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

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1 USA Hockey Concussion Management Program (as adopted by MAHA, with revisions 12/7/12) 1 Michael Stuart MD Alan Ashare MD 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. This Policy applies to the youth athlete, as defined as an individual who participates in a MAHA activity and who is under 18 years of age. Diagnosis Players, coaches, parents and heath care providers should be able to recognize the symptoms and signs of a concussion: Symptoms Headache Nausea Poor balance Dizziness Double vision Blurred vision Poor concentration Impaired memory Light Sensitivity Noise Sensitivity Sluggish Foggy Groggy Confusion 1 The USA Hockey Concussion Management Program and Post Concussion Functional Return to Play protocols were prepared by Drs. Michael Stuart and Alan Ashare. Additional materials regarding concussion management are located on the USA Hockey website ( 1

2 Signs 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 If the athlete is not breathing: start CPR ü DO NOT move the athlete ü DO NOT remove the helmet ü DO NOT rush the evaluation 3. Assume a neck injury until proven otherwise ü 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 normal sensation to light touch 4. If the athlete is conscious & responsive without symptoms or signs of a neck injury help the player off the ice to the locker room perform an evaluation do not leave them alone 5. Evaluate the player in the locker room: Ask about concussion symptoms (How do you feel?) Examine for signs Verify orientation (What day is it?, What is the score?, Who are we playing?) Check immediate memory (Repeat a list of 5 words) Test concentration (List the months in reverse order) Test balance (have the players stand on both legs, one leg and one foor in front of the other with their eyes closed for 20 seconds) Check delayed recall (repeat the previous 5 words after 5-10 minutes) 6. A player with any symptoms or signs, disorientation, impaired memory, concentration, balance or recall has a concussion. 2

3 When in doubt, sit them out Remove immediately from play (training, practice or game Inform the player s parents Refer the athlete to a qualified health-care professional Medical clearance is required for return to play 7. If any of the signs or symptoms listed below develop or worsen: go to the hospital emergency department or dial 911. Ø Severe throbbing headache Ø Dizziness or loss of coordination Ø Memory loss or confusion Ø Ringing in the ears (tinnitus) Ø Blurred or double vision Ø Unequal pupil size Ø No pupil reaction to light Ø Nausea and/or vomiting Ø Slurred speech Ø Convulsions or tremors Ø Sleepiness or grogginess Ø Clear fluid running from the nose and/or ears Ø Numbness or paralysis (partial or complete) Ø Difficulty in being aroused 8. An athlete who is symptomatic after a concussion requires complete physical and cognitive rest. A concussed athlete should not participate in any physical activity, return to school, play video games or text message if he or she is having symptoms at rest. Concussion symptoms & signs evolve over time- the severity of the injury and estimated time to return to play are unpredictable. 9. The athlete cannot return to participate in any team activities until the organization receives written authorization from an appropriate health professional. The organization must retain a copy of the written clearance for the duration of the youth athlete s participation in the MAHA or until the youth athlete is 18 years of age. 10. Although not required, a local association may refer to USA Hockey s Post-Concussion Functional Return to Play Protocols, set forth on Page 4, for further follow-up if an athlete has sustained a concussion. 3

4 USA Hockey Post-Concussion Functional Return to Play Protocol This protocol should not be initiated until after the athlete has been released to participate in the functional return to play protocol by a qualified health care provider. If symptoms appear during a functional test, the test should be stopped and the athlete monitored until symptoms resolve. No further functional testing should be performed that day. Functional testing may resume the following day at the previously asymptomatic level if the athlete remains asymptomatic. If symptoms do not resolve, appropriate medical attention should be obtained. After each phase of functional testing, the presence of post-concussive symptoms should be assessed and progression to the next phase of functional testing will require the absence of post-concussive symptoms. Each phase requires a minimum of 1 day before progressing to the next phase. Level 1: Physical and cognitive rest. Level 2: Light aerobic exercise such as walking or stationary cycling. No resistance training. May read 20% of normal volume. TV ok. No video games. Level 3: Sport-specific exercises. No resistance training. May read 40% of normal volume. No video games. Level 4: Non-contact practice. Resistance training ok. May read 60% of normal volume. No video games. Level 5: Full contact practice. May read 80% of normal volume. Video games ok. Level 6: Return to unrestricted competition and cognitive activities if medical clearance is provided by a qualified health care provider 4

5 Concussion Materials Browse this compiled list of resources available to you for information about concussions, concussion prevention and returning to play after a concussion. Concussion Materials Resources Resource Concussion Summit Recommendations 2010 Concussion Summit NFHS online course Center for Disease Control and Prevention in Atlanta Concussions in High School Sports ImPACT Returning to play after concussion NHL.com feature article Minn. Hockey Journal article The 33 News article LA Times article Information available Dr. Michael J. Stuart presented this piece for the 2011 USA Hockey Winter Meetings. Download Coaches are invited to join physicians to discuss this important safety topic. More information USA Hockey Magazine's report from the summit Online course titled Concussion in Sports - What You Need to Know. Read more CDC concussion downloads at CDC free online training More information DVD/Videotape with examples of returning to play too soon after mild traumatic brain injury. ImPACT psychometric testing program is used by the NHL, NFL and many colleges and high schools. Download articles about returning to play guidelines after a concussion. Dr. Alan Ashare discusses what you should know and do about returning to play after a concussion. Read the article Guidelines National Academy of Neuropsychology (NAN) and National Athletic Trainers' Association (NATA) team up on campaign. Read more A medical and psychosocial perspective on concussions in ice hockey. Read more News article and video about how a Texas hockey league deals with concussions. Read more Los Angeles Times report on concussions among child athletes. Read more

6 n o i s s u c n Co WHAT TO LOOK FOR WHAT TO DO SIGNS AND SYMPTOMS THESE SIGNS AND SYMPTOMS MAY INDICATE THAT A CONCUSSION HAS OCCURRED. SIGNS OBSERVED BY COACHING STAFF SYMPTOMS REPORTED BY ATHLETE Appears dazed or stunned Headache or pressure in head Is confused about assignment or position Nausea or vomiting Forgets sports plays Balance problems or dizziness Is unsure of game, score, or opponent Double or blurry vision Moves clumsily Sensitivity to light Answers questions slowly Sensitivity to noise Loses consciousness (even briefly) Feeling sluggish, hazy, foggy, or groggy Shows behavior or personality changes Concentration or memory problems Can t recall events prior to hit or fall Confusion Can t recall events after hit or fall Does not feel right ACTION PLAN If you suspect that a player has a concussion, you should take the following steps: 1. Remove athlete from play. 2. Ensure athlete is evaluated by an appropriate health care professional. Do not try to judge the seriousness of the injury yourself. 3. Inform athlete s parents or guardians about the known or possible concussion and give them the fact sheet on concussion. 4. Allow athlete to return to play only with permission from an appropriate health care professional. It s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: U.S. D EPARTMENT OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

PARENT/LEGAL GUARDIAN CODE OF CONDUCT AGREEMENT

PARENT/LEGAL GUARDIAN CODE OF CONDUCT AGREEMENT PARTICIPANT PACKET The following documents must be reviewed, signed and returned to GVAHA prior to players being allowed to participate in team practices or games. Contents: 1. STAR Parent Code of Conduct