I would like to thank you for having me here today to speak before the committee.
I'm a sport and exercise medicine physician. We're uniquely qualified and experienced in concussion management.
Sport and exercise medicine physicians have been founding members of the Canadian Concussion Collaborative. They've played key roles in the international consensus statement on concussion in sport. This is an international gold standard that physicians look towards when they're looking to treat a sport-related concussion or return a patient to play. They are also experts in the design and implementation of medical systems and protocols for sporting events. A diploma in sport medicine is granted after examination ensuring competence.
Unfortunately, there are still many barriers for Canadians who have a concussion. I see too many patients like the following one: a young girl who was required to travel over an hour to see me. Her expectation and her mother's expectation was that she was simply going to walk in, get a note saying she could return to hockey for the weekend, play her playoff game and head back home. A concussion assessment takes 45 minutes or more. During this assessment, we discovered that this young lady, who is very intelligent and was expecting a scholarship from MIT to become an engineer, was unable to subtract seven from 100 and get the right answer. She really had no idea of her deficit, nor did her family.
Sport and exercise medicine and family physicians are able to safely manage most concussions like this one because they do indeed get better. What these patients do need is time. They need time to understand their injury and they need extra support that we often don't see with other patients because they have a brain injury, which means they can miss appointments or they can have difficulty coordinating their care. That puts an extra burden on physicians who are trying to manage a full waiting room and have the financial reality of the increasing burden of overhead.
Qualified, multidisciplinary treatment in their own area is extremely effective for these patients because the burden of travelling can actually increase concussion symptoms, so it's very important that they have treatment that's close to home.
Appropriately designed community-based clinics with evidence-based care could help to alleviate many of these barriers. However, the reality is that there are only 531 physicians in Canada with a sport and exercise medicine diploma, but all Canadians can benefit from their expertise through a public health-style approach. There's no doubt that community sport medicine and family physicians are excellent resources for patients with concussions. However, using the integration of sport and exercise medicine physicians in the planning of sport events can empower people to have prevention, detection and management of concussion at all levels. We've done a fairly good job at the elite level, so that's coming along, but most of our participants are at a recreational level. Some of our pediatrics, or our children, are at the most risk from concussions, so it's important that we hit all levels.
The legislated requirements of medical expertise in concussions for the planning of sporting events and protocols at all levels would greatly benefit the health and safety of all Canadians.
I recall a young patient that I had who suffered a tackle in a community football league. At the time, he didn't know he was concussed; his teammates didn't know he was concussed and there was no protocol in place to address this within his context. I saw him several weeks later, after his academic performance had started to decline and he'd been suffering from headaches and feeling dazed and confused for several weeks. Unfortunately, this is all too common to see in my practice.
The reality is that sport culture changes slowly and it often does not include medical considerations. It's important that we bring this to light at all levels of sport in Canada. The medical involvement in planning gives credibility to change within the sport and to sporting bodies or community bodies to say, “Do you know what? We know we haven't done things this way in the past, but this is why we feel it's important to make these changes.”
I want to make it very clear that I believe participation in sports should not be discouraged. It should be encouraged. It's important for Canadians' health. Any requirements should not create an undue burden so that people are unable to participate in organized sport. Canadians need to be active. They need to know that they are safe being active and that if they should suffer an injury, they can get the best possible care.
Thank you for your attention. I look forward to the discussion.