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USA Hockey Concussion Management Program


Michael Stuart MD

Alan Ashare MD




The standard of care for current medical practice and the law in many states requires that any athlete with a suspected concussion is immediately removed from play.


  • A concussion is a traumatic brain injury- there is no such thing as a minor brain injury.
  • A player does not have to be “knocked-out” to have a concussion- less than 10% of players actually lose consciousness.
  • A concussion can result from a blow to head, neck or body.  
  • Concussions often occur to players who don’t have or just released the puck, from open-ice hits, unanticipated hits and illegal collisions.
  • The youth hockey player’s brain is more susceptible to concussion.  
  •  In addition, the concussion in a young athlete may be harder to diagnosis, takes longer to recover, is more likely to have a recurrence and be associated with serious long-term effects. 
  • Treatment is individualized and it is impossible to predict when the athlete will be allowed to return to play- there is no timetable.


A player with any symptoms or signs; disorientation; impaired memory, concentration, balance or recall has a concussion. 


Remember these steps: 

  1. Remove immediately from play (training, practice or game)
  2. Inform the player’s parents 
  3. Refer the athlete to a qualified health-care professional 
  4. Treatment begins with complete physical and cognitive rest
  5. When free of symptoms, the athlete begins a graded exertion protocol.
  6. Medical clearance is required for return to play  




     Players, coaches, parents and heath care providers should be able to recognize the symptoms and signs of a concussion:



  • Headache
  • Nausea
  • Poor balance
  • Dizziness
  • Double vision
  • Blurred vision
  • Poor concentration
  • Impaired memory
  • Light Sensitivity
  • Noise Sensitivity
  • Sluggish
  • Foggy
  • Groggy
  • Confusion



  • Appears dazed or stunned
  • Confused about assignment
  • Moves clumsily
  • Answers slowly
  • Behavior or personality changes
  • Unsure of score or opponent
  • Can’t recall events after the injury
  • Can’t recall events before the injury



Management Protocol

1.  If the player is unresponsive- call for help & dial 911


2.  If the athlete is not breathing: start CPR

  • DO NOT move the athlete
  • DO NOT remove the helmet
  • DO NOT rush the evaluation


3.  Assume a neck injury until proven otherwise

  •  DO NOT have the athlete sit up or skate off until you have determined:
    • no neck pain
    • no pain, numbness or tingling
    • no midline neck tenderness
    • normal muscle strength