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

Minister’s message

In 2018, Ontario passed Rowan’s Law, which was ground-breaking legislation and the first of its kind in Canada, changing the way Ontario sport organizations identified and addressed potential concussions.

It raised awareness of concussions, and educated parents, teachers, coaches, athletes, and trainers across the province on the signs and symptoms of concussions. The legislation made it mandatory for sport organizations to have a concussion code of conduct and protocols for removing injured athletes from play, and when they may return. Collectively, these measures are working to protect Ontario athletes on the field of play and fostering a safer sport environment for all participants.

These accomplishments would not have been possible without the perseverance and commitment of the Rowan’s Law Advisory Committee and the Rowan’s Law Concussion Working Group. I would like to personally thank the members for the time and effort they dedicated to implementing Rowan’s Law over the years. I also want to recognize the contributions of community partners and Ontario’s sport organizations in the implementation of Rowan’s Law.

At the August 2022 Conference of Federal-Provincial/Territorial Ministers Responsible for Sport, Physical Activity and Recreation, I renewed Ontario’s commitment to work collaboratively with my fellow ministers on concussion awareness, prevention, detection and management.

I was also pleased to attend the 2022 Canada Summer Games in Niagara and cheer on our Ontario athletes as they competed on home turf. Seeing Team Ontario athletes with the Rowan’s Law logo on their uniforms warmed my heart — an important reminder of Rowan’s legacy.

As a former professional football player who has remained active in sport as a coach and parent, I know how important it is for everyone on a field of play to be aware of the dangers of concussions, and the concussion protocols that help keep our loved ones safe. I will continue to work with our sport partners and Federal-Provincial/Territorial (F-P/T) colleagues to make sure the culture of concussion safety continues to grow in Ontario and across the country.

I wanted to thank Gordon and Kathleen Stringer for sharing Rowan’s story. Rowan’s legacy will be seen every day, at training, practices and games across Ontario. She will be remembered.

The Honourable Neil Lumsden
Minister of Tourism, Culture and Sport

Rowan’s Law background

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

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

Rowan’s Law has changed the culture of sport in Ontario. 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 with 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 Rowan Stringer Coroner’s Inquest Jury Recommendations.

Implementation of Rowan’s Law

Year one

September 2018 to September 2019

Eleven recommendations completed:

• July 1, 2019: Sections of the Act and Regulation came into force: mandatory education (e.g., 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 completed:

• Updated PPM 158 for School Boards (tied to amendments made to the Education Act as part of Recommendation #1)
• Develop 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 completed:

• 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)

Ongoing

• 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 completed 18 of the 21 recommendations put forward by the Rowan’s Law Advisory Committee.

Work under consideration

The remaining three recommendations will continue to be under consideration.

Due to the scope and complexity of these recommendations, the Ministry of Tourism, Culture and Sport (MTCS, “ministry”) will continue to work with partners to explore opportunities to advance these recommendations.

1. Ministry of Health to Collate and Share Concussion Incidence Data Annually (Recommendation #2): The Ministry of Health continues to explore options to leverage existing national surveys to obtain more accurate concussion incidence and prevalence data for children and youth in Ontario. As part of this effort, the ministry continues to review concussion and/or head injury data from existing health databases that can potentially be shared on an annual basis.
2. Amateur Sport Delivery Partners Should Collect and Report Concussion Incidence Data (Recommendation #3): MTCS continues to explore best practices and options for the collection and reporting of data regarding incidents of concussion within sport organizations.
3. Investment in Electronic Data Collection/Sharing Tool About Incidents at Field of Play (Recommendation #9): The government continues to assess the feasibility of building or acquiring an electronic data collection/sharing tool for sport organizations to report concussion incidents at the field of play.

Year three achievement highlights

Information for health care providers

To support the professional development of health care providers, an information sheet was developed by the Ministry of Health about the specific requirements that came into effect under Rowan’s Law on January 1, 2022, and what the implementation impacts will be on their work. The information sheet highlights that under Rowan’s Law, physicians and nurse practitioners are specified as the only health care providers that can medically assess and provide confirmation of medical clearance for athletes to return to unrestricted participation in amateur competitive sport. The information sheet also includes the diagnostic code physicians should submit for a concussion (850) when submitting claims to OHIP. It also provides resources to support health care providers in their assessments. The information sheet was disseminated to relevant health care provider stakeholders, and it is currently posted on the government’s Concussion Safety Webpage.

As we look back over the last year in this Minister’s Progress Report, it is heartening to witness the ongoing efforts to pay tribute to Rowan Stringer’s memory and prioritize safety in sport participation. Since the Rowan’s Law (Concussion Safety) legislation was passed in 2018, there have been significant strides towards making amateur competitive sport in Ontario safer. I am pleased to see Ontario at the forefront of important advancements in concussion prevention and management, and, above all, reinforcing the importance of athletes' health and safety.

Dr. Kieran Moore, chief medical officer of health

While we wear helmets in cycling for protection, they do not necessarily prevent concussions. Through the application of Rowan’s Law, we not only have an education tool, but we have a much stronger concussion protocol in place where we are able to enforce the need for assessments by medical doctors after a crash in order to continue to participate.

Pam Julian, president & chief executive officer, Ontario Cycling

Removal/Return-to-Sport: education and awareness

A series of webinars were held to inform and educate the sport sector on new Rowan’s Law requirements that came into effect on January 1, 2022. The webinars reached more than 100 sport organizations with responsibilities under Rowan’s Law, including Provincial and Multi-Sport Organizations (PSOs/MSOs), their member clubs, and municipalities delivering physical activity and competitive sport programs. In addition, in support of the 2022 Ontario Summer Games, 2022 Ontario Parasport Games, and the 2022 Canada Summer Games in Niagara, ON, MTCS also delivered a training session on these requirements for Games Ontario and Canada Games officials in spring 2022. The new requirements include:

• establishing Removal-From-Sport and Return-to-Sport Protocols that meet the requirements of the Act and the regulation
• identifying a designated person(s) as having specific responsibilities under the Removal/Return-to-Sport Protocols
• making these protocols available to designated person(s) and any athlete or, if under 18 years, their parent/guardian who has been removed from training, practice or competition due to a suspected concussion

The webinars also provided resources and templates to support sport organizations in the implementation of these new requirements.

Rugby Ontario continues to be a proud advocate for Rowan’s Law. The sport of rugby in Ontario has taken significant steps to enhance player safety and game welfare by introducing, in partnership with Rugby Canada, a progressive and integrated removal-from and return-to-sport management initiative – the Blue Card Program. We are delivering community and Match Official training, ensuring all levels of the game are positioned to mitigate the risk of concussions and other head injuries to keep players in the game.

Myles Spencer, chief executive officer, Rugby Ontario

We know from our conversations with coaches in local community clubs that the Rowan’s Law annual requirements, such as signing the code of conduct, are helping club staff, coaches, parents and athletes understand the importance of concussion management. Additionally, there is a high level of engagement with the coach’s concussion toolkit and coach feedback states the resources are helpful with removal and return to play protocols.

Jeremy Cross, executive director, Coaches Association of Ontario

The introduction of Rowan’s Law education and awareness into our annual registration process for basketball programming keeps the importance of properly managing concussion injuries top of mind with parents, coaches, and athletes. Increased education and awareness provide the tools for parents & coaches to identify the symptoms of concussions and ultimately create a safer playing environment for our athletes.

Dave Stockton, executive director, Ontario Basketball

Concussion spotter tool

A concussion spotter is an individual that is responsible for observing participants on a field of play and flagging any potential head injuries to the “designated” individual under the Act. It is recommended that sport organizations in higher-risk sports identify a concussion spotter to be present at all games and practices, in addition to the designate. To support this effort, a tool was developed for higher-risk sports to outline criteria for establishing a concussion spotter and required training.

Field of play inspection guidelines

Field of play inspection guidelines were developed for sport organizations to help identify unsafe fields of play and to make them safer. The guidelines support Ontario’s PSO/MSOs in developing field of play inspection guidelines specific to their sport. These guidelines address specific requirements for each sport, including considerations related to whether the sport is played indoors or outdoors, the type of facility that will be used, and any specialized equipment used in the sport.

Games Ontario and Rowan’s Law implementation

Games Ontario is a brand under the Government of Ontario and five multi-sport games are delivered under this brand. Rowan’s Law applies to the following three multi-sport games that have participants under 26 years of age:

• Ontario Summer Games for youth
• Ontario Winter Games for youth
• Ontario Parasport Games

These three games are delivered in accordance with Rowan’s Law requirements and protocols. This includes ensuring athletes, coaches and trainers have reviewed the Concussion Awareness Resources and the Concussion Code of Conduct established by the Games and that Removal-from-Sport and Return-to-Sport protocols are in place for the protection of participants.

The Ontario Federation of School Athletic Associations (OFSAA) is committed to safety mandates during competition and the health and wellness of its participants. In accordance with the requirements set out in Rowan’s Law and its associated regulations, OFSAA has implemented all steps within the prescribed timelines set out by the Ontario Government.

By establishing consistency within concussion management and prevention for all Ontario sport organizations, a greater awareness, consistent safety protocols and required record keeping of injury have been established. The OFSAA Executive Council believes Rowan’s Law has created a safer environment for all student-athletes and teacher-coaches across the province.

Ontario Federation of School Athletic Associations (OFSAA)

Rowan’s Law and mental health

Research has shown brain injuries can impact the mental health of athletes. The Ontario government provided funding to the Canadian Mental Health Association — Ontario Division (CMHA) to build on its commitment to advance athlete safety. The funding raised awareness of the mental health of young athletes by providing educational resources for coaches and parents to help them recognize the symptoms of stress, anxiety and depression.

Rowan’s Law at the 2022 Canada Summer Games

The Canada Summer Games are Canada’s largest multi-sport event. The 2022 Canada Summer Games were held from August 6 to 21, 2022, in Niagara, ON, where more than 5,000 young athletes representing provinces and territories from across the country competed in 18 different sports.

As a result of Rowan’s Law, the 2022 Canada Summer Games was the first multi-sport national competition in Ontario where concussion protocols and processes were required to be in place.

Team Ontario’s uniforms adorned the Rowan’s Law logo, which promoted and enhanced awareness of concussions at the Games and sent a strong message to participants that concussion awareness and prevention is a priority in sport.

The 2022 Canada Summer Games were a resounding success. Athletes and participants from across Canada took home the message that concussion awareness and prevention is key in ensuring athlete safety — a testament to Rowan’s legacy.

Rowan’s legacy

Rowan Stringer was a 17-year-old, Grade 12 student athlete who died in May 2013 from a condition known as second impact syndrome — swelling of the brain caused by a subsequent injury that occurred before a previous injury has healed.

The Government of Ontario reviewed the Coroner’s Inquest Recommendations and considered the advice of the Rowan’s Law Advisory Committee. As a result, in 2017, the Ontario government decided to introduce Rowan’s Law.

Rowan’s Law was named in her honour.

Rowan’s Law is landmark legislation. It’s the first of its kind in Canada. Since its introduction, it has increased awareness, prevention, detection, and management of concussions.

The last Wednesday in September is now known as Rowan’s Law Day, which celebrates Rowan’s memory. It serves as a reminder that concussions can happen unexpectedly, at any time, and that we need to be vigilant in identifying potential concussions and follow all protocols and processes to help prevent concussions.

Mandatory requirements put in place to make athletes safer on the field of play include the annual mandatory concussion education for athletes, parents/guardians, coaches, team trainers and officials, concussion codes of conducts and the Removal-from-Sport and Return-to-Sport protocols for amateur competitive sport organizations.

Rowan was an avid athlete, captain of her high school team and was on her way to study to become a registered nurse when she died. Although Rowan’s life was cut short, she touched many people’s lives, leaving a lasting legacy of concussion safety culture that serves as a catalyst for change across Ontario, throughout Canada, and around the world.

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.

Its mandate is to provide advice to the Ontario government in implementing the remaining 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 the members of the Rowan’s Law Concussions Working Group for your significant contributions and dedication to the health and safety of all Ontario athletes:

• Todd Anderson, Mixed Martial Arts (MMA) referee and police sergeant with the Regional Municipality of Niagara
• Kent Bassett-Spiers, chief executive officer, Ontario Neurotrauma Foundation
• Dr. Dan Cass, executive vice-president and chief medical executive, Sunnybrook Health Sciences Centre (Chair)
• Warren Hoshizaki, director of education, District School Board of Niagara
• Paul Hunter, senior director of community rugby & development, Rugby Canada
• Susan Kitchen, former executive director, Coaches Association of Ontario
• Jennifer Knox, vice-president, Ontario Federation of School Athletic Associations
• Eric Lindros, retired NHL hockey player, member of the Hockey Hall of Fame and advocate for concussion research, care and awareness
• Louise Logan, former president & chief executive officer of Parachute Canada, a national charity dedicated to preventing injuries
• Chris Markham, executive director & chief executive officer, Ophea
• Fran Rider, president & chief executive officer of the Ontario Women’s Hockey Association
• Dr. Rosana Salvaterra, former medical officer of health, Peterborough Public Health
• 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

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