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.
  • Athletes who have sustained a concussion, or are suspected of having sustained a concussion, must be removed from further training, practice, or competition (and cannot return to full participation in amateur competitive sport) until:
    • medically assessed
    • cleared to return to training, practice or competition by a physician or nurse practitioner
  • Amendments to the Education Act requires school boards, school authorities, and provincial and demonstration schools in Ontario to have concussion policies in place that are consistent with Rowan’s Law and include similar removal and return requirements for interschool sports. These requirements have been in effect since January 2020 and were an expectation under the previous Ministry of Education policy since January 2015.

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.
  • As a result, physicians and nurse practitioners could see 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

Resource

Description

Berlin Consensus Statement on Concussion in Sport (PDF)
  • The Berlin Consensus Statement on Concussion in Sport guides clinical practices and develops the current understanding surrounding sport-related concussions (SRC). It offers recommendations on how to:
    • Recognize SRC;
    • Remove players demonstrating SRC;
    • Re-evaluate players with SRC;
    • Determine how long players with SRC should rest;
    • Rehabilitate players with SRC;
    • Refer players with SRC to higher care;
    • Determine when to allow players with SRC to return to sports;
    • Prevent SRC; and
    • Reduce future risk of SRC.

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 Sports, with the goal of standardizing concussion recognition, diagnosis, treatment, and management.
  • There are 7 CATT free online educational modules available in English and French:
    • CATT for Medical Professionals
    • CATT for Coaches
    • CATT for Parents
    • CATT for Athletes
    • CATT for School Professionals
    • CATT for Workers & Workplaces
    • CATT for Women’s Support Workers

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.

Concussions Ontario
  • An information and resource portal that informs patients, family members, clinicians, administrators, and the public about the latest research and practice advancements in concussion care across Ontario.

Ontario Neurotrauma Foundation:
Guideline for Concussion/Mild Traumatic Brain Injury (mTBI & Persistent Symptoms, 3rd Edition (PDF)
  • The Guideline for Concussion/mTBI 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/mTBI.
Living Guideline for Diagnosing and Managing Pediatric Concussion
  • The Living Guideline for Diagnosing and Managing Pediatric Concussion supports health care practitioners to identify and treat youth and children (aged 5-18) experiencing prolonged symptoms following a concussion/mTBI. The guideline also educates parents and individuals working in community settings with children and youth who have sustained concussion/mTBI.

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 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.
    • Developed by Parachute and its Expert Advisory Concussion Subcommittee, the Guideline, published in July 2017, is based on a review of the current scientific evidence and expert consensus on best practices for the evaluation and management of Canadian athletes who sustain a concussion during a sport activity.

University of Laval 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 to implement 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

Sport Concussion Assessment Tool
  • Designed for medical and health professionals as a standardized method of evaluating injured athletes for concussion.

Sport Concussion Library
  • A free and publicly accessible storehouse for all non-commercial peer-reviewed literature on sport-related concussion for all audiences, including health care professionals and researchers.

Centre for Disease Control and Prevention: concussion information for health care providers
  • The "Heads Up: Brain Injury in Your Practice" tool kit contains information on concussion diagnosis and management including an online concussion training, a patient assessment tool, and a care plan to help guide a patient's recovery.