Improving Concussion Policies

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Researchers develop the first expert consensus on concussion policies for the school setting.
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(L-R) Swapna Mylabathula, MD/PhD student in Dr. Tator’s lab and first author of the study (Photo: Changmo Joseph Kim), and Dr. Charles Tator, Emeritus Scientist at the Krembil Brain Institute and senior author of the study.

Researchers at the Krembil Brain Institute, the Hospital for Sick Children and the University of Toronto have developed a comprehensive list of recommendations for concussion policies for the school setting. 

Concussions are a significant public health issue and several government-initiated policies address concussion diagnosis, management and prevention, particularly in student athletes in elementary and secondary schools. 

According to Dr. Charles Tator, an Emeritus Scientist at the Krembil Brain Institute and Director of the Canadian Concussion Centre, “school-based concussion policies vary widely in content and in the way that they are implemented.”  

Dr. Tator explains that increasing consistency between policies is an important first step towards ensuring that they are applied effectively and have a positive impact. “If we can streamline policies, we can reduce confusion and facilitate communication among various stakeholders, including educators, students, parents and guardians, and clinicians. We can also better allocate funding to support policy development and implementation.” 

Dr. Tator’s team comprised Swapna Mylabathula, an MD/PhD student in Dr. Tator’s lab and first author of the study, Dr. Colin Macarthur, a Senior Scientist at the Hospital for Sick Children, and Drs. Astrid Guttmann and Angela Colantonio, Professors at the University of Toronto. The team brought together 20 experts who have roles in concussion prevention and management to form the Concussion Policy Consensus Group—tasked with reviewing school-based policies and developing recommendations to improve their consistency. This group included public health representatives, policymakers, clinicians, school board representatives, and parents and guardians of students who have experienced a concussion. The group also included members of Parachute Canada—a national injury prevention organization—and the Ontario Physical and Health Education Association

After providing feedback about an initial set of recommendations prepared by the research team, the experts met by teleconference to discuss recommendations and suggest revisions. This process was repeated, resulting in a comprehensive list of 30 recommendations that spanned concussion education, prevention and communication, as well as best practices for return-to-learn or play following a concussion. 

Final recommendations for concussion policies included: 

1. Outlining that concussion education should be required for coaches, referees, trainers, teachers, school staff, students, and parents and guardians;
2. Specifying which individuals are responsible for planning return-to-learn or play following a concussion; 
3. Outlining that schools should communicate information about previous concussions for students moving between grades or schools; and
4. Requiring that concussion surveillance data be collected at the school level and collated by school boards and the province or territory to help assess the policy’s impact. 

This list of recommendations represents the first expert consensus for school-based concussion policies and reflects the diverse perspectives of a multidisciplinary group of stakeholders in and outside the school system. 

“The aim of these recommendations is to safeguard the well-being of children and youth by improving concussion management and prevention in the school setting,” says Mylabathula. “An important next step is to assess the feasibility of implementing these recommendations and the impact of the new policies on concussion in schools.” 

This work was supported by the UHN Foundation. Dr. Astrid Guttmann holds a Tier I Canada Research Chair in Applied Child Health Services and Policy at the University of Toronto. Dr. Angela Colantonio holds a Tier I Canada Research Chair in Traumatic Brain Injury in Underserved Populations at the University of Toronto. Dr. Charles Tator is a Professor in the Department of Surgery at the University of Toronto. 

Mylabathula S, Macarthur C, Guttmann A, Colantonio A, Tator C. Development of a concussion public policy on prevention, management and education for schools using expert consensus. Inj Prev. 2022 May 4. doi: 10.1136/injuryprev-2021-044395.


School-aged athletes competing in contact and non-contact sports are at risk for concussions. Sports-related concussions in the school setting have drawn considerable attention from Ontario policymakers.