Safety

Return to Play Guidelines after Head Injuries
USA Hockey Safety and Protective Committee

The evaluation of an athlete with a suspected concussion should be prompt and thorough. Treatment is individualized according to patient age, concussion history, symptoms, signs and type of sport. All concussed athletes should be cleared for return to play by a sports medicine professional.

Based on the Summary and Agreement Statement of the First International Conference on Concussion in Sport, Vienna 2001 http://www.bjsportmed.com/.

Concussion in Sport Group (CISG) Protocol
Acute Response: When a player shows ANY symptoms or signs of a concussion.

• The player should not be allowed to return to play in the current game or practice.
• The player should not be left alone; and regular monitoring for deterioration is essential.
• The player should be medically evaluated after the injury.
• Return to play must follow a medically supervised stepwise process.
• A player should never return to play when symptomatic. "When in doubt, sit them out!"

Symptoms

• unaware of situation
• confusion
• amnesia
• loss of consciousness
• headache
• dizziness
• nausea
• loss of balance
• flashing lights
• ear ringing
• blurred or double vision
• vision
• sleepiness
• feeling dazed

Signs

• loss of consciousness
• altered mental status
• poor coordination
• slow to answer
• poor concentration
• nausea or vomiting
• vacant stare
• slurred speech
• personality changes
• inappropriate emotions
• abnormal behavior

Return to Play Protocol
Return to play after a concussion follows a stepwise process:

Proceed to the next level if free of symptoms at the current level. If any symptoms or signs occur, drop back to the previous level and progress to the next level again after 24 hours.

1. No activity, complete rest.
2. Light aerobic activity, exercise such a walking or stationary cycling.
3. Sports specific training- skating.
4. Non-contact training drills.
5. Full-contact training after clearance by a sports medicine professional .
6. Return to competition.

On Feb. 20, 2008, the Colorado Springs Gazette published a series of articles focusing on concussions in hockey. Reprinted with permission from The Gazette, USA Hockey brings you the collection of important information regarding this injury.

Excerpts of the three articles, written by Kate Crandall, are below with links to the full versions.

The dangers of having your bell rung

Dazed, dizzy, but driven to establish his place in the lineup, Colorado College forward Eric Walsky kept playing after an opponent's shoulder check left a dent in his metal facemask.

Not until later, when the symptoms persisted, did Walsky admit to himself what had happened in the Tigers' exhibition against the U.S. under-18 team. 

It was the fourth concussion of his career, although it was mild compared to one he suffered in junior hockey, when he couldn't remember the date or where he was. 

Concussions occur after a direct blow to the head, face, neck or body. The force causes the brain to shift. That impact can immediately result in a wide range of symptoms including confusion, amnesia, loss of consciousness, headache, dizziness, nausea, loss of vision or loss of balance. Once a person has had one concussion, the odds greatly increase that another blow, even a small one, will result in a second concussion. 

Research has shown that multiple concussions can have a snowball effect, magnifying the symptoms, but no one is exactly sure what the longterm effects are, said Dr. Michael Stuart, USA Hockey's chief medical officer.

Patience is key for players in recovering after concussions

As freshmen, Colorado College players take a cognitive test that measures mental facets such as memory in order to establish a baseline. 

Once a player suspects a concussion, he will retake the test to get an indication of his neurological health. 

If the player is diagnosed with a concussion, he is put on rest. 

Dr. Michael Stuart, chief medical officer for USA Hockey, said even reading and TV watching are discouraged. 

"The safe way is to recognize the concussion symptoms, give the brain a chance to rest and heal, gradually return to play and that gives you the best chance of being able to compete for the rest of the season," Stuart said. 

Unlike most hockey injuries, which have somewhat predictable timetables for healing with ice and heat and can be patched up with tape, concussions require patience.

Equipment makes difference

Defenseman Nate Prosser suffered a serious concussion - his second in as many seasons - against North Dakota in early November. To return to play, Prosser was required to switch to a helmet with padding three-quarters of an inch thick that is adjustable on the back and sides for a snug fit. 

Many Colorado College players prefer lighter, smaller helmets with a thin layer of foam. 

While no equipment can guarantee protection from a concussion, CC equipment manager Ed Warner said he believes more helmet padding "can't hurt."