YORK CURLING CLUB - CONCUSSION GUIDELINES AND RETURN TO PLAY POLICY

DEFINITIONS

1. The following terms have these meanings in this Policy:

1. “Council” – York Curling Club;
2. “Members” – The Ontario Curling Association and the Northern Ontario Curling Association
3. “Participants” – Coaches, athletes, volunteers, renters, officials, and other members.
4. Designated Person” – an individual or individuals identified by York Curling Club who shall have the responsibilities as described in this Policy including, but not limited to, as it relates to the removal from sport and return-to-sport protocols described herein
5. “Novice Curlers” – Participants who have less than forty on ice experiences, averaging approximately 2 hours each (games, lessons) or approximately two curling seasons.
6. “Sport-Related Concussion (SRC)” – A sport-related concussion is a traumatic brain injury induced by biomechanical forces. Several common features that may be used to define the nature of an SRC may include:

1. Caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
2. Typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over several minutes to hours.
3. May result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality may be visibly apparent.
4. Results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

POSITION STATEMENT

2. This Policy is intended to be compliant with the Government of Ontario’s Rowan’s Law (Concussion Safety), 2018. If any provision of this policy is in conflict with Rowan’s Law, that legislation shall prevail.

3. The Council takes seriously the health and well-being of all curlers and is committed to ensuring the safety of those participating in the sport of curling.  The Council recognizes the increased awareness of concussions and their long-term effects and believes that prevention of concussions is paramount to protecting the health and safety of participants.

4. As part of a responsible risk management plan, the Council recommends that its members and Curling Clubs adopt and implement these Guidelines, as well as recommend the following: use of double grippers (when not delivering a stone) and helmets (or other approved head protection) by novice curlers, or curlers who are at high risk of falling. 

PURPOSE

5. The Council enacts this Policy as a tool to help manage concussed and possible concussed participants.  The Policy provides guidance in identifying common signs and symptoms of concussion, protocol to be followed in the event of a possible concussion and return to play guidelines should a concussion be diagnosed.

6. Awareness of the signs and symptoms of concussion and knowledge of how to properly manage a concussion is critical to recovery and helping to ensure the individual is not returning to physical activities too soon, risking further complication.

7. Please keep in mind that a concussion is a clinical diagnosis that can only be made by a medical doctor.  It is imperative that a medical doctor examines someone with a suspected concussion.

REGISTRATION OF PARTICIPANTS

8. When a participant registers with York Curling Club, the participant must provide written or electronic confirmation that they have reviewed concussion awareness resources within the past 12 months. The Ontario Government has produced age-appropriate concussion resources located here:

1. Ages 10 and under
2. Ages 11-14
3. Ages 15+

9. All participants ages 17 and under are required to have a Medical Profile (Appendix B) submitted to York Curling Club so that this information can be provided to emergency medical personnel should the need arise.
   
10. Participants must also sign the Concussion Code of Conduct.

11. Coaches, officials, and team trainers must provide confirmation that they have also reviewed the concussion resources and sign the Concussion Code of Conduct.

PROCEDURE

12. Prior to and during all Council curling events, competitions, and practices, participants will use their best efforts to:

1. Be aware of incidents that may cause a concussion, such as:

• Falls
• Accidents
• Collisions
• Head trauma – (blow to the head, face or neck, OR a blow to the body that transmits a force to the head)

2. Recognize and understand the symptoms that may result from a concussion.  These may appear immediately after the injury or within hours or days of the injury and may be different for everyone.  Some common signs and symptoms include, but are not limited to:

• Nausea
• Poor concentration
• Amnesia
• Fatigue
• Sensitivity to light or noise
• Irritability
• Poor appetite
• Decreased memory
• Poor balance
• Slowed reaction time

3. Identify injured participants or other individuals who have been involved in any of the above incidents and/or exhibit any of the above symptoms, notify the Designated Person at the club and have them complete the Screening Tool (Appendix A) to determine if 911 should be called.

RESPONSIBILITY OF DESIGNATED PERSON

13. If a participant has been identified as having a suspected concussion, the Designated Person at the club will notify all affected parties, including the participant, a parent/guardian (when appropriate) as well as other coaches, administrators and/or supervisors of the suspected concussion.  At this point, the individual should not participate in any physical activity until he/she has visited a medical doctor or nurse practitioner.

14. If the participant is unconscious or has a seizure – initiate emergency action plan and call 911

1. If applicable, contact the child/youth’s parent/guardian to inform them of the injury and their child is being transported to hospital.
2. Stay with the individual until Emergency Medical Services arrives.
3. Monitor and document any physical, emotional and/or cognitive changes.
4. Even if consciousness is regained, he/she needs to be examined by a medical doctor or nurse practitioner prior to the participant returning to physical activity. (NOTE: Paramedics are not considered a qualified medical professional in determining the severity of a head strike)

15. If the Participant is conscious – remove the participant from the activity immediately and:

1. Complete Concussion Assessment Tool (Appendix A) to determine if 911 should be called or if outside medical attention is required.
2. Notify the participant’s parent (if the participant is a minor) or suggest someone close to the participant be notified(if the participant is not a minor).
3. Suggest a ride home for the participant be arranged.
4. Isolate the participant into a dark room or area if the light is bothering them.
5. Reduce external stimulus if it is bothering the participant (noise, other people, etc.).
6. Remain with the participant until they feel ready to go home.
7. Monitor and document any physical, emotional and/or cognitive changes.
8. If concussion is suspected they must consult with a medical doctor or nurse practitioner before returning to play. (NOTE: Paramedics are not considered a qualified medical professional in determining the severity of a head strike)

INCIDENT REPORT

16. Once the injured participant has been properly attended to, an Incident Report shall be filed with York Curling Club within 48 hours.

RETURN TO PLAY

17. Once the participant’s immediate needs have been met, the participant’s family or the participant should be directed to the following protocol, in accordance with the following guidelines:

4. If no concussion is diagnosed: The participant may return to play for the next game, or during the same game according to the Rules of Curling.

5. If a concussion is diagnosed: Participants diagnosed with SRC should rest during the acute phase (24-48 hours following the SRC.) The participant should only return to the activity after following the six steps outlined below and as directed by a physician or nurse practitioner. (Please note that each step must take a minimum of 24 hours and the length of time needed to complete each step will vary based on the severity of the concussion. The concussed participant should be monitored regularly for the return of any signs and/or symptoms of concussion.  If signs and/or symptoms return, consult with the medical doctor):

STEP 1:        Symptom-limited activity:  Daily activities that don’t make symptoms worse, such as moving around the home and simple chores. Goal of Step: Gradual reintroduction of daily school and work activities.  To proceed to Step 2, at least 24 hours must pass.          

STEP 2:        Light aerobic exercise: Light activities such as walking or stationary bicycle at a slow to medium pace for 10-15 minutes. Goal of Step: Increase heart rate.  To proceed to Step 3, at least 24 hours must pass.        

STEP 3:        Sport-specific exercise: Individual physical activity such as running or skating. No contact or head impact activities. Goal of step: Add movement. To proceed to Step 4, at least 24 hours must pass.

STEP 4: Non-contact training, practice drills: Harder training drills. Add resistance training (if appropriate.) Goal of Step: Exercise, coordination, and increased thinking.  To proceed to Step 5, at least 24 hours must pass.        

STEP 5:        Unrestricted training and practice: Unrestricted training and practice but no games or competition. Goal of Step: Restore confidence and assess functional skills. To proceed to Step 6, at least 24 hours must pass AND obtain clearance from a physician or nurse practitioner before unrestricted training, practice or games/competition.

STEP 6: Return-to-sport: Unrestricted competition.

18. Participants who display persistent post-concussion symptoms (i.e., symptoms beyond the expected timeline for recovery as outlined in concussion plan – typically 10-14 days for adults and 4 weeks for children) should be advised to seek further advice from the clinician following their concussion and/or a physician who has experience in treating SRCs.

MEDICAL CLEARANCE

19. An athlete, or the athlete’s parent or guardian must share the medical advice or recommendations they receive with the designated person(s) before being permitted to return to training, practice, or competition through the graduated return-to-sport steps, if any. The Council will comply with all directions provided by the physician, which may supersede this policy.

20. If a participant is showing signs of concussion and/or has been clinically diagnosed as concussed, the Coach, Administrator and/or Supervisor of that participant shall prevent the participant from curling until the required medical clearance has been provided.
    
21. Once the participant has provided medical clearance, the coach, administrator and/or supervisor will be required to forward a copy of the medical clearance letter to York Curling Club where it shall be attached to the participant’s Incident Report for record keeping purposes.

RISK REDUCTION AND PREVENTION

22. Curling Canada and York Curling Club mandates the use of helmets (either CSA or designated specifically for the sport of curling, NO BIKE HELMETS) for all participants under the age of 12.
    
23. Curling Canada and York Curling Club strongly recommends that any participants in a ‘Learn to Curl Program’ (age 12 or under) and anyone who is vulnerable (novice curlers, medical, etc) wear protective headgear on the ice.
    
24. York Curling Club recognizes that knowing a participant’s SRC history can aid in the development of concussion management and the return-to-sport strategy. The clinical history should also include information about all the participant’s previous head, face, or cervical spine injuries. York Curling Club encourages participants to make coaches and other stakeholders aware of their individual histories.

NON-COMPLIANCE

25. Failure to abide by any of the guidelines and/or protocols contained within this policy may result in disciplinary action.

Appendix A

Concussion Assessment Tool

The purpose of this tool is to assist the Designated Person at York Curling Club in assessing whether a participant is presenting with signs and symptoms of a concussion. A participant who has sustained a blow to the head, face or neck in any way, regardless of the use of head protection, should be assessed using this tool. Mark which signs/symptoms affect the participant if applicable.

DO NOT REMOVE FROM THE ICE SURFACE (OR INCIDENT LOCATION) IF THE PATIENT IS UNCONSCIOUS OR SEIZING.

1. Call 911 if the participant is/was:

• Unconscious at any time (even if they have regained consciousness)
• Had a seizure (even if they have regained consciousness)
• Bleeding significantly or has a large wound
• Neck pain/tenderness
• Double vision
• Weakness or tingling in arms or legs
• Severe or increasing headache (worst headache ever)
• Vomiting more than once
• Increasingly restless, agitated, or aggressive
• Getting more and more confused
• Requesting an ambulance

2. Memory Questions that may Suggest a Concussion (if unable to answer one or more questions, 911 must be called for concern of increasing confusion):

• What is your full name?
• Where are you right now?
• What day is it (day of the week, date, month)?
• What league, event, activity are you participating in?
• How old are you?

3. Common Signs and Symptoms of Concussion (if yes to one or more refer to bolded statement below):

IF PARTICIPANT IS PRESENTING WITH ANY ONE OR MORE OF THE SIGNS/SYMPTOMS/QUESTIONS ABOVE, THEY MUST BE ASSESSED AND CLEARED BY A MEDICAL DOCTOR OR NURSE PRACTITIONER BEFORE RETURN-TO-PLAY.

If a participant FAILS SCREENING QUESTIONS, the following must occur:

• Notify the participant’s Parent/Guardian (if the participant is a minor) or suggest someone close to the participant be notified (if the participant is not a minor).
• Suggest a ride home for the participant be arranged.
• Isolate the participant into a dark room or area if the light is bothering them.
• Reduce external stimulus if it is bothering the participant (noise, other people, etc.).
• Remain with the participant until they feel ready to go home.
• Monitor and document any physical, emotional and/or cognitive changes.
• Participant will not be allowed to return to play without direction from a Medical Doctor or Nurse Practitioner. Please review the Concussion Guidelines and Return to Play Policy on the York Curling Club Website for details on what is required. (NOTE: Paramedics are not considered a qualified medical professional in determining if a participant has a concussion)

It is advised that someone with a suspected concussion not be left alone for 12-24 hours after sustaining the injury.

If a participant PASSES SCREENING QUESTIONS advise them that concussion symptoms take minutes to hours to present. If any of the above symptoms develop or the participant is unable to continue answering the memory questions after returning home they should seek assessment from a Medical Doctor or Nurse Practitioner as soon as possible and not return to curling until a concussion has been ruled out.

A copy of this document will be provided to any participant who sustains a blow to the head, face, or neck at York Curling Club.

Designated Person Assessing Participant:

Name:        _____________________________  

Signature:    ______________________________  

Date:                _______________________

Participant Acknowledgement of Assessment (if possible):

Name:        _____________________________  Signature:______________________________  

Date:________________________

Appendix B

Medical Profile for Participants 17 and Under