Concussion Prevention Strategies

This section is intended to assist school boards with their requirements to:

• include strategies for preventing and minimizing the risk of sustaining concussions at school;
• establish Concussion Codes of Conduct for students participating in interschool athletics, as well as for parents/guardians, coaches, and team trainers involved in interschool competitions;
• receive confirmation of review of the Concussion Codes of Conduct by individuals involved in interschool athletics.

(Refer to School Board Policies on Concussion (PPM158) for the specific policy requirements.)

Any time a student is involved in a school-sponsored activity, there is a risk of concussion. Therefore, it is important to establish and encourage a culture of safety and prevention when students are physically active. Educating students, parents/guardians, school staff, and other individuals involved in providing students with academic, social, and physical activity opportunities plays a vital role in the prevention of concussion.

Concussion prevention is a fundamental and continual practice in sport and physical activity. Prevention takes place at multiple, complementary levels: primary prevention works to prevent a concussion; secondary prevention focuses on reducing the effects of a concussion; and tertiary prevention involves the prevention of long-term complications from one or more concussions.

Primary Prevention

The first step in primary prevention is understanding how concussions occur in the school context. This can include gathering data (e.g., through injury surveillance), consulting published literature, and identifying sport- or activity-specific risks—such as common injuries and how they occur. Primary prevention will also help to determine if strategies/changes implemented have the desired effect.

Secondary Prevention

If a concussion does occur, timely recognition and removal, proper assessment, and appropriate management are linked to faster recovery and improved outcomes. Establishing and implementing evidence-informed concussion policies and procedures can help to prevent poor outcomes resulting from delays or mismanagement.
All school boards are required to have policies and procedures in place to support the effective management of a concussion and to prevent it from worsening (e.g., identification, removal, and management; Return to School Plan).

Tertiary Prevention

Through primary and secondary prevention efforts, as described above, schools and school boards can support the long-term participation and wellbeing of students. Having policies in place to support best practice processes for concussion management may also help to reduce recurrent concussions. (Eliason et al., 2023) This includes situations where:

• a student is recovering from a concussion and is experiencing long-term difficulties that begin to affect their learning, the school board should follow established processes for identifying and documenting instructional approaches and resources that may be required for responding to the student's ongoing learning needs (e.g., individualized classroom accommodations) (Ontario Ministry of Education, PPM 158, 2020).
• it may be in the best interest of a student to discontinue their participation in sports that involve contact or collision. There are no objective factors to determine this decision; it is specific to the individual and should involve the student, their parent/guardian, if applicable, and licensed healthcare professionals (Patricios, Schneider et al., 2023).

References

Ontario Ministry of Education. (2020, January 31). Policy/Program Memorandum No. 158: School board policies on concussion. https://www.ontario.ca/document/education-ontario-policy-and-program-direction/policyprogram-memorandum-158

Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. British journal of sports medicine, 57(11), 695–711. https://doi.org/10.1136/bjsports-2023-106898