Overview
The North York Knights Hockey Association (“NYKHA”) has introduced a concussion policy that includes a Suspected Concussion Report and a Return to Play Protocol for all players involved in its Learn to Play, House League and Select programs. In simple terms, if a suspected concussion occurs, it is the responsibility of a team official (whether it be the head coach, assistant coach, trainer, manager or executive member) to immediately remove the player from participation in the hockey activity. If and when present, an accredited team trainer holds the final decision to remove players with a suspected concussion; if an accredited trainer is not present, the head coach then holds the final decision. If there is doubt as to whether a concussion has occurred, it should be assumed that it has. If in doubt, sit them out. If a concussion is suspected, the player must be assessed by a medical doctor or nurse practitioner at an ER or at a walk-in clinic or by the family physician and must complete the Return to Play Protocol before returning to play in the North York Knights Hockey Association.
A Flow Chart and a Summary Version of the policy is available at the end of the full NYKHA Concussion Policy. Furthermore, two forms that need to be completed as part of the Concussion Policy, namely the Suspected Concussion Report form and the Return to Play Protocol can be found in PDF form at the end of the Concussion Policy.
Concussion Policy
STEP 1: RECOGNIZE A SUSPECTED CONCUSSION & REMOVE-FROM-PLAY
a) What is a concussion? A concussion is an injury to the brain caused by a blow to the head or to another part of the body that causes the brain to move inside the skull. All players who experience any concussion signs and symptoms (Figure 1) and/or observable signs of a suspected concussion (Figure 2) following a blow to the head, face, neck or another part of the body is considered to have a suspected concussion and must stop participation in the hockey activity immediately.
b) A suspected concussion can be identified in three ways:
i. Self-reported signs and symptoms by player – even if only one symptom (Figure 1)
ii. Visual signs and/or symptoms observed by any team official (Figure 2)
iii. Peer-reported signs and symptoms observed by players, parents, and/or team officials (Figure 1 and 2)
iv. If a player experiences a sudden onset of any of the “red flag symptoms”, 911 should be called immediately (Figure 3).
CONCUSSION SYMPTOMS
| Figure 1 General Concussion Symptoms | ||
| Headache | Feeling mentally foggy | Sensitive to light |
| Nausea | Feeling slowed down | Sensitive to noise |
| Dizziness | Difficulty concentrating | Irritability |
| Vomiting | Difficulty remembering | Sadness |
| Visual problems | Drowsiness | Nervous/anxious |
| Balance problems | Sleeping more/less than usual | More emotional |
| Numbness/tingling | Trouble falling asleep | Fatigue |
| Figure 2 Visual Symptoms |
| Lying down motionless on the playing surface |
| Slow to get up after a direct or indirect hit |
| Disorientation or confusion, or an inability to respond appropriately to questions |
| Blank or vacant look |
| Balance or gait difficulties, motor incoordination, stumbling, slow labored movements |
| Facial injury after head trauma |
| Figure 3 Red Flag Symptoms | |
| Headaches that worsen | Inability to recognize people or places |
| Seizures or convulsions | Increasing confusion or irritability |
| Repeated vomiting | Weakness/tingling/burning in arms or legs |
| Loss of consciousness | Persistent or increasing neck pain |
| Looks very drowsy/can’t be awakened | Unusual behavioural change |
| Slurred speech | Focal neurologic signs (e.g. paralysis, weakness, etc.) |
c) Who is responsible for removal from play? If a suspected concussion occurs, it is the responsibility of all team officials (including the head coach, assistant coach, trainer, manager or executive member) to immediately remove the player from participation in the hockey activity. If and when present, an accredited team trainer holds the final decision to remove players with a suspected concussion; if an accredited team trainer is not present, the head coach then holds the final decision. If there is doubt as to whether a concussion has occurred, it should be assumed that it has. If in doubt, sit them out. If a concussion is suspected, the player must be assessed by a medical doctor or nurse practitioner at an ER or at a walk-in clinic or by the family physician and must complete the Return to Play Protocol before returning to play in the North York Knights Hockey Association.
STEP 2: REPORTING A SUSPECTED CONCUSSION
Completion and submission of the Suspected Concussion Report Form
a) Monitoring the player and recommending a medical assessment: Head coaches (for House League) or team trainers (for Select/CDS) are responsible to monitor the player with a suspected concussion until a parent/guardian is contacted and present. Head coaches or team trainers are also responsible to recommend to the individual’s parent or guardian that they seek medical assessment immediately. Medical assessment must be done by a medical doctor or nurse practitioner. In addition to nurse practitioners, medical doctors that are qualified to evaluate patients with a suspected concussion include: family physicians, pediatricians, emergency room physicians, sports-medicine physicians, neurologists or internal medicine specialists. Documentation from any other source will not be acceptable. If no team trainer (Select/CDS) or head coach (House League) is present for 2(a) and 2(b;) the order of next most responsible individuals is:
i. Assistant coach
ii. An individual with trainer certification
b) Completion of the Suspected Concussion Report Form: Team head coaches (House League) or team trainers (Select/CDS) are responsible for filling out the Suspected Concussion Report Form immediately after a concussion is suspected.
c) Submission of the Suspected Concussion Report Form: If a suspected concussion occurs, the head coach (House League) or team trainer (Select/CDS) is responsible for completing and reviewing the Suspected Concussion Report Form and giving one copy of the report to the player’s parents/guardian to bring to the medical assessment and scanning another copy and forwarding it to Steve Horvath, North York Knights Safety and Health Co-Ordinator.
STEP 3: INITIAL MEDICAL ASSESSMENT
Assessment and diagnosis by a medical doctor (MD) or nurse practitioner (NP)
a) Seeking medical assessment: If a player is suspected to have incurred a concussion, it is the parent/guardian’s responsibility to take the player to see a medical doctor or nurse practitioner immediately.
b) Required type of medial assessment: To provide a comprehensive evaluation of players with a suspected concussion, the medical assessment must rule out more serious forms of traumatic brain injury and spine injuries and must rule out medical and neurological conditions that could present concussion-like symptoms based on findings of a physical examination. In addition to nurse practitioners, medical doctors that are qualified to evaluate patients with a suspected concussion include: family physicians, pediatricians, emergency room physicians, sports-medicine physicians, neurologists or internal medicine specialists. Documentation from any other source will not be acceptable.
c) Obtaining appropriate diagnosis and documentation: Written medical documentation/diagnosis must be obtained from one of the qualified medical professionals listed previously whether a concussion has occurred or not.
STEP 4: MEDICAL DIAGNOSIS
Submission of medical documentation of concussion diagnosis
a) If a medical doctor/nurse practitioner determines that the player with a suspected concussion does not have a concussion:
i. Parent/guardian must take the written documentation from the medical assessment (highlighting that the player does not have a concussion) and give this document to the head coach (House League) or team trainer (Select/CDS).
ii. It is the responsibility of head coach (House League) or team trainer (Select/CDS) to submit medical documentation to Steve Horvath, North York Knights Safety and Health Co-Ordinator before the player is permitted to return to a North York Knights hockey activity.
iii. Parent/guardian should continue to monitor the player for at least 24-72 hours after the event, as signs and symptoms may take hours or days to appear.
iv. Head coaches (House League) and/or team trainers (Select/CDS) have the right to refuse a player to return to any North York Knights hockey activity if they deem the player unfit to do so.
b) If a medical doctor/nurse practitioner determines that the player has incurred a concussion:
i. Parent/guardian must take the written documentation from the medical assessment (highlighting that the player has been diagnosed with a concussion) and give this document to the head coach (House League) or team trainer (Select/CDS).
ii. It is the responsibility of the head coach (House League) or team trainer (Select/CDS) to submit medical documentation, in addition to the Hockey Canada Injury Report Form, to Steve Horvath, North York Knights Safety and Health Co-Ordinator.
iii. The player is to begin Step 5 (Concussion Management) of the NYKHA Concussion Policy.
STEP 5: CONCUSSION MANAGEMENT
Initial recovery and management
An initial period of 24‐48 hour of rest is recommended before starting the Return-To-Play protocol. Children and adolescents should not return to hockey/sport until they have successfully returned to full school schedule and workload. However, early introduction of symptom-limited physical activity is appropriate.
Most players who sustain a concussion while participating in sport will make a complete recovery and be able to return to full school and sport activities within 4-6 weeks of injury. However, approximately 15- 30% will experience symptoms that persistent beyond that time frame. If available, players who experience persistent concussion symptoms for > 4 weeks may benefit from referral to a medically supervised multidisciplinary concussion services.
STEP 6: RETURN-TO-PLAY PROTOCOL AND MEDICAL CLEARANCE
a) After an initial period of 24‐48 hour of rest, the player with a concussion must complete each step of the Return to Play Protocol.
b) Parent/guardian and the player are responsible to ensure that each step of the Return to Play Protocol recommendations is followed appropriately and the required signatures are completed at each stage. Players must be able to participate in each step’s activities for a minimum of 24 hours without experiencing any symptoms during or after the activities BEFORE moving onto the next stage.
c) If the player experiences any symptoms during OR after the activities in any stage, the player should stop that activity immediately, rest for 24 hours and return to the previous successful stage before trying those activities again.
d) Once Stages 1-4 of the Return to Play Protocol have been completed, the player must receive medical clearance to proceed. A player is not permitted to return to play hockey in the NYKHA until written clearance is received from a medical doctor or nurse practitioner. In addition to nurse practitioners, medical doctors that are qualified to evaluate patients with suspected concussion include: family physicians, pediatricians, emergency room physicians, sports-medicine physicians, neurologists or internal medicine specialists. Documentation from any other source will not be acceptable.
e) Once medical clearance is obtained, the parent/guardian must take the written documentation from the medical professional (highlighting player is safe to return to full team practice) and the completed Return to Play Protocol with signatures completed by parent and player to the team’s head coach (House League) or team trainer (Select/CDS).
f) It is the responsibility of the head coach (House League) or team trainer (Select/CDS) to submit medical clearance and Return to Play Protocol with completed signatures to Steve Horvath, North York Knights Safety and Health Co-Ordinator.
g) Head coaches (House League) or team trainers (Select/CDS) have the right to refuse a player to return to any North York Knights hockey activity if they deem the player unfit to do so.
Special Considerations
The above steps relate most directly to a player who sustains a concussion during a North York Knights hockey activity and this injury is identified immediately. Not all concussions will be identified immediately and not all concussions will take place during North York Knights hockey activities. Two alternative scenarios are presented below:
Scenario 1: A suspected concussion from a North York Knights activity is not identified and/or reported until days or weeks after the North York Knights activity. Enter at Step 2. Immediately upon the suspected concussion being identified and/or reported to team officials, the head coach (House League) or team trainer (Select/CDS) is to complete the Suspected Concussion Report Form and recommend that the player seek appropriate medical assessment immediately.
Scenario 2: A player is diagnosed with a concussion from a non-North York Knights activity (i.e. school, other sports, non-team/club related games or training). Enter at Step 4. Upon receiving medical concussion diagnosis from parent/guardian, the head coach (House League) or team trainer (Select/CDS) is to submit medical assessment documentation to Steve Horvath, North York Knights Safety and Health Co-Ordinator. As the concussion did not happen at the North York Knights activity, no Suspected Concussion Report Form is needed.
NYKHA Concussion Policy Summary
To assist North York Knights officials (i.e. head coach, assistant coach, trainer (Select/CDS) , manager (Select/CDS) or executive member) in visualizing the steps to take if a player occurs a suspected concussion, we have provided two options that briefly outline the key points of the Knights Concussion Policy.
- NYHKA Concussion Policy Flow Chart
- NYKHA Concussion Policy – Summary Version
NYKHA Forms To Be Completed
To assist North York Knights officials, we have provided a link to the two forms that need to be completed if a concussion to a player has been observed or is suspected.