Evidence of meeting #4 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 education.
A video is available from Parliament.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
We'll be moving over to the Conservatives now, to Mr. Robert Kitchen.
Souris—Moose Mountain, CPC
Thank you, Mr. Chair.
Gentlemen, thank you both very much for being here today.
With the two of you here, we basically have the coaching aspect and an individual sport aspect of things. Although you interact with each other, you do have separate responsibilities. I appreciate hearing your comments and I agree wholeheartedly with everything you've said.
I'll start with you, Mr. Niedre.
On this issue, from the coaching point of view, you provide coaches with training for the multiple sports that are out there. Do you have a system or are you looking at a system for monitoring? I realize that in today's world, with computers, it's a lot easier to keep data collection on an individual and to regulate that. Do you have a system like that which you have suggested to the various sporting organizations?
Director of Education Partnerships, Coaching Association of Canada
I mentioned the number of coaches who have gone through it. We have a database of over a million coaches. Those numbers that I pulled—I have more data we can chat about—come from, basically, the contents of our national database. We have 66 sports, and all of the coaches linked to those sports are in the database along with a full record or transcript of everything they've taken. That's why I was able to produce those numbers. We know the percentage of coaches and we know which sports are making the most headway. We track all those things as part of our monitoring.
Souris—Moose Mountain, CPC
In my previous life I was a regulator for the chiropractic profession in Saskatchewan as well as for Canada. We looked at things involving regulating professionals, which is where my angle on this is.
Is there an avenue for you to do this? Obviously, there's a cost that would be added, but is there an avenue along those lines whereby you might see this as of value?
Director of Education Partnerships, Coaching Association of Canada
It's funny that you ask that. Right now we're in the midst of what I guess you could call a revamp. We're in the midst of approving our chartered professional coach profession. We are looking, from the chartered professional coach aspect, at certain different pathways to lead to it.
Has Making Head Way or concussion management come into that discussion? No it hasn't, not that I'm aware of, anyway.
Aside from the fact that we can track these things, and apart from the sports I've mentioned, there are other organizations—provincial secondary school athletic associations—that are tracking this and making it mandatory for their school coaches to have this.
That's where we are, from a regulatory body standpoint. This is not really our role. Our role is education, creating and working with our partners through the—
Souris—Moose Mountain, CPC
Your emphasis, then, is more on that aspect of it, in which case that might throw it to the individual sports per se to regulate their own individuals.
Would you agree with that? Would that be the better way of doing it?
Director of Education Partnerships, Coaching Association of Canada
We're providing education. We try to guide them. We keep a lot of statistics on what coaches report, after taking the education, to work with our sports to say that the content in the education shows that our coaches, from a self-efficacy point of view, feel more confident in managing concussions. From that standpoint, we don't legislate coaches; we work, in the national coaching certification program, with our partners.
Souris—Moose Mountain, CPC
Thank you.
Mr. Hunter, having been a rugby coach myself at one point, I appreciate your comments on tackling. To me, that is the most important thing. I learned the game in England when I was six years old, so I grew up learning how to tackle from that age.
I found, once I came to Canada, that tackling wasn't there and that we had football players coming to play rugby and not rugby players coming to play rugby. These are two different sports with two different approaches. I'm glad to hear about your approach to lowering the tackling levels. A hit to the head is a hit to the head. We knew the risk when we played the game, and ultimately it was there. As you said, the ruck is one of the riskiest parts, but tackling, I believe, is truly that aspect of it.
I'm wondering, sir, whether you believe it should be the individual sport that makes the decisions on how you regulate your game, or do you see an avenue whereby the federal government should be regulating you?
Director of National Rugby Development, Rugby Canada
That's a good question.
I think the sport has a very strong responsibility for prevention. I don't think anyone knows their sport more than the sport experts, whether they be analysts who tag games and incidents.... It is through our analysts that we found a lot of our data for knowing it is in tackle that we see the most increased likelihood of concussions.
I think the sport has a part to play in prevention. How do you change or make changes to your sport? For us, it's in the way we changed the tackle height and the way we implemented laws around refereeing. I think that is where sport has a responsibility.
There may not be too many avenues for further partnership in this. Where I see the opportunities for partnership is in the detection of concussion-related injuries and the way we manage concussion-related injuries. If we're talking about prevention, the sport has to look at its own sport, understand where these concussion-related injuries are going, and then evaluate whether they can be minimized. Yes, there's an inherent risk in participating in sport, but our job in our sport is to ensure that we minimize that risk as far as possible, if not remove it.
I believe, then, that the sport has a responsibility to self-reflect and self-evaluate and make changes to their game to ensure a safer environment for all participants.
Souris—Moose Mountain, CPC
Throughout sport—and we look at hockey today, as we see hockey growing up—we now have trainers involved with sporting organizations, which is something we didn't have before. We had people on the bench who recognized.... When I was playing rugby at the University of Waterloo, the reality was that we had a trainer who was there to help us. There are multiple professionals who meet the standards and have within their professional standards the recognition of sport injuries, and in particular sport concussion training. Those avenues are out there.
Recognizing that the athletic trainer is probably the closest one to this problem, because others are trying to make money, do you see value in utilizing all of this expertise?
Director of National Rugby Development, Rugby Canada
Yes, I do. I think it's very clear that we have roles and responsibilities. An athletic therapist can detect signs and symptoms, but an athletic therapist cannot diagnose. We have to be very clear on who has the scope of practice to make a medical diagnosis. However, anyone from a parent, a player, a coach, to an athletic therapist can be educated around the signs and symptoms of a potential concussion, but not to make a diagnosis. When we suspect a concussion, we should be moving them to the appropriately trained medical professionals who can make a medical diagnosis.
Was that 11 seconds?
January 30th, 2019 / 6:05 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
You were right on the button.
We're moving to Ms. Hardcastle, from the NDP, for seven minutes.
Cheryl Hardcastle Windsor—Tecumseh, NDP
Thank you very much, gentlemen.
I think we'll keep going on that line, Mr. Hunter. You mentioned a key phrase, which is detection of concussion. I'm sure, Mr. Niedre, you'll have some ideas around this too.
What should be our next steps in terms of whether it's a federal role or a concerted course of action? I understand you have education programs and there are apps for phones. Where do you get your content to detect a concussion or suspect a concussion before we get into the whole idea of what the protocol is once it's determined someone has a concussion? I'm trying to get my head around your idea of that detection of concussion.
Just because of the limits of our committee here and what we're supposed to be doing and arming ourselves with information and perspective, if you have ideas of what you think we should be looking at or what we should try, as well as what your best practices are, that would probably be helpful.
I'd like to front-load my time with my question so that you can use the remaining time if you want to have a discussion about that.
Director of Education Partnerships, Coaching Association of Canada
Would you like to start?
Director of National Rugby Development, Rugby Canada
Sure.
Where do we get information? I'm sure the committee's heard that in Berlin we had the Berlin consensus statement. We brought world experts across multiple disciplines in the medical field who have really moved mountains in terms of where they were eight or 12 years ago. Between the Zurich convention in 2012 to the Berlin convention in 2016, we're starting to see a bit more consistency, not a huge amount of change.
We didn't know what a concussion was 12 years ago. Even now there are some grey areas. I think we were getting more consistency from 2012 to 2016, which is helping us identify signs and symptoms, for example.
Where do we get our information from? We get a lot of our information from that statement and that convention. That's from the medical experts. How we then localize that information into our sports would be the role of the sport and using various other agencies. For example, we are using Parachute Canada to harmonize our process.
When a concussion or suspected concussion occurs, how we manage that can be the same across multiple sports. About how the concussion happens differs within the sport. That's why the prevention is really important.
On detection, everyone involved in sport has to be able to detect the signs and symptoms of a concussion, not just on the field but also off the field. We know that young players will talk to each other. They'll text each other. They'll do a Google search for this information. They're having that conversation and they're looking for education. That education is not there yet to meet those standards.
It's realizing that it's not just a coach's responsibility; it's not just a referee's responsibility. When the person goes home, they're going to speak to their parents. Parents have a responsibility to be educated on the signs and symptoms, not just being able to identify the signs and symptoms, but what to do after they've identified the signs and symptoms. Who are the reputable people they can speak with to ensure they get the appropriate medical help?
We're not just talking about sport here. We're also talking about returning to learn. We also have a big piece that is mental health. As soon as a young child has a suspected concussion, they may start missing time at school. They may potentially start falling into debt. They may start missing exams. This has a knock-on effect. There's more education needed around how to manage a concussion.
Once we've detected the signs and symptoms, we look to pass that on to the appropriate medical practitioners, but we also have to manage that concussion. There's not just an education piece to be done before suspicion of a concussion, but there is an education piece to be done on managing that concussion and what happens post-diagnosis as well.
My recommendation is this: How do we ensure that everyone has access to reputable, current and evidence-based resources that can help identify the signs and symptoms of a concussion and take them down a path of seeking the appropriate medical help?
Director of Education Partnerships, Coaching Association of Canada
I would like to add, as Paul just said and as I mentioned in my opening statement, that our goal as a coaching association in Canada is alignment across the country. We work very closely with Parachute Canada. We serve on the FPT working group on concussions as well. There are many different representatives in the group.
When you ask about content in that area, aside from what I mentioned about our current module, it is updated as Paul said. The Berlin consensus—
Windsor—Tecumseh, NDP
If I may interject, I wasn't questioning the content. Who were the people who developed the content? I'm assuming you're an educator, a physiotherapist. That's what I mean.
Director of Education Partnerships, Coaching Association of Canada
Again, aside from the conference, I mentioned that many other doctors were involved in that. The other people who were involved in the creation of it were practitioners on the field of play, so sport technical experts and coaches at all levels of play. That's important to understand.
That's really the piece from which we gather this content. Those are all the experts with whom we deal. It's not just the medical experts. The coaches or technical leaders in the sport understand what the coaches face on a daily basis.
Paul really hit it well. It's about suspecting a concussion and the big thing that coaches face as well is the ethical piece. They have to be comfortable with saying, “I suspect a concussion. It's time to remove this athlete from the field of play or practice environment.” That's where they need a certain comfort, because athletes also feel a pull and push from their parents, from the other people in the league and others.
That's something as well. When we talk about content, it's really important to make coaches feel comfortable with making sure they're protecting the participants first and foremost, regardless of the level, whether it's a practice or a competition they're going into. That's a big piece. We need to make sure we're reinforcing that, so that when they suspect a concussion, as Paul said, it should go right to a medical practitioner who's an expert in this area, because the majority of our coaches are 15 to 24 years old, and then there are parents like me who are 45 plus.
Ottawa—Vanier, Lib.
Thank you, Mr. Chair.
Gentlemen, I'll be asking my questions in French. If you don't understand the language, you can listen to the interpretation in order to understand my questions.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
We have translation devices here.
Ottawa—Vanier, Lib.
Am I losing my time there?
Mr. Chair, have you reset the timer to zero?