Evidence of meeting #2 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was know.
A video is available from Parliament.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Okay.
We're going to move back to the Liberals, with Mr. Eyolfson.
Doug Eyolfson Charleswood—St. James—Assiniboia—Headingley, Lib.
Thank you, Mr. Chair.
Thank you so much for coming, Mr. Dryden. It's an honour and a pleasure. Thank you for taking on this initiative; it's an important issue.
I practised emergency medicine. I was an ER doctor for 20 years before going into this line of work. We would see a lot of sports-related injuries, and we would read up on the science behind how to treat them, but also on how to prevent them. I'm sure you know there are certain medical guidelines. Of course, the big one we talk about a lot is around return to play. It's fairly well spelled out. If they don't remember the event but they weren't confused, they're off for an hour or so. The big one is that if there is a loss of consciousness, they're pulled for the season.
I'm glad you're talking about the decision-makers, because sometimes it would be a problem, first of all, getting the science to those who would make the decisions in policy, but the other challenge was enforcement. On more than one occasion, I'd be talking to a young athlete—and this would be someone who is under 18, so there's a parent there helping them make their decisions—and I'd say, “No, you are out for at least two weeks because of this.” But they'd say, “Well, we're in the playoffs. Two weeks and the season's over.” Then I'd say, “I'm very sorry, but you are pulled for the season”, and there would be the same reaction. They'd look at each other, and the athlete would say, “Okay, okay, I'm off for the season”, and I swear I'd see them wink. I know they're going to play, and I have no power to prevent it.
What are the challenges? Those of us who work with the science and know this is what needs to be done, how do we get this filtered in a meaningful way through the decision-makers, and how do we get it enforced?
Author, As an Individual
It's very interesting. It's a part of lots of discussions about this subject. You talk about the players becoming more aware, and then it's “Yes, but the players want to play.” Then you want the coaches to be more aware, and you get out the cheat sheet that tells them to ask this question, and it's “Well, yes, but it's hard to get those out to everybody because most games are fairly informal” and this and that.
It's the same in terms of the doctors. You get this awareness out to them, but then you're into these moments of, "Is he okay? Is she okay, or is she not? She's almost okay", and you get into all that. You can do a lot better in each of those areas, but you're always going to have a “yes, but” in it. You're never going to get 16-year-old, 18-year-old or 25-year-old players who are going to say, with any great frequency, “I'm done. I know I can't continue", and doctors and coaches and all the rest of it....
That's why prevention matters so much. All of those other things offer partial answers, but they have answers you can drive a freight train through. The key to it all is in terms of doing the best you can to avoid the circumstance where the player is put into that situation, where the coach, the doctor, the trainer, the parent, the on-ice official or on-field official is put into that position, because we're going to fall short. We're going to fall shorter than we need to fall.
That's why we need to acknowledge that. Always try to do better that way, but don't assume that it's going to end up being your best answer. The best answer is still going to be in how we play and in the sports decision-makers.
Charleswood—St. James—Assiniboia—Headingley, Lib.
Absolutely, but again, the return-to-play guidelines are prevention in a way. They're not the prevention of the first injury, but as we know, the effects of concussions are additive. Someone can have one concussion, a minor one, and they might go on and do well. The second concussion on top of that is worse. The third concussion is worse.
You're right, although.... They come to the emergency department when they've had their concussion, but you have means of preventing another concussion. There are some simple ideas that we don't know how to filter through. I've never actually been shown a form—because I don't think there is a policy for one—that would have to be returned to the coach with my signature and my recommendations on it. That would be a simple administrative fix where I would have a very meaningful way to say that this player is not allowed to play without this note, and that note has my recommendations.
How do we get these kinds of recommendations that we know could be effective out to the decision-makers so that it gets enforced?
Author, As an Individual
I think that's a question for you to ask the doctors and the sports administrators. I think what they will say, in part, is, “Oh my God, the number of players, the doctors, the ability to get appointments....” Whatever those answers are, at least in part they do represent answers and represent significant obstacles.
I think those are questions that you ask to find out the extent to which that represents a big part of the answer, a lesser part of the answer or even less than a part of an answer. I think that's part of the discovery that you're going through and that you have the chance to do, because you're going to be able to ask those questions of people who are attempting to apply this on the ground.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Now we're going to be moving over to the Conservatives again. It will be Mr. Nuttall.
Alexander Nuttall Barrie—Springwater—Oro-Medonte, CPC
Thank you, Mr. Chair.
There are a few things before I get going. I don't mean this as a partisan jab, Mr. Dryden, but I've heard that the greatest politicians do their best work after politics, and that's not because of your political stripes in the past, but you're taking on a serious issue.
It's interesting. I come from a hockey town, Barrie, Ontario. Don Cherry and Shayne Corson, I'm sure, would both have a major interest in this exact issue, but being born a Brit, I never could quite make it work on the ice. I literally was a fighter to play hockey at points.
I've seen it throughout all sports. I have played varsity basketball, varsity soccer. A gentleman who lived maybe 10 houses from me is a guy by the name of Gary Goodridge, who was a UFC champion and does a lot of talking on this. This has occurred to me, because I'm struggling so heavily on this subject: Where does the personal responsibility begin and the societal norms go actually against that?
If you look at the growth in sports over the past 15 years, where has it really been? I think the sports that have seen a humongous amount of growth are among the most aggressive and have the highest number of concussions. As a society, we're endorsing this. I think you're right—this committee has the opportunity to act—but as a society we're endorsing this. I want to hear your comments on that as a whole.
Author, As an Individual
I think that, if you looked at the growth of sports in the last number of years—10 years, 20 years—you would certainly see the advent of UFC, mixed martial arts, extreme sports, but if you were to look at the sports that have grown the most and get the greatest global attention, they're probably soccer and basketball. Neither of those games would be like the activities and the sports you're describing.
You watch the Olympic Games, where now it's the half-pipe and more dangerous games, but at the same time, by far the greatest number of participants in sports are not in those activities. They are in things like soccer and basketball. In hockey, the numbers are fairly stable in Canada, but they have remarkably increased in a lot of other places in the world, in particular in the U.S.
Barrie—Springwater—Oro-Medonte, CPC
I hear you completely. What I have been looking at is what you were saying earlier in terms of coaches and managers and trainers being so intimately involved in this, in ensuring that the person who is coming off the ice or the field, or is on the ice or the field, is given the right advice at that point. I've coached soccer a lot. I've seen coaches. My staff coach hockey. It's interesting, because you get training on almost everything, even social issues, training on perhaps having a transgendered person on your team, but I've never had concussion training in my life.
To your point on the trainer specifically, when I hurt my quad, I can actually fight through it and I get off the field or whatever it is and I feel the pain two days later. Your brain is not any different, but we treat it so much differently. Can you comment on that?
November 21st, 2018 / 6:50 p.m.
Author, As an Individual
Yes, and I think that a concussion or a brain injury is often described as a sort of invisible injury. In a lot of ways, it is. In the normal way in which things are visible, we look at somebody who has suffered a concussion or a brain injury, and the standard line is that he or she looks fine. You do something to your quad, and you're limping around. The other person can see that in fact you've done something, and you know you've done something.
When you are experiencing these other symptoms of depression, anxiety, memory loss and all the rest of it, your first response is to say you're just sort of down. You've been down before and no big deal. For any of these things, you have a first explanation. Then your second explanation is to ask, "What's wrong with me?" And others are kind of doing the same thing, and then things don't happen.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
We're moving to the Liberals again.
Madame Fortier, go ahead.
Mona Fortier Ottawa—Vanier, Lib.
Thank you, Mr. Chair.
Mr. Dryden, thank you very much for your testimony.
I will ask my questions in French because it is important to be able to communicate in both official languages.
I have three children who participate in amateur sports. One daughter plays soccer, and two other older children play volleyball. When you watch kids play, you see that concussions occur. Trainers are concerned at the time, and they check whether everything is okay afterwards. Parents know that it can happen.
In the report we will produce at the end of this study, what measures could we recommend as legislators or parliamentarians? If you could propose one or two measures, what would they be?
Author, As an Individual
I think the first thing I would say is that I wouldn't say it now, because you're at the start of your own journey in this. As you've described, you've had some experiences with your own children and with others you've seen. But you're going to have an immersive experience in the next couple of months, and you need to find out for yourselves. You're going to find some surprises along the way. You'll feel something that you didn't think you'd feel, and you'll think something that you didn't think you'd think, and all that.
The only thing that I would say to you is what I was trying to say at the end of my comments, in terms of listening hard, thinking hard, and then acting hard. As you move along from the athletes to the scientists and then to the decision-makers, I think you're going to have the background and the feeling where you can ask the right questions of those sports decision-makers and essentially be able to say, “You've heard about those athletes. Tell me what you are doing in your game. Your game has changed. Your game is always changing. Your game can change again.”
As I said in my comments, you are not just the custodian of your game. First and foremost, you're the custodian of those who play your game. How can you make your game a game that is so exciting and pleasurable to play, but is also safer? We need to hear an answer to that. If you say there's no answer to it, I'm sorry, but look at this sport over here and what it's trying. Look at what the other one is trying. Why aren't you trying that? It's your obligation to do that.
I don't even know enough about this to say much about it, but I've talked to some people in rugby. They have a really interesting challenge. They have a game that isn't a particularly popular game in Canada in terms of participants. They have an experience with lots of head injuries, and they can't put a helmet on it to pretend that it goes away. What do they do? The only thing they can do is look at how the game is played. They have an absolute necessity to park impossibility and to focus on possibility. What are they doing? All these things that don't fit with rugby, show me how they fit.
Ottawa—Vanier, Lib.
Another question came to me during your presentation.
You talked about scientists, health professionals and sports decision-makers. But sponsors have a great deal of influence over the sports world and are part of that environment. Businesses that sponsor sports want to see more. How do you view their participation in this discussions?
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
We're going to have to hold that until the next questioning. Maybe you can have some time shared.
We're going to move over to the Conservatives with Mr. Kitchen again.
Souris—Moose Mountain, CPC
Thank you, again, Mr. Chair.
Just to follow up, I'll go back to what I was getting at with the rural athletes. We see the challenges we have with rural Canadians in sporting events. Ultimately, what we as a committee here are being tasked to do is to identify ways in which we can make sports safer, in particular when dealing with concussions. In my opinion, it comes down to talking with those governing bodies and finding ways to interact with them.
With that said, I'd like to hear your comments on the challenges that you might see or you might have thoughts on. We will hear from doctors and specialists and so on regarding how we deal with these injured athletes, but I'd like your thoughts on whether you've looked at this from a rural or an urban perspective.
Author, As an Individual
That's a very good question.
Actually, I think it is the best of times for that now. As you know, in rural areas there's access to a whole lot more things than once was the case. Virtually everybody in the country, even in small rural areas, has access to TSN or Sportsnet. They're watching the same things. They're watching the same teams with the same frequency. They're hearing the same commentary, so a lot of those messages are getting there as they are getting to the big cities, and that's really helpful. If, in fact, in the kind of work you're doing the message goes out more and more about how to focus on making this game less dangerous, that message will resonate with those instruments, and those instruments will find their way into those communities.
The other part of it, and it goes back to what I was saying before, is about doing symposiums in small places. I knew they would work in big cities because there are always athletes and former athletes. There are coaches and former coaches. There are doctors, administrators, and these respected people within a community. What if you get into a place of 6,000, like Dryden, Ontario? How do you make that work? Actually, it was easy. Again, there are still local athletes. There are still some local doctors. Beyond there, Kenora isn't that far away, and even Thunder Bay isn't that far away. As you know, in smaller places, especially when you get into sports, they travel, so they make connections to certain larger places as well.
I think there's a very available way now to have that kind of reach. If the NHL administrators and the NHL coaches deliver a certain message, then what right will the coach in a town of 1,200 have to feel like, “Well, I don't care what anybody else says. We're going to do it the way we've always done it in our town of 1,200.” The voices that penetrate into that town from those very respected people carry a lot of weight.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
We're going to move back over to the Liberals, who will be splitting their time between Madam Fortier and Mr. Fisher.
You have four minutes.
Ottawa—Vanier, Lib.
I get a chance to have an answer.
My former question was about funding for the culture of sports. I don't know if you have a comment on that.
Author, As an Individual
When you look at the sponsorship of sports now—hockey is an example, but it could be other sports—what are the messages out there? The messages out there are usually homespun messages: the driveway, the street, the kids yelling, “Car!”. It's affectionate; it's warm. That's what is being appealed to. When you're watching the kids playing ball hockey, there isn't somebody out there who's giving somebody a shot. That isn't part of that game and it's not part of the commercial sponsors' message that they're looking to deliver.
There are some other interesting ones and they are some of the best commercials now. Instead of trying to replicate what these athletes will do on the field or on the ice, they show them in training. Everybody is used to seeing the image of them being on the ice or on the field and they look amazing. If you watch them in a gym, they are doing stuff that is impossible to do and that nobody at home could even imagine doing. That's what the commercial sponsors are attracted to.
All of these things are completely consistent with the way the game is moving, with the way you want it to move, and in a way that makes it far better, far more exciting to play, far more skilled and less dangerous.
Dartmouth—Cole Harbour, Lib.
Thank you to Mrs. Fortier for sharing her time with me.
You brought up rugby and the fact that rugby players don't wear helmets. Mr. Kitchen and I had this conversation about a week ago. We talked about what appears to be a level of respect for the players in the game because they don't have gear.
I went to a friendly rugby match in Halifax at Wanderers Grounds, between U.S.A. and Canada, and I was saying that I was amazed at the fact that they are out there competing in a game that is so absolutely physical but I didn't see an injury on the field. Now, for the most part, they have to look out for themselves.
In other sports, where there is gear, how much of an impact is that loss of respect, or perceived loss of respect, for a potential head injury because of the gear?
Author, As an Individual
It may have some role; I'm sure it does have some role. The question is, as a solution, whether it is possible to roll that back. My suspicion is that it isn't. If you come out of here and you recommend to the Canadian public that the way of resolving the worst of these injuries is to cut back on the equipment that people are wearing, I don't think you're going to get very far. To whatever extent it is true, I'm just not sure that it is the essential point.
One of the things that are problematic in this is that equipment manufacturers have been responsive and successful in a lot of ways, in terms of protecting shoulders, elbows, hips and even knees probably to some extent, but with heads they haven't. The helmet doesn't protect the head the way the shoulder pad protects the shoulder, and there is no foreseeable answer in that direction.