Minister’s Year Six Progress Report on Rowan’s Law (Concussion Safety), 2018

Minister’s message

I was first introduced to Rowan’s Law while I was coaching, and I have had the opportunity to see first-hand the difference that it is making.

Concussions can have long-term impacts on an athlete’s physical, emotional and mental health, and I take pride in our government’s leadership in concussion safety. Since 2018, the Ontario government has invested more than $1.1 million to support concussion safety, management and prevention projects that expand the capacity of the sport community to develop and implement safety measures and to increase awareness of how to manage and prevent concussions in sport, in school and at play. We are hearing from stakeholders throughout the province that the implementation of Rowan’s Law is helping to drive culture change in sport.

This past year, the Ministry of Sport (SPORT) launched a pilot project to support four Provincial Sport Organizations (PSOs) in enhancing their concussion data collection systems and processes. This initiative marks our first step in gathering field-of-play concussion data, which will provide valuable insights for the sport sector, helping to create safer sports environments.

Additionally, my ministry is supporting research, led by the Concussion Legacy Foundation Canada (CLFC) in partnership with the Centre for Addiction and Mental Health (CAMH), examining patterns of care and health outcomes for individuals who have experienced sport-related concussions. Combined with the data collection pilot, these efforts could help sport organizations and medical practitioners refine practices to help manage concussions and improve health outcomes for Ontarians who have been concussed.

For years, Ontario has been a leader in concussion safety, and I continue to engage with my counterparts in other provinces to share the message about what we are achieving through Rowan’s Law. I am pleased to see movement at the national level, with Bill C-277 introduced in the House of Commons. Bill C-277 would require the federal Minister of Health to develop a national strategy to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of persons living with a brain injury in consultation with representatives of the provincial governments responsible for health, Indigenous groups and relevant stakeholders. If Bill C-277 is passed, my ministry will be prepared to offer the many valuable lessons learnt improving concussion safety for athletes in Ontario through Rowan’s Law and to engage with leading experts, like those at Parachute, to help shape a successful national brain injuries strategy.

I also want to recognize the global advancements in concussion safety. In June 2023, the sixth Concussion Statement was released following the International Conference on Concussion in Sport. Thirty-one experts from around the world, including Ontario, gathered to review and develop new concussion assessment tools based on the latest research. My ministry is currently examining the sixth International Consensus Statement as the science on concussion research continues to evolve.

The sport landscape has changed dramatically since Rowan’s Law came into effect. Every athlete is safer because players, students, coaches, officials, team trainers, educators, spectators and families better understand the vital role they play in recognizing the signs and symptoms of a concussion and reducing the pressure to continue playing following a suspected head injury. However, the work and the awareness must continue because knowing what to do if a concussion happens — regardless of your role at the field of play — can save lives.

I am confident that by working together we can ensure that athletes in Ontario and across Canada can participate, train and compete in a safe, inclusive and welcoming sport environment.

The Honourable Neil Lumsden 
Minister of Sport

Rowan’s Law background

Rowan’s Law (Concussion Safety), 2018 (“Rowan’s Law”, “the Act”) is landmark legislation, the first and only of its kind in Canada.

In 2015, a Coroner’s Jury Inquest was held to examine the circumstances surrounding the 2013 death of Rowan Stringer, an Ottawa teenager who died from a condition known as second impact syndrome (catastrophic swelling of the brain caused by a second injury that occurred before a previous injury healed). In Rowan’s case, she experienced three head injuries in six days while playing rugby — she was concussed but didn’t know it.

On June 7, 2016, the Rowan’s Law Advisory Committee was established for a one-year term, and in September 2017, the committee released their report containing 21 recommendations that would go on to inform Ontario’s next steps for concussion safety, focusing on safe participation in organized amateur sport, including in the school, university and college settings for athletes age 25 and under, through awareness, prevention, detection, management and surveillance.

Rowan’s Law is an all-of-government effort to improve concussion safety in amateur sport. The Ministry of Sport has been leading the implementation of the Committee’s recommendations in partnership with the ministries of Health, Education, Colleges and Universities, and Municipal Affairs and Housing.

Each year, in honour of the memory of Rowan Stringer, Rowan’s Law Day is commemorated in Ontario on the last Wednesday in September to raise awareness about concussions in sports.

Rowan’s Law has changed the culture of sport in Ontario. Every athlete is safer because the entire sport community, from athletes to spectators, better understand the vital role they play in recognizing the signs and symptoms of a concussion and reducing the pressure to continue playing following a head injury.

Since September 2017, the Government of Ontario has worked to address the 21 recommended actions brought forward by the Rowan’s Law Advisory Committee in response to the jury recommendations from the Rowan Stringer coroner’s inquest.

Thanks to the hard work, determination and dedication of Rowan Stringer’s family, the Rowan’s Law Advisory Committee, and countless sport organizations, schools, coaches, volunteers and administrators, Ontario is now a national leader in concussion prevention, awareness, detection and management.

The impact of Rowan’s Law

Ontario Soccer, in collaboration with a select number of clubs, has taken a leadership role in implementing enhanced player safety measures in support of Rowan’s Law by conducting a pilot test of the AgileIS CAPT (Concussion, Awareness, Protocol, and Training) technology. With real implementation data in our CAPT pilot being captured until end of 2024, early trends are indicating the value of streamlined step-by-step protocols, to take the guesswork out of concussion management. We look forward to our full review of the pilot results when completed in the Fall as we assess the efficiency of the return to play protocol management for athletes, while reducing risk and liability for community organizations.

Johnny Misley (CEO, Ontario Soccer)

Rowan's Law has been instrumental in elevating the standard of safety within Alpine Ontario, ensuring that our athletes are better protected from concussions. By fostering a culture of awareness and prevention, we have significantly enhanced the well-being and long-term health of participants in our sport.

Patrick Biggs (executive director, Alpine Ontario)

The Rowan’s Law concussion incidence data collection pilot is allowing us to innovate rugby’s existing “Blue Card” system, which has positively impacted the reporting of suspected head injuries and concussions. Increased awareness and enhanced tools for those close to an athlete is helping to keep players in the game.

Myles Spencer (CEO, Rugby Ontario)

Kickboxing Ontario has been successfully implementing Rowan’s Law initiatives within our PSO. We see a profound impact on our sport through this work. The Ministry of Tourism, Culture and Sport supported our PSO through a data collection pilot over the past year. The data collected thus far has had significant impact on our sport. Kickboxing Ontario has used early data to revise competition safety policies, developed education modules for our officials and referees, and has now developed awareness materials for athletes and parents. We applaud the Ministry in prioritizing the health and safety of our athletes!

Muzammal Nawaz (CEO, Kickboxing Ontario)

Implementation of Rowan’s Law

Year one

September 2018 to September 2019

11 recommendations implemented:

• July 1, 2019: sections of the Act and Regulation came into force: mandatory education (for example, concussion awareness resources), codes of conduct, proclamation of annual Rowan’s Law Day (in force March 7, 2018) and minister’s progress reports (in force September 25, 2019); related amendments to the Education Act proclaimed (Recommendation #1)
• Evaluation of Policy and Program Memorandum (PPM) 158 in schools (Recommendation #4)
• Codes of conduct (Recommendation #5)
• Annual concussion training for coaches (Recommendation #8)
• Coach’s tool kit (Recommendation #11)
• Teacher candidate exposure to concussion awareness (Recommendation #12)
• Concussion website (Recommendation #13)
• Sustained marketing and awareness campaign (Recommendation #14)
• Annual concussion awareness education event in schools (in PPM 158) (Recommendation #16)
• Established mandatory concussion education for relevant school staff (in PPM 158) (Recommendation #17)
• Creation of Concussion Partners Committee (Concussion Working Group) (Recommendation #21)

Year two

September 2019 to September 2020

Two recommendations implemented:

• Updated Policy and Program Memorandum (PPM) 158 for school boards (tied to amendments made to the Education Act as part of Recommendation #1)
• Developed concussion education modules for students for delivery in schools (Recommendation #15)

Year three

September 2020 to September 2022 (extended due to COVID‑19 pandemic)

Five recommendations implemented:

• January 1, 2022: remaining sections of the Act and Regulation pertaining to removal-from-sport & return-to-sport are expected to come into force (Recommendation #1)
• Field of Play Inspection Guidelines for sport organizations (Recommendation #6)
• Concussion spotter tool for higher risk sports (Recommendation #7)
• Confirmed existing codes should be used when submitting claims to OHIP (Recommendation #10)
• Enhanced professional development for health care professionals (Recommendation #18)

Year four

September 2022 to September 2023

Three recommendations in progress:

• Ministry of Health to collate and share concussion incidence data annually (Recommendation #2)
• Amateur sport delivery partners should collect and report concussion incidence data (Recommendation #3)
• Investment in electronic data collection/sharing tool about incidents at field of play (Recommendation #9)

Year five

September 2023 to September 2024

Two recommendations being implemented:

• Amateur sport delivery partners should collect and report concussion incidence data (Recommendation #3)
• Investment in electronic data collection/sharing tool about incidents at field of play (Recommendation #9)

Ongoing:

• Sustained concussion awareness promotion
• Work with Federal-Provincial/Territorial (F-P/T) partners towards achieving a national harmonized approach to concussions in school/non-school environments (Recommendation #19)
• Work with Indigenous partners to support goals of increased safe participation in amateur sport and concussion management (Recommendation #20)

To date, Ontario has implemented, or continues to implement, 20 of the 21 recommendations put forward by the Rowan’s Law Advisory Committee and one remaining recommendation is currently in progress.

Recommendation in progress

Ministry of Health (MOH) to collate and share concussion incidence data annually (Recommendation #2)

The Ministry of Health is working in partnership with Public Health Ontario to analyse administrative health data and other vital statistics to support the development of a public report on concussion incidence in Ontario.

This information will serve as a starting point to help assess the extent of concussion incidents across the province.

Year five achievement highlights

Investing in research

In 2024, SPORT provided the Concussion Legacy Foundation Canada (CLFC) with $52,500 to support research that will uncover important insights on sport-related concussions. The CLFC, in partnership with CAMH, will link data from emergency department visits, in-patient hospital records and the Ontario Trauma Registry to examine patterns of care and mental health outcomes for individuals who experienced a traumatic brain injury during a sport-related activity. A public report on this research will be made available to provide the sport sector with useful and important information specific to sport-related concussions.

Improving concussion data collection for amateur sports

SPORT provided $84,300 to support a concussion data pilot with four PSOs to collect data on the factors involved when a suspected concussion occurs on the field of play. Participating PSOs are collecting data on the age and gender of athletes who are removed from the field of play after a suspected concussion, the type of sport activity and movement that resulted in a suspected concussion, number of confirmed concussions and duration between a concussion diagnosis and clearance for an athlete to return to sport. This initiative will help quantify the incidence of sport-related concussions in Ontario and provide data on the impact of concussion safety measures put in place through Rowan’s Law and may be used to inform the development of future concussion safety policies and procedures.

Documentary on concussions in amateur sport featuring Rowan Stringer’s life

SPORT provided the CLFC with funding to develop a documentary to bring global attention to Ontario’s efforts to help make participation in sports safer for Ontarians. The documentary highlights the impacts of concussions in amateur sport and features Rowan Stringer’s life and the impact of Rowan’s Law. This documentary demonstrates the global scale of the threat of brain injuries to young athletes’ physical and intellectual development and provides instruction on the safest and smartest ways to practice and play sports. The documentary was recently publicly released.

Resources to support concussion safety in schools

Schools across Ontario continue to host annual concussion awareness events on Rowan’s Law Day to engage students, staff, coaches, and parents/guardians in activities that increase awareness of concussion safety and share Rowan Stringer’s story.

With support from the Ministry of Education, the Ontario Physical and Health Education Association (Ophea) — under the leadership of Chris Markham — continues to update and maintain the concussion protocol and safety resources to support concussion awareness, prevention, detection, and management in Ontario schools. This includes an updated e-learning module on concussion safety for school staff and the Rowan’s Law Day school toolkit to support concussion awareness and knowledge building for the school community. The resources are made available and promoted to all schools, including private schools, First Nations schools and federally-operated schools.

The Ministry of Education also supported the 10th Annual International Concussion Summit hosted by the District School Board of Niagara in Spring 2024.

2023 Rowan's Law Day across Ontario

Since 2018, the government and sport sector have made great strides in promoting awareness and educational resources about concussion safety. Rowan’s Law Day is the opportunity to remind everyone and increase awareness about concussion safety, not just across the sport sector but within Ontario households and beyond. Rowan’s Law marks a profound shift in creating sporting environments that are healthier and safer for all participants.

Government webpages on Rowan’s Law made up the top 78 per cent of URLs shared that day with more than 15,500 visits to all pages related to Rowan’s Law. Images and social media messaging were used more than 100 times by sport partners and stakeholders, totalling 48 per cent of net new posts. The social media campaign included videos of the Premier, Minister Lumsden and many sport experts and athletes, which were shared far and wide.

Schools, hospitals and sport organizations across Ontario held events to raise awareness about concussion safety. Across the province, iconic Ontario landmarks such as the CN Tower, Niagara Falls, the Big Nickel and the Toronto and Ottawa city signs were lit up in purple — Rowan’s favourite colour — in honour of her memory. At Toronto’s Rogers Centre, a message from Minister Lumsden played on the jumbotron during the Blue Jays game. The online audience for the campaign eclipsed the crowd at the game; social media impressions for the campaign (57,550) were more than the maximum capacity of the entire stadium (41,500).

Rowan’s memory went global; news articles highlighting the campaign were published in international outlets across the world, reaching an estimated 25 million readers. These articles, events and moments are part of the ongoing campaign to raise awareness among Ontarians of the importance of concussion safety. The message was clear: whether you are an athlete, a coach, a parent, an educator or an official, knowing what do when a concussion happens can save lives. The Ontario government will continue to develop awareness of not only these issues, but sport safety in its entirety.

Rowan’s Law Concussion Working Group

The Rowan’s Law Concussion Working Group was established in response to one of the recommendations contained in the Rowan’s Law Advisory Committee Report.

The working group’s mandate is to provide advice to the Ontario government in implementing the recommendations of the Rowan’s Law Advisory Committee.

Members were invited to participate because they have knowledge, expertise and/or experience in injury prevention, public health and/or amateur competitive sport.

The ministry thanks all the members of the Rowan’s Law Concussions Working Group (current and former) for their significant contributions and dedication to the health and safety of all Ontario athletes.

Current members

• Dr. Dan Cass, executive vice-president and chief medical executive, Sunnybrook Health Sciences Centre (chair)
• Dr. Allison Chris, associate medical officer of health, Toronto Public Health
• Pamela Fuselli, president & CEO of Parachute, a national charity dedicated to preventing injuries
• Warren Hoshizaki, director of education, District School Board of Niagara
• Paul Hunter, CEO, Wheelchair Rugby Canada
• Susan Kitchen, former executive director, Coaches Association of Ontario
• Jennifer Knox, school principal, Peterborough, Clarington and Northumberland Center for Individual Studies
• Drew Laskoski, former president, Ontario Athletic Therapist Association
• Eric Lindros, retired NHL hockey player, member of the Hockey Hall of Fame and advocate for concussion research, care and awareness
• Chris Markham, executive director & chief executive officer, Ophea
• Fran Rider, president & chief executive officer of the Ontario Women’s Hockey Association
• Gordon Stringer, Rowan Stringer’s father
• Dr. Charles Tator, leading educator and researcher dedicated to neurosurgery and the study of injury prevention and recovery from concussions
• Elisabeth White, nurse practitioner, Neurosurgery Outreach, The Hospital for Sick Children, with a role of educating the public on traumatic brain injury

Former members

• Todd Anderson, mixed martial arts (MMA) referee and police sergeant with the Regional Municipality of Niagara
• Kent Bassett-Spiers, CEO, Ontario Neurotrauma Foundation
• Louise Logan, former president & CEO of Parachute, a national charity dedicated to preventing injuries
• Dr. Rosana Salvaterra, former medical officer of health, Peterborough Public Health

Action items status