ROWING PRINCE EDWARD ISLAND
CONCUSSION MANAGEMENT POLICY AND PROCEDURES |
Effective Date February 24, 2022
Table of Contents
Appendix A – Concussion Awareness and Education Guides 7
Appendix B – Concussion Recognition Tool 5 8
Appendix C – Return to Rowing Protocol 9
Purpose
The health and wellbeing of all individuals involved in the sport of rowing is always at the forefront of Rowing Canada Aviron’s efforts. This Concussion Management Policy, and associated procedures, provide guidelines on how concussion education and management should be addressed at all levels of rowing throughout Canada. The policy addresses four key areas including Prevention and Awareness, Recognition and Removal, Assessment and Return to Rowing. It aims to ensure that anyone in rowing with a suspected concussion receives timely and appropriate care with proper management to allow them to return to rowing safely. This protocol cannot address every possible clinical scenario that can occur during sport-related activities, the goal is to provide critical elements based on the latest evidence and current expert consensus.
(Note this policy is designed to support the Sport Related Concussion Guidelines developed by Own the Podium for High Performance athletes available here https://www.ownthepodium.org/getattachment/Initiatives/Sport-Science-Innovation/2018-COPSI-Network-Concussion-Guidelines/2018-COPSI-Network-Concussion-Guidelines-EN-(2).pdf.aspx, as well as support provincial legislation governing concussions in various regions of Canada.)
Scope and Application
This Policy applies to all RCA Members and participants including but not limited to coaches, officials, umpires, athletes, team managers and team staff, regatta organizers, administrators, volunteers, staff and contractors of Rowing Prince Edward Island (Rowing PEI).
It is incumbent on Rowing PEI Members (Clubs and Special Associations) to establish their own regulations and procedures for concussion management taking into account provincial and regional legislation and within their own jurisdiction which will apply to those activities, programs and events under the control of their respective organizations. However, RCA provides this policy and procedure in partnership with Rowing PEI as a minimum standard for the sport of rowing in Canada.
Policy Statement
Rowing PEI is focused on ensuring the wellbeing and safety of all participants, members, volunteers, and staff. We recognize the potential severity of a head injury and the commitment and intent behind research to manage concussions. We are committed to educating those involved with rowing in Prince Edward Island, creating awareness to help prevent injuries and appropriately managing any suspected concussions and diagnosed concussions.
Rowing PEI’s Concussion Policy is committed to the following actions regarding concussions:
- Committed to increasing awareness regarding what concussions are and the potential for serious complications.
- Enforcing procedures and training that promotes preventative actions to help reduce the number of concussions.
- Providing procedures that support coaches, volunteers, umpires, and athletes in ensuring quick recognition and removal of any individual with a suspected concussion from activities.
- Ensure that following a suspected concussion there are clear steps for all parties to follow before a return to sport occurs to ensure the focus is on the individual’s long-term health.
Responsibilities
The cooperation and support of the entire rowing community, including but not limited to, athletes, coaches, umpires, officials, team managers and team staff, regatta organizers, administrators, volunteers, and staff of Rowing PEI is required for this policy to be effective.
Athletes need to be open and honest regarding their health. Coaches, with their training and role, have special responsibilities to support athletes in the recognition of potential concussions and support them in appropriately managing their return to rowing, always focusing on the long-term health of the individual.
Procedures
Prevention and Awareness
Prior to the first practice (on water or land) each season, each athlete (and their parent/guardian if they are considered a minor) will confirm with their coach, and the organization they are participating with, that they have reviewed the Concussion Guide provided to them. (Links to all Concussion Guides in Appendix A)
Annually, all other rowing personnel such as coaches, umpires and administrators will provide confirmation to their organization that they have reviewed the appropriate Concussion Guide.
Leaders in rowing communities will actively seek out opportunities to remind and educate rowers, their families, and all other sport stakeholders on current evidence-informed approaches that can prevent concussions and more serious forms of head injury and help identify and manage an athlete with a suspected concussion.
Educational sessions will include up to date information on what concussions are, how to recognize potential concussions and best practices in concussion prevention in rowing. Training will also include the contents of the concussion policy including roles and responsibilities in recognizing and removing individuals who are involved in a situation that potentially could result in a concussion or individuals who have a concussion.
During practices and programs, coaches will remind participants of the need to take care around docks and boathouses, as well as while moving and setting up boats, also ensuring everything is working properly. Ongoing reminders for participants to be aware of potential situations where head injuries could occur will help build awareness and prevention related to concussions.
Athletes or other individuals who engage in dangerous or reckless behaviour that could potentially create a high risk for a concussion causing situation will be subject to disciplinary actions as described in the Rowing PEI Code of Conduct.
Recognition and Removal
All sport stakeholders including athletes, parents, coaches, umpires, officials, administrators, and licensed healthcare professionals are responsible for the recognition, removal and reporting of athletes who may demonstrate visual signs of a head injury or who report concussion-related symptoms.
A concussion should be suspected:
- In any athlete who sustains a significant impact to the head, face, neck, body, or their boat and demonstrates ANY of the visual signs of a suspected concussion or reports ANY symptoms of a suspected concussion as detailed in the Concussion Recognition Tool 5 (Appendix B).
- If any athlete reports ANY concussion symptoms to one of their peers, parents, umpires, or coaches or if anyone witnesses an athlete exhibiting any of the visual signs of concussion.
In some cases, an athlete may demonstrate signs or symptoms of a more severe head or spine injury including convulsions, worsening headaches, vomiting or severe neck pain. If an athlete demonstrates any of the ‘Red Flags” indicated by the Concussion Recognition Tool 5, a more severe head or spine injury should be suspected, and urgent Emergency Medical Assessment should be pursued. If “red flag” signs and symptoms of a concussion are present, Emergency Procedures in partnership with the facility’s location specific Emergency Action Plan will immediately be followed.
If any individual suffers any kind of injury where there is potential for there to have been direct or indirect force to the head, neck, face, or body and is experiencing or demonstrating any concussion related signs or symptoms, the individual will be removed from activity immediately and directed to rest. The staff or volunteer in charge of the program or practice will err on the side of caution in their decision making.
In competition, athletes, coaches, umpires, and regatta officials all have a responsibility to communicate openly and honestly about situations where significant impact to the head, face, neck, body, or their boat occurs. If a situation occurs where a potential concussion awareness is required the coach will communicate with the athlete, umpires, and regatta officials (and parents/guardian as appropriate). The coach in attendance at the competition will make the decision for their athlete if they can continue based on the suspicion of a concussion as described above. Under Rowing PEI’s Concussion Policy, all rowers will recognize the authority of their on-site coach in making decisions about removal from activity.
We recognize that symptoms may not appear immediately and that concussions can occur in many different situations. In the case of a potential for a concussion, the individual may not be in a condition to assess themselves or make appropriate decisions.
For individuals under 18, all suspected concussions or situations that occurred that potentially could result in a concussion will be reported to the guardian. The guardian should monitor the individual for delayed signs and symptoms for the next 72 hours.
Additionally, upon removal each individual, and their parent/guardian if they are a minor, will be given a handout detailing Rowing PEI’s concussion procedure for removal from sport and return to sport. Participants will be reminded that they are responsible to disclose any concussion diagnosis to any other sport organization they are registered with and/or their school.
(More information on signs and symptoms of a concussion as well as appropriate response needed can be found in the concussion resources provided to coaches, instructors, parents, and athletes at the links available within Appendix A and through the Concussion Recognition Tool 5 located in Appendix B of this policy).
Assessment
All individuals of any age with a suspected concussion will be referred immediately to a medical doctor (or nurse practitioner) for a medical assessment and the athlete must not return to play until receiving medical clearance.
Note if a licensed healthcare professional experienced in concussion diagnosis and management is present and providing medical coverage for the rowing activity, they may make the determination that a concussion has not occurred based on the results of the Sideline Medical Assessment. In these cases, the athlete may return to the practice or regatta, but this should be clearly communicated to the coaches. Rowers that have been cleared to return to rowing should be monitored for delayed symptoms. If the athlete develops any delayed symptoms they should be removed from activity and undergo another medical assessment by a medical doctor or nurse practitioner.
If the athlete is a youth, considered a minor, only if there are NO visual signs of a concussion and the athlete reports NO concussion symptoms then the athlete can be returned to play but should be monitored for delayed symptoms.
Participant Disclosure
If an individual discloses, or coaches/umpires/administrators become aware through any means, that an individual suffered a possible concussion through other activities, they will be unable to participate in rowing activities. Discovery or disclosure of a suspected concussion will be reported on an athlete disclosure form, following procedures for incident reporting.
Any registered participant who fails to disclose a possible concussion as a medical issue may be subject to discipline as described in the Rowing PEI Code of Conduct.
The individual’s return to rowing activities will be treated the same as individuals who incur concussions during rowing activities.
Reporting
An incident report form will be completed in the case of any incident resulting in injury or removal from activity. These are to be submitted as laid out in the Rowing PEI safety guidelines and the host facility’s emergency procedures.
The coach will keep a copy and update the report to document the athlete’s progression to return to sport regularly updating the organization the individual is registered with until the incident is closed with the receipt of medical clearance which will be added to the report and securely filed. In documenting the incident and its follow up, the confidentiality and privacy of the individual involved will be honoured and respected.
Returning to Rowing
If removed from rowing due to a suspected concussion the athlete may return once they have confirmed to the coach that they have undergone an assessment by a physician or nurse practitioner and have not been diagnosed as having a concussion.
Athletes who are diagnosed with a concussion should be provided with education about the signs and symptoms of concussion, strategies about how to manage their symptoms, the risks of returning to sport without medical clearance and recommendations regarding a gradual return to school and sport activities. Athletes diagnosed with a concussion are to be managed according to their individualized Return-to-School and Sport-Specific Return-to-Sport Strategies under the supervision of a medical doctor or nurse practitioner. RCA has developed a rowing focused suggested Return to Sport Plan. All return plans are graduated strategies to ensure the long-term health of the individual.
Rowing PEI is committed to supporting the individual in their recovery. For athletes at any level of education, the Return to Learn strategy is prioritized before Return to Sport. Each individual involved in educational pursuits must focus on commencing their educational components integrated with Return to Rowing aiming to get them back in the classroom before back on the water.
Before a participant or athlete is permitted to participate in any rowing practice or program after being diagnosed with a concussion, they will need to submit written proof of medical clearance that permits them to return to participating in a full range of physical activities. Note that if post-concussion symptoms include dizziness (vertigo) or other balance related symptoms return to the water should be delayed and managed by a medical doctor experienced in concussion treatment.
The written clearance must be provided by a medical doctor or nurse practitioner and submitted to their coach or the organization’s administrator. The clearance will be filed with the original copy of the incident report or athlete disclosure.
Due to the unpredictability of water conditions, they can only rejoin activities on the water once they have medical clearance to return to normal training activities. (Stage 5 of the Standard Return to Sport Strategy as found in Appendix C).
Once cleared, coaches will gradually build the activity level to help progress the individual slowly. This will include attempting to ensure the first time on the water is in mild weather conditions and starting with crew boats or boats with stabilising pontoons. Competition (Stage 6) will only be permitted once they have demonstrated symptom free completion of a minimum of two on the water training experiences involving a mix of conditions. (The time required to complete this may depend on the weather conditions occurring in the location. The coach will work with the individual focusing on an individualized progression with the individual’s long-term health as the priority.)
Incident Form Template with Concussion – Rowing Prince Edward Island
Appendix A – Concussion Awareness and Education Guides
Concussion Guide for Athletes
English https://parachute.ca/wp-content/uploads/2019/06/Concussion-Guide-for-Athletes.pdf
Concussion Guide for Parents and Caregivers
English https://parachute.ca/wp-content/uploads/2019/06/Concussion-Guide-for-Parents-and-Caregivers.pdf
French https://parachute.ca/wp-content/uploads/2019/06/Commotion-Parents-UA.pdf
Concussion Guide for Coaches. Trainers and Officials
English https://parachute.ca/wp-content/uploads/2019/06/Concussion-Guide-for-Coaches-and-Trainers.pdf
French https://parachute.ca/wp-content/uploads/2019/06/Commotion-Entraineurs-UA.pdf
Appendix B – Concussion Recognition Tool 5
Appendix C – Return to Row Concussion Management Plan
A CONCUSSION is a serious event, but you can recover fully from such an injury if the brain is given enough time to rest and recuperate. Returning to normal activities, including sport participation, is a stage-wise process that requires patience, attention, and caution.
Each stage must take a minimum of one day but could last longer, depending on the athlete and their specific situation. Starting the return to rowing and progression between stages may only occur if athlete remains symptom-free. A physician, preferably one with experience managing concussions, should be consulted before beginning the staged process to return.
If symptoms reappear at any stage, go back to the previous stage until symptom-free for at least 24 hours.
STAGE 1: Symptom limited activity – Goal: A gradual reintroduction of activity
After an initial short period of rest of 24-48 hours, light cognitive and physical activity (such as daily activities and light chores) can be initiated as long as they don’t worsen symptoms.
STAGE 2: Light aerobic exercise – Goal: Increased heart rate
Activities such as walking or stationary cycling. The athlete should be supervised by someone who can help monitor for symptoms and signs. No resistance training or weightlifting. The duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day.
Symptoms? Return to previous stage and only engage in activities as tolerated. If symptoms persist consult a physician.
No symptoms? Proceed to Stage 3 after 24 hours.
STAGE 3: More Diverse Cardio – Goal: Add movement
Activities such as light running or gentle body weight resistance exercises can begin at stage 3. There should be no body contact or other jarring motions such as high-speed stops or hitting a baseball with a bat.
Symptoms? Return to previous stage and only engage in activities as tolerated. If symptoms persist consult a physician.
No symptoms? Proceed to Stage 4 after 24 hours.
STAGE 4: Building Cardio with Increased Cognitive Challenges – Goal: Exercise, coordination, and increased thinking
Activities such as indoor rowing and resistance training can be added to activities from previous stages.
Symptoms? Return to previous stage and only engage in activities as tolerated. If symptoms persist consult a physician.
No symptoms? The time needed to progress will vary with the severity of the concussion and with the athlete.
Proceed to Stage 5 only after medical clearance in writing
STAGE 5: On water practice, once cleared – Goal: Restore confidence and assess functional skills by coaching staff
Coaches will allow return to the water in gradually challenging conditions. Start on water activities in a crew boat or a boat with stabilising pontoons.
Symptoms? Return to previous stage and only engage in activities as tolerated. If symptoms persist consult a physician.
No symptoms? Proceed to Stage 6 after minimum of two on water situations without symptoms.
STAGE 6: Competition
Return to sport with normal activities
** Core of document from Parachute Canada (parachutecanada.org/concussion) Revised Nov 11, 2019, with specific to rowing additions.