:
Welcome, everybody. We're delighted you're here.
This is the health subcommittee on sports-related concussions. Pursuant to the motion by the standing committee that was adopted on October 4, 2018, we started our proceedings and we have heard from many witnesses. We commenced with Ken Dryden, who has done extensive work on concussions, and listened to parents, coaches, experts and everybody in between. It has been quite eye-opening for us.
Today we have the federal-provincial-territorial concussion working group. I think they can tie it all together for us in terms of the pan-Canadian work they've done. With us today are Jocelyn East and Greg Guenther.
As well, from the Canadian Standards Association, we have Nancy Bestic and Dr. Patrick Bishop.
Before I turn over the floor, I will ask the members for unanimous consent, which I think I have gotten before, to continue through the bells if they start ringing, as we might have votes up in the House. We'll run up, get our votes done, and come back down to hear from the witnesses.
Thank you.
You now have the floor. We'll start with Nancy and we'll go across. I don't know if everybody has a statement to make.
:
Thank you, Mr. Chair and honourable members. We appreciate the opportunity to address the subcommittee today. We would like to express our support for your work in studying sports-related concussions.
My name is Nancy Bestic, and I am Director of Health and Safety Standards at Canadian Standards Association, operating as CSA Group. With me is a CSA Group volunteer member, Dr. Patrick Bishop. Dr. Bishop, a professor emeritus at the University of Waterloo, serves as chair of the CSA technical committee on equipment for ice hockey. He will provide his own perspectives on the topic of concussions, not necessarily those of CSA Group.
In our remarks, we would like to highlight the following key points. First, we will provide some background on CSA Group. Second, we will summarize our activities regarding protective sport equipment and the concern for concussion intervention. Finally, we will identify some future concerns and offer recommendations that may help guide this subcommittee's work.
CSA Group was established 100 years ago, in 1919, and it continues to be Canada's largest accredited standards development organization. We're a member-based association serving business, government and consumers with over 3,000 published standards and codes in more than 50 subject areas, including health care and well-being, public safety and worker safety. Our mission is to enhance the lives of Canadians through the advancement of standards in the public and private sectors. The technical and management standards developed with our 10,000 members help improve safety, health, the environment and economic efficiency in Canada and beyond.
Specifically related to sport and injury prevention, CSA has developed standards since the 1970s to help protect against head and face injury for hockey and other sports, such as lacrosse, ringette, skiing and snowboarding. A series of four standards address helmets and face protectors for their ability to withstand impact trauma to the head, to fit properly, to avoid penetration by pucks and sticks, and to stay on the head during play. These standards, which are systematically reviewed and updated, are referenced in Canadian legislation. Hockey Canada has mandated the use of helmets and face protectors certified to the CSA standards for use in hockey under its jurisdiction. Such certified products have been most successful in reducing the risk of catastrophic head injury and reducing eye injuries. We are now revisiting the helmet standard to address the concussion issue—more specifically, to determine whether we can find a way to help mitigate the problem.
:
Thank you, Mr. Chair and honourable members.
I, too, would like to highlight a few key points as they relate to head trauma in sport.
As you already know, concussion is a complex injury caused by rotational motion of the brain. In hockey, there are four ways in which a player can be concussed by these rotational forces, namely, a shoulder or an elbow to the head, a collision with the boards, a collision with the ice or a puck to the head. I will return to this in a few minutes.
Concussion is not a new injury in sport. In the early days of head injury research, studies were concerned with what were then called “closed head injuries” sustained mainly in assaults and auto accidents. The injuries involved loss of consciousness without skull injury and the patient usually survived. These were concussions, and plenty of athletes sustained such injuries.
Today, concussion is defined by symptoms other than loss of consciousness, such as headaches, memory loss, motor dysfunction and other related signs and symptoms.
Because hockey players wear helmets to protect against catastrophic injury such as skull fracture, subdural hematoma and so on, there's an expectation that helmets should also play a role to protect against concussion. However, concussion in hockey—unlike in football—has many mechanisms, as I mentioned earlier. Reducing injury risk against all of these mechanisms is indeed a challenge.
CSA Group members have been working diligently to try to determine whether helmets and helmet standards can be modified to mitigate the concussive risk. This is not a trivial pursuit, as the conditions that cause concussion—namely, trauma induced by rotational motion of the head and the ensuing strain on the brain—are difficult to reproduce in a testing laboratory and are difficult to quantify as a safety metric. Work to find possible test conditions that are suitable for testing such injury-causing situations is ongoing.
For example, CSA Group, in collaboration with the University of Ottawa, undertook a research project to examine test protocols to help limit head rotation in hockey. After a full year of work, it was determined that although much was learned in regard to the different types of concussion-causing events, additional research is needed to learn more about mitigation and the ways to offer protection.
There are certainly opportunities to investigate improvement of the protective value of such equipment, especially with the study of these rotational forces and their role in concussions. We recommend that this research be continued and expanded.
Goaltenders are another group that has experienced an increase in concussion, and we recommend that research should be undertaken on this group's unique protective needs as well.
CSA Group is an established and experienced standards development organization with a history of developing important standards on protective equipment for various sports. These have helped reduce catastrophic head and eye injuries, but the complexities of concussion require more research to determine a role for such equipment.
We welcome the opportunity to work with members of this subcommittee, particularly where standards may be needed, to find a solution that leverages the work we have undertaken with the mandate of this committee.
Thank you, Mr. Chair and honourable members, for the opportunity to address you today. We will be happy to attempt to answer any questions you might have.
:
Good afternoon, everyone.
My name is Jocelyn East.
[English]
I will do my introduction in French, and I will be happy to answer questions in the two official languages.
[Translation]
Mr. Chair and members of the Subcommittee on Sports-Related Concussions in Canada, good afternoon.
I'm Jocelyn East, and I am the manager of the new international unit on safety and integrity in sport at Sport Canada. My duties include co-chairing the Federal-Provincial-Territorial Concussion Working Group on concussions in sport. I have been doing that since the group was created in 2015.
On behalf of the working group, my colleague Mr. Guenther and I want to thank you for this invitation to come share with you, in all humility, accomplishments stemming from the hard work and dedication of members, to shed some light on your work.
It is a true privilege to be here and to have been co-chairing that working group since 2015. I feel fortunate to have contact with frontline experts and truly passionate leaders in this field who work tirelessly to make sport safer.
I would like to commend the work and dedication of all current and former members, including Michel Fafard, who was our first co-chair. I also want to pay tribute to all the victims of concussion and their families, as well as the researchers who have educated us about taking action in this area.
Since we started our work, seven members of our working group have testified before you. Their appearances show the expertise and diversity of our group and the inclusion of various sectors, such as education, health and governments, including Sport Canada, the Public Health Agency of Canada, six provinces and one territory. That is a unique situation for this type of a working group.
It is important to point out that concussions are a complex problem and a public health issue—I believe you have heard this a number of times. Concussions are not unique to sport, but sport is in the hot seat because of repeated exposure to risk. It is on that premise that the working group began its work in 2015.
In 2014, the Federal-Provincial/Territorial Sport Committee, to which we report, wondered whether governments had a role to play in this area, given the many existing initiatives.
With the help of Sport Canada, in 2015, we invited those in charge of the national sport community, health and governments to a workshop here, in Ottawa, to answer that question. The answer came very quickly: yes, governments have a role to play, and it is one of harmonizing initiatives, protocols and key messages.
Sport organizations clearly told us two things at that workshop. First, they asked us to tell them what to do and said they would do it. Second, they said they needed support from all levels of government, so that their message and the information on their activities and their policies would get to clubs and families.
As a working group, we have a mandate to provide recommendations to the ministers responsible for sport, physical activity and recreation, and we have done so on three occasions: in 2016, in 2017 and recently in 2019, in Red Deer. Our objective is clear: support the harmonization of tools to ensure that Canadians have them and know how to use them, as concussions are a collective responsibility. In all, we have provided 16 recommendations to ministers since 2016. They have all been accepted by the provinces and territories.
Of course, the greatest accomplishment is still the acceptance of a harmonized Canada-wide approach, which includes awareness, prevention, detection, management and oversight components. That harmonized approach is our strategy and remains at the heart of our actions.
We have also developed a framework for action, so that all the provinces and territories, regardless of their approach—a piece of legislation, a framework for action, a strategy—would have the essential and minimum components for moving forward and having concerted action.
In 2019, in Red Deer, following a recommendation from the working group, the provinces and territories all accepted to dedicate one day a year to concussion awareness and to develop an action plan to facilitate tool dissemination.
Through our expertise, we have supported other important projects, including the Governor General's conference on concussions in sport in 2016, Parachute Canada's Canadian guidelines, which you have heard about frequently, and the national campaign “Headstrong Canada”, which we could talk about later.
That was an overview of what the working group has done so far. You will find more details in a support document that will be submitted to you.
In closing, allow me to specify that, at the request of federal, provincial and territorial ministers responsible for sport, our working group will focus on two essential elements by 2021. First, we will work on tracking the implementation of the recommendations accepted since 2016 in order to continue to support governments in their advances, including when it comes to the Canadian guidelines, the framework for action and concussion awareness days. Second, we will work on making recommendations and implementing prevention measures by and for sport communities in order to combat this scourge.
It is with great pleasure that I yield the floor to my co-chair, Mr. Guenther, who will talk about the reality of the provinces and territories in relation to the implementation of these recommendations. Afterwards, we will be pleased to answer any questions you may have.
Thank you Mr. Chair and members of the subcommittee.
[English]
Thank you for the opportunity to present.
Jocelyn has been doing great work since 2015. I've been fortunate to join the national working group more recently as it's a portfolio I hold in the province of Manitoba.
My presentation will focus a little more on the provincial-territorial perspective to give you an understanding of how some of this work is supporting what we do.
The Red Deer recommendations, the six recommendations that came forward from Red Deer endorsed by the ministers, are a tremendous opportunity for provinces and territories to continue the good work that's been done to date in the area of concussion prevention, education, awareness and management. Some of those good things that have been done are certainly the Canadian concussion guidelines. It's a key tool that we and other provinces and territories have used as a chance for us to ensure we standardize the pan-Canadian work that we're doing. The national sport organizations are also beginning to do good work in the area of increased coach education, athlete training and prevention methods. They are starting to look more at the rules, and how rules of the game need to be altered to ensure we have a safer sport experience.
Absolutely, the work on prevention needs to continue, and sport needs to take a leadership role in this area. It's really important in increasing the ongoing network of coach training, rule changes, equipment adaptations and facility management that make sure the sport environment is safe. The national sport bodies, NSOs, have a big role to play there.
In terms of the enhanced awareness, the leadership and work being done in the PT jurisdictions, many of the provinces and territories are now looking at the protocols that have been developed nationally and we're starting to see more provinces and territories come on board to adopt them. That is tremendous news because it ensures we're all singing from the same songbook.
Parachute is leading the work with the national sport organizations and has done a great job in the last year in making progress in that area. Jocelyn mentioned the national “We Are Headstrong” campaign. It is available to all the national, provincial and territorial sport bodies, and the messages of recognize, remove, refer and return are really important messages we need to get to everyone in the sport community. We've often heard, “When in doubt, sit them out”. But once they sit out, where do we go from there? That's really important.
We're starting to see the concept of the creation of provincial-territorial sports-specific concussion working groups fall into place. Specific to my experience in Manitoba, we have created a working group. It includes sport medicine practitioners, physician expertise, provincial education representatives and experienced sport administrative staff. It has allowed us to make significant progress with our provincial sport governing bodies in the area of adopting concussion protocols.
The other thing the FPT working group has provided is the opportunity to share best practices and the opportunity to learn from good things that are happening from one province to another. It is a tremendous achievement that we can be proud of.
It's important to note that the work being done at the national level does help provinces and territories in moving toward a consistent harmonized approach, and again that we're all using the same tools.
One of the challenges we face at a provincial-territorial level is ensuring collaboration among sport, education and health. I think everyone can appreciate those portfolios reside in each province and territory, so it's really important that the communication is open and collaborative.
The other thing is that parents and athletes need help in navigating the health care system when they need care. That is an area we need to work on.
Many valuable tools have been developed around education and awareness. If you think about a national team, a university or a provincial team program, where they have access to comprehensive care through an integrated support team and medical practitioners, many tools can be used, but those models don't work at the community level.
The reality of a community sport team or a community-level coach is very different from someone who has access to a physician, physio, AT and so on. We need to keep that in mind. As has been mentioned here before, drilling down to the community level, it is really a challenge, because we rely heavily on a volunteer sector to deliver community-level sport.
It's really important to end on a positive note, though. How far we've come in such a short time is really something we should be proud of in terms of some of the recommendations that have come forward. It's a tremendous opportunity to work with all the sectors, including education and health, towards the issue of prevention. Many folks have said, “We've talked about what we do when it happens, but how can we stop it from happening?”
There are good examples in terms of a number of national sport bodies—rugby, basketball, volleyball and hockey, just to name a few—that are already doing good work in this area of addressing how they might be able to ensure prevention is looked at.
The endgame has to be active for life; that's what we want for Canadians. We need to be smart and practical in our approach, because community sport is large, complex, and again, functions with a high number of volunteers. I speak from my own perspective, but in what we think sometimes is possible from our office, we always need to remember how we can implement in a realistic and cost-effective manner. We have lots of great conversations in my shop, but we always need to think about how we're going to do this in terms of delivery.
Thank you very much. I'm happy to answer any questions during the question period.
:
You've had a couple of good ones in the past.
The issue of surveillance is really a critical thing in Canada because it's not ongoing. There is a surveillance system run by the major Toronto hospitals in the country. I think it's called CHIRPP. However, they only see a fraction of the trauma that is seen in sport because most of the time the injured party doesn't have to go to that trauma unit.
Keeping track of this kind of data is kind of a hit-and-miss affair, and it only takes shape when somebody decides they should collect injuries for three years. They do that. They do a nice job of it and make a report, but the report is issued two years after the last injury, so you're two years behind already. You can see trends, though. Then the surveillance stops, and we don't see it again for another 15 or 20 years, or until somebody is doing a Ph.D. or a master's degree and is interested in concussions in water polo or something.
It's an issue, really. I know that Hockey Canada, through their insurance program, tries to collect data, but again, it has to be an injury that requires insurance intervention. If it doesn't require insurance intervention, it doesn't necessarily get reported.
The CSA has an audit program where, if there is a faulty helmet and an individual is injured because the helmet's cracked or something, that gets reported to CSA and then down to the manufacturer, but that doesn't happen very often.
:
Thank you for the question, which is excellent.
Our main recommendation to the subcommittee is really to ensure that your report will build upon what has been done. You heard from various witnesses throughout the winter.
It is really essential to recognize all the work that has been done, with its strengths and its weaknesses, as we know that it is not complete. It must provide value added and take into account these recommendations, for example. That may be the so-called “umbrella” recommendation, if I may call it that. It is certain that, for the five components of the harmonized approach, there is still work to be done. It's a matter of supporting sport organizations and ensuring that harmonization takes place. So message dissemination remains a major challenge to be addressed. Mr. Guenther mentioned it a few times. In fact, nationally, things are being done, but they must continue to be extended to the entire system. In terms of sport, those key messages must be disseminated.
Another recommendation is to stimulate the partnership in each province and territory between sport, education and health. We saw this in Manitoba and in New Brunswick; provinces are starting to have those working groups. That is fundamental, as each has its own reality, but each has its responsibility in terms of concussions.
There will be more recommendations in our document.
Ladies and gentlemen members of the committee, good evening.
My name is Andrew Campbell, and I am the senior assistant deputy minister at Canadian Heritage for the sport sector. Sport Canada falls under my responsibility and continues to be a key component of Canadian Heritage where our mission is to ensure Canadians participate and excel in sports. Within this mission, the health and safety of all participants in sport, not only high-performance athletes, is a key priority for us.
Over the years, I have been seized by the issue of concussions and impressed by the strong engagement not only of Sport Canada, but of the sport sector as a whole, along with the health and education sectors, and the provinces and territories, which are indispensable, as it has been said.
Indeed, five years ago, concussions were not a priority. However, let me be clear in saying that, while we have made many strides in addressing this public health issue, there is still work to be done. But today, I would like to highlight some of the accomplishments made by Sport Canada in order to help you identify remaining gaps and recommendations for moving forward.
[English]
First, I'm pleased to report that Sport Canada has been monitoring this issue since 2009, and we're seeing increased consciousness throughout the country around the scope of the concussion issue. In 2009 it seemed to be just within the professional sport sector. Shortly thereafter, in 2011, during the sport leadership conference in Toronto, Sport Canada was involved in the organization of a workshop with Dr. Charles Tator and another one around our 2010 Vancouver games Olympic medallists. This represented our first initiative to sensitize the sport community as a whole to the issue of concussions and to highlight the need for action.
At this point, Sport Canada embarked on a robust collaborative work with provinces and territories. The federal-provincial-territorial sport committee and the sport, physical activity and recreation, SPAR, committee allow us to work closely with all provincial and territorial governments and experts in addressing issues in the sport sector, as you saw earlier today.
Sport Canada is the co-chair of the federal-provincial-territorial sport committee and the sport, physical activity and recreation committee, and through this mechanism, in addition to managing Canada Games, we also address matters that emerge regarding our sport governance, including harassment, abuse, and in this case, concussions. We're very proud of the solid, multi-sector partnership that we've developed in managing concussions, and it is within these fora that the vital decisions on nationwide policies and their relevant implementation are made.
To support the work of this federal-provincial-territorial coordination, Sport Canada hosted the first multi-sector consultation in January of 2015. 2015 also marked the issuance of respective mandate letters for the Minister of Sport and the Minister of Health, who respectively indicated the importance of directing efforts towards the development of a pan-Canadian strategy on concussions.
I'd like to underline that our collaboration with the health sector, represented by the Public Health Agency of Canada, has been crucial in helping us to move this yardstick in both sport and society. My colleagues from PHAC will highlight the important work they have supported.
I also want to highlight that we are working with the education sector through the joint consortium for school health, and that we are building stronger collaboration to reach the school sport system to disseminate required information.
Further, during the 2017 conference of the Council of Ministers of Education, Sport Canada provided a presentation in which we showcased our work on concussion management in sport.
Another foundational event that represented outreach to the wider public was the 2016 Governor General's conference on concussions in sport hosted at Rideau Hall. This event represented a huge success in raising awareness and outreach to communities across the country to emphasize the importance of working together to harmonize our work in this area.
Sport Canada's work also includes a close relationship with 56 national sport organizations and several multi-service sport organizations, some of which have appeared in front of this committee.
Since 2016, Sport Canada has been working alongside Parachute Canada to facilitate their work with the national sport organizations in developing and refining their return-to-sport protocols and to ensure that they are aligned with the Canadian guidelines on concussion referenced in previous sessions.
To ensure dissemination of this extensive work, in 2017 we hosted another conference to highlight the work on management and detection of concussions. This work was done with the support of the Sport Information Resource Centre. During that event, we also launched with the SIRC the “We Are Headstrong” national campaign. That campaign, aligned with the Canadian guidelines from federal-provincial-territorial work, was designed in consultation with the sport sector ranging from those at the national level to those in smaller communities. These stakeholders underscored the desire to ensure that the communication on concussion management remains clear, simple and instructive on crucial steps to follow, from the moment an athlete or player receives a blow to the head to the return to sport activity. The “We Are Headstrong” campaign focused on four key general principles to apply to a suspected concussion: recognize, remove, refer and return.
I just presented a list of different activities that Sport Canada has taken on, which demonstrates the scope of Sport Canada's contribution to the wide-ranging management of concussion in sport, including the areas of awareness and detection. Resulting from discussions on pan-Canadian harmonized approaches, which you have heard about already at the committee and in the previous presentation, we have identified that we still have work to do in the areas of surveillance and prevention of concussions.
On the surveillance front, the sport community has indicated that it will be difficult for them to conduct thorough data collection since the type of personal data resides in the health domain. The sport sector has also identified to us a lack of capacity to sustain data collection due to the limited capacity of those who undertake the work. I think, as highlighted earlier, the sector is primarily voluntary.
This is not to suggest that the sport sector should have no involvement in the surveillance component, but at this point the federal-provincial-territorial SPAR ministers have indicated that Sport Canada should discuss with the Public Health Agency of Canada how to enhance the existing systems that my colleagues from the Public Health Agency will describe to you shortly.
We will also explore with the sport community how they can contribute to enhance the surveillance within their reality, given the constraints of the sport system. This will be part of the work that Sport Canada does moving forward.
At the federal-provincial tables, and with Sport Canada, consensus around the next focus for the sport sector has emerged, and this focus is that of prevention of concussions. We have come to a point that the next big logical step is one that the sport sector does own, and that is prevention. It's also an area in which the sport community can show a huge amount of leadership throughout society.
[Translation]
As you heard from my colleagues from the Federal-Provincial-Territorial Working Group on Concussions, we must turn our focus to prevention and consider this through the vectors of rules of the game, training methods and behaviours.
As part of our next steps, all federally funded sport organizations will be required to incorporate a concussion policy in their operations, covering all components of the harmonized approach. This policy will include the return-to-sport protocols developed with Parachute Canada.
[English]
As you can see, collectively and with a significant amount of coordination at the federal-provincial-territorial level and across government organizations, we have done a lot to address concussions, but we still have work to do. This work is mainly in the area of prevention and in ensuring the sharing of knowledge from the national level down to the club level.
Let me thank you again for inviting us here today. It's a privilege to share with you these facts and to answer your questions.
:
Mr. Chair and honourable members, thank you for the opportunity to address this committee regarding the role of the Public Health Agency of Canada on sport-related concussions. As mentioned, I'm pleased to be joined by my colleague, Andrew MacKenzie, who is the Director of the Behaviours, Environments and Lifespan Division team with the Centre for Surveillance and Applied Research in the Public Health Agency of Canada.
As we've heard, playing sports is part of a healthy and active lifestyle. Regular activity in childhood develops physical and mental health and reduces the risk of chronic diseases later in life. Those include type 2 diabetes, cardiovascular disease, as well as some forms of cancer. However, there are risks.
Concussion in sport is a recognized public health issue because of the frequency of occurrence, as well as the potential short- and long-term consequences, including sometimes tragic outcomes.
[Translation]
Our role is to: support Canadians to be more physically active in safe and responsible environments; conduct surveillance of chronic diseases and injuries, including traumatic brain injury and concussion; invest in the development of guidance, protocols and tools; and, increase concussion awareness among Canadians.
[English]
In 2015, the Minister of Health and the Minister of Sport and Persons with Disabilities were mandated to support a national strategy to raise awareness for parents, coaches and athletes in concussion treatment.
Budget 2016 allocated $1.4 million to the Public Health Agency of Canada to harmonize concussion guidelines in collaboration with provinces and territories, focusing on helping students and athletes return to school as well as to sport.
[Translation]
In June 2016, the federal, provincial and territorial ministers responsible for sport, physical activity and recreation acknowledged concussions as an important public health issue that requires collaboration between sport, health and education sectors.
[English]
Ministers asked officials to develop a plan to harmonize the efforts of governments and stakeholders, leading to the creation of the federal-provincial-territorial concussion working group that you heard from earlier. The Public Health Agency of Canada has been a member of that group.
In July 2017, ministers endorsed the framework for action in five key areas: awareness, prevention, detection, management and surveillance.
Here is a bit more about what PHAC's role is in this. From a surveillance perspective, to help us understand the scale and scope of the problem, the Public Health Agency of Canada collects data on traumatic brain injuries—including concussions—and monitors changes over time. This includes data from an emergency department surveillance system from 11 pediatric and eight general hospitals across Canada. We know that children and youth suffer a disproportionate number of these injuries, particularly while participating in sports and recreational activities.
Our recent surveillance data indicates that there are 46,000 children and youth between the ages of five and 19 diagnosed in emergency departments with concussions in 2016-17. Boys typically have higher rates of concussion for most sports in an age group as compared to girls. Among them, ice hockey, rugby and ringette are the sports with the highest proportion of traumatic brain injuries, including concussion.
Now I'll speak a bit about tools for Canadians.
In 2016, we recognized the need for better and consistent information, tools and resources for athletes, their parents, their coaches and teachers, as well as the health professionals who care for them.
To help address this gap, the Public Health Agency of Canada funded Parachute to convene experts to develop guidance and tools to prevent, identify and manage concussions. These include the “Canadian Guideline on Concussion in Sport”, published in July 2017. It outlines parameters for prevention, identification and management, as well as return to activity.
[Translation]
Return-to-school and return-to-sport protocols were released in spring 2018 to support the safe return of students and athletes to their learning and sport environments.
[English]
It also includes online training for health professionals, which aims to increase their knowledge of the awareness, recognition and management of concussions. Links to these materials are available on our website, as well on Parachute's website.
The guideline and related protocols form the foundation for subsequent awareness tools and resources. After that guideline was developed, the Public Health Agency of Canada also conducted public opinion research to better understand what Canadians know about sport-related concussions. We learned that there were significant knowledge and awareness gaps about concussion among parents, coaches and teachers, as well as health care professionals.
For example, half of respondents indicated they had little or no knowledge about concussion. One quarter of respondents did not know how concussion was treated. Only 15% could correctly identify the best treatment.
[Translation]
Only four in 10 respondents were aware of available concussion resources such as the Canadian guideline on concussion in sport, and the return-to-school and return-to-sport protocols.
[English]
Budget 2016 also provided funding to support the development of additional practical tools and resources for parents, coaches, athletes, teachers and health professionals.
A few more examples include the “SCHOOLFirst” handbook, which is a concussion tool for teachers and school administrators on how to support students and athletes in their return to school, and the Progressive Activation and Concussion Education app, which is available for use on Apple or android phones. It outlines step-by-step instructions for children and youth, parents and coaches on how to identify and manage a suspected concussion, as well as how to manage the safe return to school and to sport.
[Translation]
The Public Health Agency of Canada has worked closely with Sport Canada to create a website on concussions on canada.ca. It includes easy to read information, an infographic, basic information on concussion and links to other online tools, like the ones I mentioned earlier, all in one online location.
[English]
In terms of results to date and looking ahead, I'm pleased to say that over the last few years our partnerships with the sport, health and education sectors across Canada have led us to create a suite of harmonized concussion tools for parents, coaches, athletes, teachers and health professionals. Building on our ongoing surveillance work, we will continue to work with these sectors to increase awareness of these tools and monitor their use.
In the coming months, the Public Health Agency of Canada looks forward to working with Sport Canada, as well as other partners, to share results from a second round of public opinion research that included a focus on understanding what youths' views were in terms of awareness, knowledge and access to resources; enhanced concussion prevention and management in primary and secondary schools; strengthened concussion prevention, identification and management in sports by working with Sport Canada and others; and further increasing the uptake of those resources and tools for parents, coaches, athletes, teachers and health professionals in communities across the country.
[Translation]
I believe that, through collaboration and harmonized concussion approaches, we will be in a position to provide better support to children and youth where they live, learn and play.
[English]
I'd be pleased to answer your questions.
[Translation]
Thank you very much.
:
Thanks to all of you for being here.
I'm going to stay a little bit on Darren's line here, because you gave me questions that I wanted to ask.
On that aspect of taking it to the provincial areas and the school bodies besides the national sport organizations, you've talked about education. That's what we heard a lot of from Mr. Stringer. We heard “education, education and education” and how it's important.
The mandate letter talked about a strategy to “raise awareness for parents, coaches, and athletes” on concussions. The trouble is that I don't see education for parents and coaches.
We hear a lot about it. In my professional career, I went to a lot of meetings. I sat through great meetings and learned an awful lot, but when I walked out of them, I always asked myself what I could take back to my office. In this case, what can we take back to the parents and to the kids who need to learn this at a young age?
I'm not hearing it, so I'm wondering if you can give us some examples of what you're doing. What I'm hearing is that you're talking to the administrators. You're not talking to the coaches and the parents.
:
Thanks for that, Andrew.
Just to add to that in regard to the notion of putting all the information in one place, that was not the case a number of years ago. This is information to go onto the concussion page on Canada.ca in terms of what is a concussion, understanding the new resources that are available, and having the surveillance data in one place, along with all of the resources that Parachute has developed, including return to sport and return to school protocols as well.
Second, we do know that intermediaries matter. Student athletes and parents will go to the school, to the coach and to their physician to get that advice, and the consistency of the advice and that information is really important. It's a problem that we were trying to solve. A lot of that has been improved with the new tools that are available. Again, working with those organizations that have the audience of the professionals in those different sectors is a really important piece.
Again, the last is practical tools based on where people live, work, learn and play. As an example, for the mobile app, you don't need to be sitting behind your computer. It's on the field if you're at a game, so you can be starting to look at some information, as well as monitoring the signs and symptoms.
:
That is the advantage of doing research based on public opinion.
As I said, we carried out a study a year and a half ago. It focused on the general public, parents, coaches, educators, as well as health professionals. It was a matter of measuring knowledge, generally speaking, on concussions in order to take action when a situation arises and provide access to tools. That was an initial survey.
We carried out another study last winter. We are currently analyzing it, so we don't have the final results. This time, we also questioned young people. We asked them the same questions to see what they think. We had three sets of questions to establish a comparison. I feel that this helps us understand the issue.
It is true that, in every context, there are very different situations, but there is incipient openness. In other words, it is not just a matter of telling people to use the tools they have. We are really also trying to understand the attitudes on this issue. That was brought up earlier. It is one thing to have information, but it is another to apply it, be it in the health sector, in a school or at home.
There is another aspect we have not yet discussed. When a situation occurs in a school or in the sport community, there is a team spirit aspect involved. Research has taught us how certain players may react.
[English]
They don't want to let their team members down, so they may not let on that they're not feeling quite on.
[Translation]
We are talking about elements of this kind, but that is truly an overview. We are not there yet, but this helps open the door a crack.
Thank you.