About Rowan’s Law

  • On March 7, 2018, new legislation called Rowan’s Law (Concussion Safety), 2018, was enacted, setting out a framework for concussion prevention, detection, and management within amateur competitive sport.
  • The legislation applies to sport organizations (as defined under the Act), which could include:
    • public and private sport clubs
    • post-secondary institutions
    • municipalities throughout Ontario
  • Rowan’s Law includes requirements for the removal from and return to sport, which came into effect on January 1, 2022.
  • Anyone who has been removed from sport with a suspected concussion should see a physician or nurse practitioner as soon as possible. That person should not return to unrestricted participation in training, practice or competition until they have received medical clearance.
  • Amendments to the Education Act provide the Minister of Education with the authority to require school boards, school authorities, and provincial and demonstration schools in Ontario to have concussion policies in place that are consistent with Rowan’s Law. Policy/Program Memorandum 158: School board policies on concussion include similar removal and return to physical activity requirements for Ontario students.

What this means for health care providers

  • Under Rowan’s Law, physicians and nurse practitioners are specified as the only health care providers to medically assess and provide confirmation of medical clearance for athletes to return to unrestricted participation in amateur competitive sport.
  • Physicians and nurse practitioners may have experienced an increase in suspected concussion cases and an increase in requests for documentation.
  • It is important to note that Rowan’s Law does not specify the type of confirmation needed to demonstrate that a diagnosis and/or medical clearance has been received from an athlete’s physician or nurse practitioner. However, some sport organizations and school boards may choose to request a medical clearance note before allowing an athlete/student to return to amateur competitive or interschool sport.
  • It is the responsibility of the athlete/student (or parent/guardian if the athlete/student is under 18 years of age) to provide confirmation to the sport organization (in accordance with the requirements of the organization’s return-to-sport protocol) or school board.
  • Please see Appendix A for existing resources and supports that can be leveraged to support health care providers in navigating this legislation.

Additional considerations for health care providers

  • Concussion management can be complex and often necessitates a multidisciplinary approach, with regular follow-up through the continuum of care, starting from diagnosis, through treatment and management, to clearance.
  • Physicians/nurse practitioners should follow the current best practices for concussion management.
  • Physicians should submit the diagnostic code for a concussion (850) when submitting claims to OHIP for services provided relating to concussion assessment and management.

Information sharing

  • The ministry will provide updates as appropriate to ensure that health care providers are kept up to date on the status of the implementation of the legislation and how it involves health care providers in Ontario.

Additional information

Appendix A: existing resources to support health care providers

Amsterdam Consensus Statement on Concussion in Sport

  • The Amsterdam Consensus Statement summarizes the latest research in concussion and shares updates based on the international consensus that can be used to optimize concussion processes in sports.
  • The 12 R’s of clinical concussion management (Recognize, Reduce, Remove, Re-evaluate, (Relative) Rest, Rehabilitate, Refer, Recover, Return-to-Learn/Return-to-Sport, Reconsider, Refine, Retire).
  • It includes revised tools, including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6).
  • This consensus process also integrated new features, including a focus on the para athlete, the athlete’s perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease.
  • This statement summarizes evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

Parachute Canada (various resources)

  • A wide range of resources exist in English and French, including concussion guides for athletes, coaches and trainers, parents and caregivers, and teachers, as well as return-to-school, return-to-work and return-to-sport strategies.
  • Parachute offers a free mobile application, Concussion Ed, to provide information on the go, including a concussion recognition checklist and symptom tracking.
  • The Canadian Guideline on Concussion in Sport, 2nd edition has been developed to ensure that athletes with a suspected concussion receive timely and appropriate care, and proper management to allow them to return to their sport.

Concussion Awareness Training Tool (CATT)

  • The Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources, based on the established principles of the Consensus Statement on Concussion in Sport, with the goal of standardizing concussion recognition, diagnosis, treatment and management.
  • There are 8 free CATT online educational modules available in English and French:
    • CATT for Medical Professionals
    • CATT for Coaches
    • CATT for Parents
    • CATT for Youth
    • CATT for Athletes
    • CATT for School Professionals
    • CATT for Workers & Workplaces
    • CATT for Women’s Support Workers

The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury

  • Diagnostic Criteria for Mild Traumatic Brain Injury (TBI)
  • New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.

Centre for Disease Control and Prevention: concussion information for health care providers

  • Practical, easy-to-use clinical information and tools for healthcare providers and their patients, including an online training with continuing education credits

Living Concussion Guidelines for Concussion and Prolonged Symptoms for Adults 18 years of Age or Older

  • The Guideline for Concussion/mild TBI and Persistent Symptoms was developed to improve care of patients aged 18+ by creating a framework that can be implemented by health care professionals to identify and treat individuals with persistent symptoms following a concussion/mild TBI.

Living Guideline for Pediatric Concussion

  • The Living Guideline for Pediatric Concussion supports health care practitioners to identify and treat youth and children (aged 5-18) experiencing prolonged symptoms following a concussion/mild TBI. The guideline also educates parents and individuals working in community settings with children and youth who have sustained concussion/mild TBI.

Sport Concussion Assessment Tool

  • Designed for medical and health professionals in evaluating for suspected concussion.

The Centre for Effective Practice Diagnosing and Managing Concussion Tool

  • Primary care providers can use the Diagnosing and Managing Concussion Tool to diagnose and manage concussion in adult patients (18+). The tool contains steps for a management and recovery plan and includes resources for monitoring and follow-up visits with the patient.

Holland Bloorview Concussion Handbook (for children)

  • The concussion handbook is designed to help with concussion management and recovery.

Project Echo Education Series

  • Links interprofessional teams, “the hub,” with primary care providers (PCP) via weekly videoconferencing sessions. Health care providers receive support to provide care to patients close to home, including supports with diagnosing and managing concussions.

Massive Open Online Course on Concussions

  • A free online course that clarifies the role of individuals involved in preventing and managing concussions. It supports individuals in implementing a concussion management protocol for a specific sport, school or community environment. The course is intended for:
    • health professionals
    • sport coaches and teachers
    • parents with children in sport
    • school administrators
    • sport leaders
    • athletes