Concussion Protocol, September 2025

For the purposes of this Bulletin, the Concussion Protocol refers to the updated Concussion Protocol outlined in the Ontario Physical Activity Safety Standards in Education (OPASSE). 

Purpose 

This bulletin is intended to: 

  • Assist school boards in fulfilling their obligations under PPM158: School Board Policies on Concussion;
  • Highlight significant updates to the Concussion Protocol; and
  • Support school board policy review and system/school-level implementation. 

Audience 

This bulletin is for Directors of Education, Supervisory Officers responsible for policy oversight and concussion protocol implementation, and other System Leaders supporting Health and Physical Education, student safety, and concussion implementation and review. 

Rationale for updates 

In response to evolving research and expert consensus, updates have been made to the current Concussion Protocol as well as relevant Tools and Resources. These updates are intended to enhance student safety, improve recovery outcomes, and streamline implementation in school settings. 

The updates are informed by the latest evidence and recommendations from the: 

 Key updates 

The following changes may impact school board policies, procedures, and/or operational guidelines. In accordance with PPM158, the Concussion Protocol serves as the minimum standard for school-based concussion risk management practices. 

The following changes may impact school board policies, procedures, and/or operational guidelines. In accordance with PPM158, the Concussion Protocol serves as the minimum standard for school-based concussion risk management practices. 

  1. Simplification of Return to Learn and Return (RTL) to Physical Activity (RTPA) Stages 

The Consensus statement advocates for symptom-informed progression, reducing confusion and streamlining protocols. This supports clearer communication between parents/guardians and school staff and allows the RTL and RTPA structure to be better aligned. The updated Concussion Protocol: 

  • Merges the Initial Stage and Stage 1 (RTPA and RTL)  

Rationale: Aligns the initial recovery pathway for learning and physical activity and simplifies the approach for parents/guardians.  

  • Combines RTPA Stages 2a and 2b into a single Stage 2 

Rationale: Reflects a more integrated approach to gradual physical activity reintroduction. 

  • Consolidates RTL Stages 3a/3b and 4a/4b into RTL Stages 3 and 4 

Rationale: Aligns with simplified stages recommended by the Consensus Statement and Parachute’s guideline.  

  1. Return to School as early as Stage 2

Students can now return to school as early as RTL and RTPA Stage 2 

Rationale: Research emphasizes an early, gradual return to school (typically beginning at Stage 2). Research supports that most students benefit cognitively, socially, and emotionally from early re-engagement with learning environments when managed with symptom awareness. 

  1. Medical Clearance Shifted to After Stage 3

Medical clearance is now required following completion of RTPA Stage 3 

Rationale: This earlier timing ensures that students are assessed and cleared by a qualified medical professional prior to engaging in more physically demanding or risk-prone activities. This supports a safer and more structured progression through the final RTPA stages. 

  1. Mild, Short Symptom Return is Acceptable Pre-Clearance 

Symptom return or mild worsening is now recognized as common in Stages 1–3 

Rationale: The Consensus Statement supports early physical and cognitive activity as long as symptoms are mild and brief (resolve within one hour). Symptom-guided progression, rather than strict symptom absence, is now the recommended approach. 

  1. Symptom Returning after Medical Clearance Require Reassessment 

If symptoms return after medical clearance (Stages 4–6), the student must return to Stage 3 and be re-assessed by a medical doctor or nurse practitioner 

Rationale: The Consensus Statement reinforces that full contact, competition, and intensive activities (Stages 4–6) should only proceed in the absence of symptoms. Any symptom recurrence at this level indicates the need for re-evaluation and progression within safer parameters. 

What this means for school boards 

School Boards should establish a process and a timeline to transition from their current concussion policy and procedures to the updated content of the Concussion Protocol.  

This may include:  

  • Reviewing and revising concussion-related policies and procedures to reflect the updates from the Concussion Protocol; and
  • Developing an implementation strategy that supports staff understanding, training, and communication of the updates across the school board.  

Resources and supports for implementation 

Updated by Ophea (2025): 

Updated by Parachute (2025): 

For more information 

Contact: safety@ophea.net