Report calls for comprehensive concussion management protocols

August 21, 2014 – A coalition of health and sporting groups across the country is calling for Canada's athletic organizations to get more proactive about protecting participants from head injuries.

The Canadian Concussion Collaborative, consisting of nine national sports advocacy groups, has laid out two specific recommendations in the September issue of the British Journal of Sports Medicine.

The collaborative says most sports organizations don't have policies in
place that address the needs of a concussion patient at every step of
the process.

The group's first recommendation is to put such policies in place immediately and to review them once a year.

The
collaborative says the protocols should address concussion education,
prevention and treatment, as well as an athlete's return to action.

They say most sporting groups have policies in place to tackle some of these aspects, but don't address the issue as a whole.

The
collaborative also recommends that organizations consult with medical
professionals and local community resources when developing their
concussion protocols.

The recommendations come at a time when
awareness of concussion risks and repercussions are at an all-time high,
according to collaborative members such as the Canadian Centre for
Ethics in Sport (CCES).

Urging athletic organizations to act on
their newly accumulated knowledge and translate it into concrete
policies, they said, is a natural and necessary next step.

CCES CEO Doug MacQuarrie said many parts of society are equipped to deal with the various aspects of concussion management.

He
said the time has come for sporting associations, school boards and
other organizers of athletic activities to bring all concussion
management tools under one roof.

“Often times these things are left to discrete parts of the system,” MacQuarrie said in a telephone interview from Ottawa.

“A
sport organization may deal with, 'what do we do on the field?' A
public health agency or local health care unit may deal with, 'what do
we do when they're in the hospital,' and the family practice might say,
'OK, how do we get the person back into sport?' What's optimal is that
all of those links are contemplated in advance so that people who get
involved in sport know that system exists in their community to assist
them should the unfortunate circumstance of a concussion arise.”

MacQuarrie
said an ideal concussion protocol would address four key points –
training coaches, parents and participants to watch for signs of head
injuries, setting up guidelines to make the environment safe for
athletes, establishing a treatment protocol should a concussion take
place and developing a process to help injured players get back in the
game slowly and safely.

This policy should be reviewed once a year to make sure information and resources are kept up to date, he added.

All
of these guidelines should be developed with the input of professionals
with specific expertise in concussion management, as well as community
resources that can ensure the program is tailored for local needs, he
said.

Chiropractic perspective
The Royal College of Chiropractic Sports Science (RCCSS) welcomed the report and supports the idea of a comprehensive protocol for providers and coaches to follow on concussion management.

"Ultimately, proper diagnosis, management and return to play is so important and we should all be on the same page when providing care and advise to athletes," said Dr. Michelle Laframboise, chair of the RCCSS public health committee. Laframboise and the RCCSS have been actively pursuing interprofessional collaboration on concussion management.

In an e-mail sent to Canadian Chiropractor magazine, Laframboise said while professional sport may be addressing concussion in the higher level, the case may not be the same in the grassroots level and "this being the most vulnerable group may in fact be the most important level to address the impacts of concussion."

"There is a lot of new emerging research on the importance of the cervical spine. This is where chiropractors (being spine specialists) can be extremely beneficial in the treatment of concussions," Laframboise said.

Collaboration among health-care professionals is also key, she said, "to come up with a strategy of how to address, treat, diagnose and ultimately manage concussions. We need to not only educate health-care providers but also parents, athletes and coaches alike."

Putting in place a protocol for concussion management, she adds, will ensure transparency and that ultimately the patient is cared for appropriately without confusion.

Guidelines for coaches
The Saskatchewan Soccer Association leaned heavily on local experts when developing their concussion protocol last year.

Executive
Director Doug Pederson said the province's Sports Medicine Science
Council offered advice on every facet of the new policy, including
providing educational links for parents to access and urging injured
players not to lace up their cleats until they had hashed out a “return
to play” plan with a doctor.

Pederson said their guidance was
essential, since association members themselves don't have the subject
matter knowledge to make the policy as sound as it could be.

“We
had good advice and good help to build our policy,” he said. “Obviously a
lot of the expertise is not our own and came from those sorts of
conversations.”

The collaborative emphasizes the many advantages a
comprehensive concussion protocol would have on athletes, but parents
and coaches say they also stand to benefit.

Calgary firefighter
and minor hockey coach Jodi Bednarek said the volunteers who offer to
lead amateur sporting activities are usually not equipped to diagnose or
treat head injuries when they take place.

Concussions are not
always the result of bruising brawls or body blows, he said, adding the
more subtle forms of injury run the risk of falling through the systemic
cracks.

Guidelines prepared by sporting associations and
approved by medical experts, he said, would give coaches more effective
tools to prevent lasting damage while easing the pressure they face in
their volunteer roles.

“The problem that a lot of the coaches
face is that they don't have a protocol to say, ‘OK, based on that
mechanism of injury, you need to now take a seat if you've got a
headache or not. We need to take a look at you before you can continue
in the game,’” he said. “It really takes the onus off of the coach and
onto the organization to develop a profile of what to follow.”

The
protocols could also reassure parents who are either anxious about a
potential injury or curious as to why their children are sitting on the
sidelines, Bednarek added.

The collaborative said it hopes its
recommendations will be broadly adopted across the country, adding their
advice is aimed at everyone from government agencies to schools that
run athletic programs.

With files from Mari-Len De Guzman