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A concussion is a traumatic brain injury caused by an impact to the head or body. Every concussion is different, and can present with different symptoms. Although the symptom severity varies from injury to injury, there is no such thing as a minor brain injury.

Injuries, including concussions, are an unfortunate reality of playing sports. The risk of concussion is greater in youth sports, as children’s brains are more susceptible to injury than adults’. As an elite youth sports program, North Park Hockey is committed to reducing this risk as much as possible through a comprehensive concussion policy including education, prevention, and injury response. The goal of this policy is to minimize the risk of these potentially career-ending injuries, ensuring that our athletes can develop into the best hockey players possible.

Below is our comprehensive concussion policy. For more information on concussion signs, symptoms, and treatment, please visit the CDC Heads Up Concussion Page. Any questions about the policy may be directed to the league Concussion Coordinator: Gary Simpson.

 

CONCUSSION EDUCATION

Education is the foundation for effective concussion management. Many stakeholders must play a role in preventing and properly managing concussions, and it is important that everyone knows the role they need to play to keep everyone safe. North Park Hockey requires education for all athletes, coaches, and volunteers.

Athletes:

Mites –No formal education required. We recommend parents and coaches model appropriate attitudes towards concussions by openly discussing concussions with athletes and refraining from dismissive responses to suspected concussions in others.

Squirts: Required annually to complete the Brain 101 online concussion training for athletes together with their parent or guardian. Be sure to bring a note signed by your parent or guardian confirming that you completed the course, or you will not be allowed on the ice. An email from the athlete’s parent or guardian confirming completion sent to the league Concussion Coordinator is also acceptable.

Pee wee and Bantam: Required annually to complete the NFHS Concussions for Students course. Be sure to bring a note signed by your parent or guardian confirming that you completed the course, or you will not be allowed on the ice. (Alternately: confirm completion via website generated email)

Coaches: Required annually to complete the Heads Up online concussion training from the CDC. Deliver your completed certificate to the league Concussion Coordinator, along with the completion letters for each of your athletes at the beginning of the season. (Alternately: confirm completion via website generated email). The link to the Heads Up Online Training is https://nfhslearn.com/courses/61064/concussion-in-sports

Parent volunteers: Any parent volunteer who will be serving as a Concussion Spotter and administering the King-Devick test must annually complete the Heads Up online concussion training from the CDC. Deliver your completed certificate to the league Concussion Coordinator. (Alternately: confirm completion via website generated email)

Non-volunteer parents: We recommend, but do not require, that all parents complete the Heads Up concussion training for parents from the CDC. We also recommend that all parents review the educational materials on this site. Often, the symptoms of a concussion are delayed, and injuries on the ice only begin to present hours after the activity is over, while the athlete is at home. Parents can play a huge role in concussion recovery by being aware of the signs and symptoms of concussion. You know your children best, and if something seems wrong, it probably is.

CONCUSSION TEAM

To ensure that concussions are properly managed, there are three important roles to be filled. It is important to understand the roll you play, as well as how your job fits within the larger plan.

League Concussion Coordinator

The League Concussion Coordinator serves as the point person for all concussion education and clearance records for the league.

Who is it? North Park Hockey Board member; currently Gary Simpson.

Responsibilities:

  1. Collecting and maintaining concussion education records at the beginning of each season, for athletes and coaches. (Possibly via website generated emails)
  2. Ensuring all athletes have completed a baseline King-Devick test, consistent with test maker guidelines.
  3. Maintaining record of written clearance to begin return to play protocols from physicians for athletes diagnosed with a concussion.

Team Concussion Spotters

Concussion spotters watch over practices and games and initiate concussion evaluations. At least one should be present at each game and practice.

Who are they? Athlete parents, guardians, or league volunteers

Requirements:

  1. Spotters must complete the CDC Heads Up concussion education course
  2. Spotters must receive training on administering the King-Devick test.

Responsibilities:

  1. Monitoring athletes during team activities for concussion signs
  2. Performing concussion evaluations using the King-Devick test, consistent with the North Park Hockey removal from play policy
  3. Communicating all concussion evaluations with athlete parents

Coaches

Responsibilities:

  1. Ensuring that the appropriate concussion letter is sent home with any athlete evaluated for concussion, along with a follow up email requesting receipt confirmation.
  2. Obtaining physician clearance from the athlete and providing to the Concussion Coordinator.
  3. Overseeing graduated return to play.

REMOVAL FROM PLAY POLICY

Continuing to play after suffering a concussion can have severe consequences. At best, it can extend recovery time. At worst, failing to remove an athlete puts them at increased risk for suffering another concussion by lowering the threshold of injury. In rare cases, a second injury can cause catastrophic brain swelling, termed second impact syndrome.

All team activities are supervised by a Concussion Spotter. If an athlete exhibits concussion signs, or if the athlete or a teammate reports concussion symptoms, the player is removed from the activity for a concussion assessment.

The Concussion Spotter performs the evaluation using the King-Devick test. If the test is positive, the athlete is removed from play. If the test is negative or inconclusive, coaches or volunteer spotters may use discretion to either keep the athlete out of play (if a concussion is still suspected), or return the athlete to play. Remember: When in doubt, sit them out.

Concussion management flow chart

 

Any athlete who receives a King-Devick test, regardless of outcome, should receive the appropriate “Just in time” information packet, as often times symptoms may not present until hours after injury. Packets include:

  1. Concussion evaluation letter: Appropriate version for inconclusive or positive test.
  2. CDC Heads Up information sheet for parents.
  3. What to do after a concussion 1 pager.

The Coach should follow up with an email requesting receipt confirmation, consistent with North Park Hockey injury notification protocols.

Athletes suspected of sustaining a concussion must provide written physician clearance before beginning the return to play protocol.

Emergency indicators

Any athlete with a suspected concussion should be closely monitored for any changes in their condition. Rapid changes or worsening of symptoms can indicate that the athlete is suffering from a more severe, potentially fatal type of brain injury. If any of the following symptoms develop, immediately call 911 and get the patient emergency medical care.

 

  • Severe throbbing headache
  • Dizziness or loss of coordination
  • Memory loss or confusion
  • Ringing in the ears (tinnitus)
  • Blurred or double vision
  • Unequal pupil size
  • No pupil reaction to light
  • Nausea and/or vomiting
  • Slurred speech
  • Convulsions or tremors
  • Sleepiness or grogginess
  • Clear fluid running from the nose and/or ears
  • Numbness or paralysis (partial or complete)
  • Unresponsiveness or difficulty responding to verbal stimuli

 

Return to play protocol

Returning an athlete to play too soon after concussion can worsen the injury and extend recovery. Even if the athlete seemed to have recovered, it is important to tread lightly through recovery.

For this reason, sports organizations are encouraged to use “Graduated return to play” protocols, slowly and incrementally increase activity. This allows the brain time to adjust to each new level of activity, and gives league staff a chance to observe any changes in symptoms. Usually, this is part of the recovery plan developed in coordination with the treating physician. We have included a sample return to play policy as an example of what a physician’s policy might look like.

North Park Policy requires that athletes are cleared to return to play by a physician before returning to practices and games, helping ensure athletes are healthy before they arrive at the rink. Even so, it is important that we return athletes to play slowly.

If the physician provides a recommended return to play policy in the clearance to play, coaches should follow those instructions. If none are provided, we offer the following guidelines:

First day back (Must be at least 48 hours from time of injury) – Practice only, no games

  1. Ensure the athlete provides physician’s clearance to return to full sports activity.
  2. Talk to the athlete and encourage symptom reporting. Make sure they understand: If they experience any symptoms, you want to hear about it.
  3. No contact under any circumstances. Ensure the athlete takes it easy. Monitor them during warm ups. If the athlete tolerates warm ups, you can include them in non-contact drills for the day, modifying intensity / number of reps as appropriate. See Rehabilitation levels 3 and 4 for sample activities.
  4. If symptoms develop or worsen: Remove from activity for the remainder of the day, try again at next practice with lighter activity load.

Second day – Practice only, no games

  1. Check in with the athlete to encourage symptom reporting at the beginning of practice, and again throughout the practice to ensure no changes in symptoms develop.
  2. If the athlete tolerated activities the first day, you can increase activity to include more involved non-contact drills and light contact (Stages 4 and 5 on the sample policy).
  3. If symptoms develop or worsen: Remove from activity for the remainder of the day, try again at next practice with lighter activity load.

Third day – Practice and/or games

  1. Check in with the athlete to encourage symptom reporting at the beginning of the practice/game, and again periodically throughout play.
  2. If symptoms develop or worsen: Remove from activity for the remainder of the day, try again at next practice with lighter activity load.

 

Sample return to play protocol:

Rehabilitation stage

Functional exercise at each stage of rehabilitation

Objective of each stage

Stage 1

No activity

Complete physical and cognitive rest

Recovery

Stage 2

Light aerobic exercise

Walking, swimming or stationary cycling keeping intensity <70% maximum predicted heart rate

Increase heart rate

No resistance training.

Stage 3

Sport-specific exercise

Skating drills

Add movement

Stage 4

Non-contact training drills

Progression to more complex training drills, e.g. passing drills.

Exercise, coordination, and cognitive load

May start progressive resistance training.

Stage 5

Full contact practice

Participate in normal training activities.

Restore confidence and assess functional skills by coaching staff

Stage 6

Return to play

Normal game play following medical clearance.

 

 

*A physician must provide written clearance before beginning the return to play protocol.

PREVENTION

The best way to manage a concussion is to prevent it from ever happening. North Park Hockey is committed to preventing injuries wherever possible.

Neck Strength

There is evidence that having a strong neck may help reduce risk of concussion by reducing head acceleration caused by an impact. Younger athletes typically have weaker necks, which could put an athlete at higher risk for concussion.

We recommend including regular neck strengthening as a part of a team’s practice routine. Including several minutes during warm-ups can help build stronger musculature that will protect athletes from future impacts. Regular training also keeps concussion safety salient, and sets the expectation that concussions are serious. A recommended program, along with detailed instructions, is provided in the Concussion Documents folder.

 

Revised September 2016