Situational Assessment: Identifying Key Questions to Inform Concussion Prevention and Education

1)What is the situation?

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Brain Injury is a common and significant public health concern in British Columbia, with rates that vary across health authorities. BC Injury Data Online Tool (iDOT) data indicate that Interior Health has a higher rate of concussion-related hospital admissions than other health authorities in the province.

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1A)What impact does the current situation have on health outcomes, quality of life, and other societal costs?

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Concussions contribute to increased use of emergency departments, diagnostic imaging, follow-up primary care visits, specialist referrals, and rehabilitation services. In regions such as Interior Health, where concussion care pathways are not standardized and access to specialized services may be limited or require private pay, individuals may experience delayed recovery or repeated healthcare encounters, further increasing system demand and costs. Damji and Babul (2018) estimate that direct healthcare costs for concussion-related hospitalizations in British Columbia totalled approximately $3.3 million, indicating a substantial cost even before accounting for emergency care, outpatient services, diagnostic imaging, or rehabilitation. Higher rates of concussion-related hospital admissions also suggest more severe presentations, barriers to early intervention and education, and community-based management.

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1B)Which groups of people are at higher risk of health problems and poorer quality of life?

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BC Injury Data Online Tool (BC iDOT, n.d.) shows regional injury data. However, across the regions of BC the highest concussion hospitalization rates occur in males aged 0–19 and 65+ years, indicating these age groups are particularly at risk of injury and injury-related outcomes. After the age of 65, falls are the highest mechanism of injury.

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1C) Which settings or situations are high risk, or pose a unique opportunity for intervention?

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Emergency departments and urgent care settings are high-risk points of contact, as many individuals present with concussion symptoms but may receive variable education or follow-up guidance depending on provider experience. These settings offer an opportunity for consistent, standardized concussion education that can ensure equity of access and a standard of care, regardless of the touchpoint of access to the health system.

Schools and youth sport environments are high-risk settings, as children and adolescents experience some of the highest concussion rates in BC (BCiDOT, n.d.). Schools pose a unique opportunity for intervention and education for their ability to reach youth, parents, coaches, and educators in one setting.

Rural and remote communities represent both higher-risk and unique opportunities for intervention. Canadian research shows that rural populations experience higher rates and poorer outcomes of brain injury (Lasry et al., 2016). In these settings, limited access to specialized services and longer travel distances make prevention, early recognition, and self-management education particularly important.

Workplaces with higher injury risk, such as resource-based industries, trades, and agriculture, are settings where concussions can be under-recognized or normalized. These workplaces can offer education that focuses on symptom recognition, reporting, and safe return-to-work.

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1D) How do local stakeholders perceive the situation? What is their capacity to act? What are their interests, mandates, and current activities? What are the needs, perceptions, and supported directions of key influential community members, and the community-at-large?

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Within Canada there is legislation that is calling for a national strategy on brain injury in Canada. The national strategy calls for coordinated prevention, care, data collection, and public awareness across Canada. At the local level, Brain Injury organizations within the IH regional are supporting the legislation for a national strategy (Bill 206). The support for the strategy indicates their capacity for advocacy beyond direct service delivery. 

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2) What influences are making the situation better and worse?

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In British Columbia, concussion management is supported through a combination of provincial legislation and policy. School protocols under the School Act and Ministry of Education guidelines, sport governance requirements through viaSport BC, and provincial clinical practice guidelines for concussion care (BC Ministry of Education and Child Care, 2018; BC Guidelines, 2017; viaSport BC, n.d.).

However, there are several factors that contribute to the worsening of the situation. A significant proportion of BC residents lack access to a regular family physician, which limits continuity of care and can delay diagnosis and follow-up for concussion (Statistics Canada, 2023). There is also variability in clinicians’ education and confidence in handling concussions, with evaluations showing inconsistent practices before standardized training (Babul et al., 2020). The absence of regional standardized care pathways means concussion management varies by provider and location, leading to fragmented care and inequities in outcomes (Damji & Babul, 2018). In rural and remote communities, barriers such as limited specialist access and travel distance further challenge timely assessment and ongoing management (Canadian Institute for Health Information, 2022).

Together, these factors worsen the overall concussion situation by creating gaps in access, consistency, and quality of care.

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2A) What high-risk or negative health behaviours by various groups of people are affecting the situation? Several high-risk behaviors contribute to concussion risk, particularly in rural and remote communities. These include higher participation in high-risk occupations (e.g., resource extraction, agriculture, and trades), recreational activities with increased injury risk (e.g., ATV use, snowmobiling, and contact sports), and inconsistent use of protective equipment such as helmets. In rural settings, longer travel distances and limited access to timely medical assessment may also lead individuals to delay care or continue activities before fully recovering, increasing the risk of repeat injury.

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2B)Which underlying causes or conditions are driving these behaviours (e.g., individual, community, organizational, or system-level causes)? Are there protective factors that can help avoid or alleviate the situation?

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Concussion-related risk behaviours are shaped by a combination of individual, community, organizational, and system-level factors. At the individual level, limited awareness of concussion symptoms, normalization of risk-taking, and pressure to continue work, sport, or recreation can increase the risk of concussion. At the community and organizational level, limited access to healthcare, fewer local education resources, and inconsistent concussion messaging across schools, workplaces, and recreational settings can increase risky behaviours. . In rural and remote communities, long travel distances, limited access to specialized services, and fewer opportunities for follow-up care are barriers tp early assessment or access to concussion recovery recommendations. These access barriers can be compounded by low public awareness of concussion. In a provincial survey, only 11% of British Columbians reported feeling confident in recognizing concussion symptoms, and 62% were unaware of appropriate concussion care practices, despite 53% reporting having experienced a concussion themselves (BC Children’s Hospital Research Institute, 2022). At the system level, variability in concussion education, absence of standardized pathways, and reliance on self-directed learning tools place the responsibility for injury recognition and management largely on individuals and families.

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2C)Which strengths and weaknesses present in your organization may affect your course of action? Which opportunities and threats in your environment may affect your course of action?

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The strength of our organization that will influence my course of action is the recognition of the care gap for this patient population, an understanding that care is variable and inconsistent. There is an acknowledgement among providers that this patient population is an area where we can increase service provision without significant investments. Our organization is operating in a tight fiscal landscape, and implementing a concussion clinic in all locations would benefit individuals, but is fiscally unavailable. This makes an education campaign a feasible, implementable solution that can have mutual benefits for providers and patients.

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3)What possible actions can you take to address the situation? What is the best available evidence that exists to support various courses of action?

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Babul et al. Found Canadian and BC-related evidence on the effects of concussion education tools. Education can improve knowledge and practice. For example, a Canadian study evaluating the Concussion Awareness Training Tool (CATT) for medical professionals found that most participants reported learning new information and changing how they diagnose and manage concussions after completing the online training. Ongoing work in BC also shows that the CATT for Youth module can improve concussion knowledge and beliefs among high school students. These findings support the idea that standardized concussion education has measurable impacts on learner knowledge and self-reported practice, reinforcing the value of an organized education campaign.

 

References:

Babul, S., Turcotte, K., Lambert, M., Hadly, G., & Sadler, K. (2020). Delivering evidence-based online concussion education to medical and healthcare professionals: The Concussion Awareness Training Tool (CATT). Journal of Sports Medicine, 2020, Article 8896601. https://doi.org/10.1155/2020/8896601

 

BC Children’s Hospital Research Institute. (2022, September 28). Survey finds low concussion awareness in BC.https://www.bcchildrens.ca/about-us/news-features/survey-finds-low-concussion-awareness-bcBC Injury Research and Prevention Unit. (n.d.). Injury Data Online Tool (iDOT): Concussion and head injury data. https://www.injuryresearch.bc.ca/idot

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Damji, F., & Babul, S. (2018). Improving and standardizing concussion education and care: A Canadian experience. Concussion (London, England), 3(4), CNC58. https://doi.org/10.2217/cnc-2018-0007

 

Canadian Institute for Health Information (CIHI). (2022). Access to health care services: Rural and remote communities. https://www.cihi.caStatistics Canada. (2023). Health indicator profile, 2023 edition: Access to a regular medical doctor.https://www150.statcan.gc.ca

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Lasry, O., Dudley, R. W., Fuhrer, R., Torrie, J., Carlin, R., & Marcoux, J. (2016). Traumatic brain injury in a rural Indigenous population in Canada: A community-based approach to surveillance. CMAJ Open, 4(2), E249–E255. https://doi.org/10.9778/cmajo.20150088

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Statistics Canada. (2023). Health indicator profile, 2023 edition: Access to a regular medical doctor.https://www150.statcan.gc.ca