has worked collaboratively with its F-P/T partners in this area. As the only Canadian jurisdiction with legislation specific to concussion awareness and prevention in sport, Ontario continues to advocate for a pan-Canadian, harmonized approach to concussion safety.

The issue of concussions in sport is a standing item at the Federal-Provincial/Territorial (F-P/T) Conference of ministers responsible for sport, physical activity and recreation. Progress has been made over the past few years in sport concussion prevention, awareness, detection and management. Annual concussion awareness days/weeks in September have been designated in 11 of the 13 provinces and territories in coordination with Ontario’s Rowan’s Law Day. In addition, most provincial and territorial governments now require funded sport organizations to have a concussion policy, including Return to Sport protocols, or are working towards implementing requirements.

Enhancing concussion curriculums for medical professionals

MOH has requested that the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC) review and enhance, as necessary, accreditation requirements regarding concussion awareness, diagnosis and management. MOH also requested that the RCPSC and CFPC consider developing, where needed, accredited educational programs/modules on these concussion-related topics.

The CFPC conducted a careful review of the Rowan’s Law Advisory Committee report recommendations and has made steady progress in including concussion awareness, diagnosis and management in its mandatory curriculum and accreditation process over the past couple of years:

1. In CFPC’s assessment objectives for certification in family medicine resource document (revised 2020), concussion management is included.
2. CFPC has developed, accredited and disseminated continuing professional development resources on concussion:
   1. Sports and exercise medicine member interest group of the CFPC
   2. Canadian Family Physician podcast
   3. Concussion related question/answer in the CFPC self-learning August 2022 package
   4. Concussion webinar for the 2023-2024 practical talks for family talks webinars
3. CFPC has certified concussion programs:
   • Extension of Community Healthcare Outcomes (ECHO) concussion
   • Dalhousie Continuing Professional Development webinar program approach to concussion
   • ICBC injury support webinar series: Concussion Management and Osteoarthritis, Medical Cannabis, Mood Disorders, Elder Care, Concussions, Exercise and Pregnancy and Pain Management
4. CFPC contributed to the creation of the roadmap for development and implementing concussion management policies and protocols, as part of the Canadian Concussion Collaborative

Annual sharing of concussion information to health care providers

MOH will be sharing up-to-date concussion information with health care providers annually to help raise awareness of available concussion protocols and resources.

Resources to support concussion safety in schools

Schools across Ontario continue to host annual concussion awareness events on Rowan’s Law Day to engage students, staff, coaches, and parents/guardians in activities that increase awareness of concussion safety and share Rowan Stringer’s story.

With support from the Ministry of Education, the Ontario Physical and Health Education Association (Ophea) continues to update and maintain the concussion protocol and safety resources to support concussion awareness, prevention, detection, and management in Ontario schools. This includes an updated e-learning module on concussion safety for school staff and the Rowan’s Law Day school toolkit to support concussion awareness and knowledge building for the school community. The resources are made available and promoted to all schools, including private schools and First Nation/federally-operated schools.

Enhancing Coaches Association of Ontario’s Coaches’ Concussion Toolkit

MTCS provided the Coaches Association of Ontario (CAO) with $50,000 in funding to enhance their existing ‘Coaches Concussion Toolkit’. The toolkit includes an interactive video outlining the duties of a ‘designated person’ and how to implement the Removal-from-Sport and Return-to-Sport protocols. The 15-minute video also directs coaches to resources and tools such as templated letters, forms and concussion awareness resources.

Rowan’s Law Concussion Working Group

The Rowan’s Law Concussion Working Group was established in response to one of the recommendations contained in the Rowan’s Law Advisory Committee Report.

The working group’s mandate is to provide advice to the Ontario government in implementing the recommendations of the Rowan’s Law Advisory Committee.

Members were invited to participate because they have knowledge, expertise and/or experience in injury prevention, public health and/or amateur competitive sport.

The ministry thanks all the members of the Rowan’s Law Concussions Working Group (current and former) for their significant contributions and dedication to the health and safety of all Ontario athletes:

Current members

• Dr. Dan Cass, executive vice-president and chief medical executive, Sunnybrook Health Sciences Centre (Chair)
• Dr. Allison Chris, Associate Medical Officer of Health, Toronto Public Health
• Pamela Fuselli, president & CEO of Parachute, a national charity dedicated to preventing injuries
• Warren Hoshizaki, director of education, District School Board of Niagara
• Paul Hunter, CEO, Wheelchair Rugby Canada
• Susan Kitchen, former executive director, Coaches Association of Ontario
• Jennifer Knox, school principal, Peterborough, Clarington and Northumberland CIS
• Drew Laskoski, former president, Ontario Athletic Therapist Association
• Eric Lindros, retired NHL hockey player, member of the Hockey Hall of Fame and advocate for concussion research, care and awareness
• Chris Markham, executive director & chief executive officer, Ophea
• Fran Rider, president & chief executive officer of the Ontario Women’s Hockey Association
• Gordon Stringer, Rowan Stringer’s father
• Dr. Charles Tator, leading educator and researcher dedicated to neurosurgery and the study of injury prevention and recovery from concussions
• Elisabeth White, nurse practitioner, Neurosurgery Outreach, The Hospital for Sick Children, with a role of educating the public on traumatic brain injury

Former members

• Todd Anderson, mixed martial arts (MMA) referee and police sergeant with the Regional Municipality of Niagara
• Kent Bassett-Spiers, CEO, Ontario Neurotrauma Foundation
• Louise Logan, former president & CEO of Parachute Canada, a national charity dedicated to preventing injuries
• Dr. Rosana Salvaterra, former medical officer of health, Peterborough Public Health

Action items status