Subcommittee on Sports-Related Concussions in Canada Committee on April 10th, 2019

[Dr. Patrick Bishop]

It's a very interesting question. I did consult with the member of the NHL who sits on our technical committee and asked him if I could get some data. It had to be minimal data on numbers, types and where they were struck. His first response was, “I don't think they'll release that to you, but I'll try.” His second response was, “I was right the first time; they won't release it to you.” We're in the dark until such time as they make something known to the general public.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You bring up an interesting point. One thing we've heard throughout the study is a question of data: collecting that data, how accurate it is and how easy it is to obtain, with issues of privacy, etc. There are a number of apps out there that do that sort of thing, which allow for the trainers, the doctors, etc. to share that information.

I'll put this out to all of the panel. Are you aware of any data or programs that you think are of value? We've heard of a number of different ones out there. Obviously, everyone has an idea, and their idea is the best. How do we, as a committee, take in all that so we can formulate a way, without picking somebody specifically? The moment we put a label on one particular organization, now that group starts to champion who they are.

[Dr. Patrick Bishop]

That's also a good question.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I learned from the best.

[Dr. Patrick Bishop]

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.

[The Chair, Liberal, Peter Fonseca]

Thank you.

We're going to be moving now to the NDP and Ms. Hardcastle.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Thank you everyone for your intriguing contribution to this subject. You know that we're exploring what an effective means would be for the government to look at the emerging issues, with diagnosis, treatment and prevention. You can go off on all these different paths for each of those intriguing things. I appreciate the spirit of collaboration, and you understand how important that is in how we get what we know to trickle down.

My first question will be for the CSA. Maybe everyone would like to weigh in on this.

We know that our protective equipment, as we have it today, even as up to date as it is, doesn't reduce all the risks. As a matter of fact, this committee has heard that sometimes it makes athletes more vulnerable to serious injury—this gladiator effect, or this idea that you're invincible or that someone has this equipment on and can take a certain kind of hit.

We can get into whole social theories of sport and all that stuff, but how do you think we proceed and balance that? What possibly could the context be? How could we measure and get a handle on both of those phenomenons? What do you suggest or see from your past experiences as a way that we should be moving forward?

[Dr. Patrick Bishop]

I think you're absolutely correct that sometimes when you develop protective equipment it gives a false sense of security to the wearer.

In fact, I think this has happened in ice hockey, where the increase in concussion, in my history of it, has been related to making better helmets. The idea isn't to take the helmets off or to make helmets that aren't as good; it's to educate the players, the coaches, the parents, the administrators and the whole community that this is to protect against certain types of injuries and is not intended to give licence for a free-for-all.

That educational aspect is critical. At the CSA, of course, our job is to write the standard, and then another group certifies it, but we do ask the governing bodies to take care of the education and administration part.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Does anybody else want to weigh in on that?

[Jocelyn East]

What you are talking about is this cultural shift that we've been hearing about since the beginning of the work of this committee. This cultural shift obviously needs education. People need to understand that protective gear is there to protect, not to become a weapon. That's very important. We also know there are several myths regarding concussions that need to be destroyed. People need to understand that these are myths.

As part of the cultural shift, you have all the gear, the behaviour, the rules of the game and the training method as well. People need to understand that within sport that's what sports hold; I mean, they own the rules of the game, the rule book, the training methods and the behaviour. Sport can look at this. It's part of the prevention aspect that we want to push moving forward. This will help in the training and also in the education of people.

In my given sport, that gear is great and you need to have it, but you have to behave in a certain way as well, to ensure that you protect yourself and are protecting others.

I don't know if you want to comment, Greg.

[Greg Guenther]

I was just going to make one other comment that I found very interesting yesterday.

I received a social media message about a new tool that athletes could wear to prevent concussions. I think we're going to see a lot more of that.

An organization like the CSA can help us in the messaging to moms, dads, athletes and coaches as to the validity of some of these tools, because they're arguably bogus science. That's a concern: that there will be a lot of people trying to take advantage of the business side of concussions.

[The Chair, Liberal, Peter Fonseca]

Thank you.

We'll move over to the Liberals, with Madam Fortier.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Thank you very much.

My first question is for Mr. East.

Regarding the whole issue of harmonization, what do you think are the challenges we should focus on with the provinces, territories and the federal government? How should we operate, or what aspects should we focus our energy on to address harmonization?

[Jocelyn East]

Thank you for the question.

There are two main vectors in harmonization: the sport community, and provincial and territorial governments. That is why national sport organizations have told us they needed support in the process from provincial and territorial governments. They were not really talking about financial resources. That is not what they meant. They were really talking about tools, by which we mean education tools, return-to-play protocols, key messages and prevention, as well as awareness messages on what should be done when a concussion occurs.

So harmonization lies in those practices. That is where the issue was when the working group began operating. The issue is on a downward trend, but it still exists. There are always new tools, and it is clear that people want to do the right thing. They want to develop tools that will benefit the community the most. However, our fundamental principle has always been that the development of those tools depends on scientific research, which is evolving considerably and at lightning speed. So it is a matter of ensuring that research bears fruit, influences the health field, which, in turn, influences the sport sector. We can then disseminate those tools through different networks. So it is truly our anchor.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Have you looked into any existing legislative frameworks or laws? For example, Mr. Stringer, Rowan's father, did a good job of presenting to the subcommittee the piece of legislation enforced in Ontario. If this is something you have looked into, do you think it could be harmonized across the country?

[Jocelyn East]

The position the working group has always adopted on laws, which the members have of course discussed, is that they are part of the toolbox. A piece of legislation is part of the toolbox. If a group is not doing what it should be doing, using the legislation can become an option. However, as we represent six provinces and one territory, each with its cultural distinctions, we are focused on the principled approach. Each administration has the power to decide what is best in relation to its culture and its context. That is why the framework we have developed is based on fundamental principles. Be it a piece of legislation, a framework for action or a provincial strategy, we want to ensure that those fundamental principles are reproduced.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

We know that you have 16 recommendations. Do you have any for us? Can you guide us toward specific potential solutions on which we should focus in our study? In your opinion, what should we prioritize in our work right now?

[Jocelyn East]

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.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

I just want to make sure, Chair, that we have those 16 recommendations in our tool box.

[The Chair, Liberal, Peter Fonseca]

The analyst is saying no.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Could we ask you to submit them to us?

[Jocelyn East]

Yes, they are in the document we will submit to you.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

That's great.

Thank you very much, Mr. East.

[The Chair, Liberal, Peter Fonseca]

We'll move over to the Conservatives for about three minutes or so and then we're going to suspend and go up for votes and then we'll be right back.

Dr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I'm appealing to the researching minds amongst you. I haven't kept up with the research on the issues of mouthguards and prevention. I'd be interested to hear about any update as to where we might sit with that or any new research or research that's saying no to the value of that.