UPFRONT | Roundup CONCUSSION New report calls for comprehensive concussion management protocols A coalition of health and sporting groups across the country is calling for Cana-da’s athletic organizations to get more proactive about protecting participants from head injuries. The Canadian Concus-sion Collaborative, consist-ing of nine national sports advocacy groups, has laid out two specific recommen-dations in the September issue of the British Journal of Sports Medicine . Most sports organiza-tions don’t have policies in place that address the needs of a concussion patient at every step of the process. The group’s first recom-mendation is to put such policies in place immedi-ately and to review them once a year. The collaborative said the protocols should address concussion education, pre-vention and treatment, as well as an athlete’s return to action. The collaborative also urged organizations to con-sult with medical profes-sionals and local community resources when developing their concussion protocols. The recommendations come at a time when aware-ness of concussion risks and repercussions are at an all-time high, according to col-laborative members such as the Canadian Centre for Ethics in Sport (CCES). CCES CEO Doug Mac-Quar r ie acknowledged many parts of society are equipped to deal with the various aspects of concus-sion management. He said the time has come for spor ting associations, school boards and other organizers of ath-letic activities to bring all concussion management tools under one roof. “Oftentimes these things are left to discrete parts of the system,” MacQuarrie said in a phone interview from Ottawa. “A sport organization may deal with, ‘what do we do on the field?’ A public health agency or local health care unit may deal with, ‘what do we do when they’re in the hospital,’ and the fam-ily practice might say, ‘OK, how do we get the person back into sport?’ What’s optimal is that all of those links are contemplated in advance so that people who get involved in sport know that system exists in their community to assist them should the unfortunate cir-cumstance of a concussion arise.” MacQuarrie said an ideal concussion protocol would address four key points – training coaches, parents and participants to watch for signs of head injuries, setting up guidelines to make the environment safe for ath-letes, establishing a treat-ment protocol should a concussion take place and developing a process to help injured players get back in the game slowly and safely. The Royal College of Chiropractic Sports Science (RCCSS) welcomed the re-port and supports the idea of a comprehensive protocol for providers and coaches to follow on concussion man-agement. “Ultimately, proper diag-nosis, management and return to play is so impor-tant and we should all be on the same page when provid-ing care and advise to ath-letes,” said Dr. Michelle Laframboise, chair of the RCCSS public health com-mittee. Laframboise and the RCCSS have been actively pursuing interprofessional collaboration on concussion management. In an email to Canadian Chiropractor magazine, La-framboise said while profes-sional sport may be address-ing concussion in the higher level, the case may not be the same in the grassroots level and “this being the most vulnerable group may in fact be the most impor-tant level to address the impacts of concussion.” “There is a lot of new emerging research on the importance of the cervical spine. This is where chiro-practors (being spine spe-cialists) can be extremely beneficial in the treatment of concussions,” Lafram-boise said. Collaboration among health-care professionals is also key, she said, “to come up with a strategy of how to address, treat, diagnose and ultimately manage concus-sions. We need to not only educate health-care provid-ers but also parents, athletes and coaches alike.” Putting in place a proto-col for concussion manage-ment, she adds, will ensure transparency and that ulti-mately the patient is cared for appropriately without confusion. – Michelle McQuigge, The Canadian Press, with files from Mari-Len De Guzman HEALTH CARE Chronic illnesses cost Albertans billions Alberta’s auditor general says caring for people with chronic health prob-lems is costing the provincial govern-ment billions of dollars each year. Merwan Saher says in a report that conditions such as high blood pres-sure and diabetes are the biggest challenges facing health care. Saher looked at figures from 2012 and 2013 when about 735,000 people in the province were known to have at least one chronic ailment. The cost to the health-care system at that time was $4.5 billion. That figure didn’t include lab tests, long-term care and home care. Saher’s report points out that the top 10 per cent of health-care users – most of whom have at least one chronic condition – account for more than 75 per cent of health-care spending. He suggests the way to lower that cost is to slow progression of diseases by better managing their conditions. The auditor’s report also says Alberta generally does a good job providing care for people with chron-ic diseases, but the care tends to be fragmented. Saher says no one has overall re-sponsibility for making sure all health-care providers are working together or that everyone is receiving the same level of care. His 18 recommendations include stronger supports for family doctors and more information sharing be-tween different health-care sectors. He urges that nine of his recom-mendations should be addressed within a year, including one that sug-gests Alberta Health Services identify and provide care to patients who don’t have a family doctor. Another nine recommendations are longer-term and deal with health-care organization and outcomes. – The Canadian Press www.canadianchiropractor.ca 10 Canadian Chiropractor October 2014
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