Rowan Stringer inquest hears Ontario concussion strategy in place by fall

Ontario schools must have a concussion management strategy by September 2015, which comes after the death of Rowan Stringer, a coroner's inquest heard on Monday.

Stringer, 17, died after suffering a third concussion in less than a week when her head and neck struck the ground during a high school rugby match on May 8, 2013.

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Witnesses said she stayed awake for a few moments after sitting up from the hit, and then fell unconscious. She was taken to hospital where doctors tried unsuccessfully to relieve the pressure in her head.

Stringer died in hospital four days later from Second Impact Syndrome, where a pre-existing injury followed by another head blow can cause death.

On Monday public school board officials testified about concussion policies including a concussion-management strategy that will need to be in Ontario schools by September 2015.

The new strategy became mandatory after Stringer's death, according to Pino Buffone, the superintendent of curriculum for the Ottawa-Carleton District School Board.

It will include the definition of a concussion, assessment rules and rules on determining when it's safe to return to play. All staff would need training, Buffone said.

Earlier in the trial, Rowan Stringer's mother, Kathleen, testified she hoped the inquest would push schools to instill mandatory concussion education in Grade 9, but Buffone said that likely would not happen.

Instead, Buffone said concussion education would be up to the "professional judgment" of teachers.

Players 'don't own up' to concussions, ref says

The inquest also heard from several witnesses last week including Stringer's friends, head coach, a paramedic, doctor and the referee who officiated the final match, Jim Carr.

Carr, who had officiated in rugby for more than 20 years, said there is "no solid process in place" to ensure athletes follow up on suspected or real concussions.

He said he would like to see high school level referees flag concussions on score sheets at the end of each game, which would then allow school boards to create databases to track injured players.

"Concussions are nebulous," he said. "You can't see them and players don't own up to them."

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Carr also described a series of dangerous tackles during the rugby match on May 8, 2013 between John McRae and St. Joseph's Catholic High School.

Dr. Michael Vassilyadi, a neurosurgeon at the Children's Hospital of Eastern Ontario, has also testified that Stringer was the first and only case of Second Impact Syndrome he has ever treated.

Vassilyadi said Stringer's brain had not healed or rested after two previous concussions causing a "rare and quite severe" head injury.

The inquest into Stringer's death, which resumes on Monday, is examining the circumstances surrounding her death, including areas of head injury recognition in high school field sports. The jury may make recommendations aimed at preventing similar deaths.​​

• On mobile? Tap here to follow Day 5 of the rugby death inquest.