Noted Emergency Signs
If you notice any of your players are experiencing any of the following signs you should make sure they receive proper treatment
- Altered level of consciousness (drowsy, hard to arouse, or similar changes)
- Persistent unconsciousness (coma)
- Muscle weakness
- Persistent confusion
- Unequal pupils
- Unusual eye movements
- Walking problems
“Our team’s top centre Ryan took a big hit while skating through the neutral zone. He got up and finished his shift fine. I went down the bench to see how he was feeling after the big hit and noticed he wasn’t making much sense talking to me. I called our team trainer over to do a full assessment on him”
Dr. Montelpare: “Excellent job recognizing something might be wrong. Recognition is most often the hardest part as many concussions usually go undetected by even people closest to the individual. Obviously coaches want their teams to win, but the main priority is keeping players safe. Your player was showing obvious signs of a concussion, and you did the right thing in having the trainer check him out further.”
Concussions can be caused by a direct or indirect hit to the head, face, neck and/or elsewhere on the body. For example, a player may be hit in the head, face, neck or other body part when being checked and this may result in the sudden jarring of the head causing a concussion. Some of these may appear to be obvious causes, while others less so. The key is any contact that causes a “jarring” of the head and brain can result in a concussion.
“One of our defensemen, Jan, got beat on the outside by a speedy forward. She started chasing her down, and at the last moment dove to try and poke check the puck. She got the puck but ended up sliding right into the goalie and the net. It didn’t look like much of a collision, but Jan came off the ice complaining of a headache, and after our trainer checked her out it was apparent that her pupils were different sizes.”
Dr. Montelpare: “Sometimes injuries to the brain can happen on the most seemingly innocent plays. It sounds like your player must have hit her head on something hard when going into the net such as the post or the ice. During a chaotic game is difficult to determine the exact cause of incidents, but the important thing is that you got your player examined by the trainer and did not allow her back in the game.”
Other Problems from Concussions
What is important to understand is hockey is only a game, concussions can be a lifetime. Concussions often cause significant and sustained neuropsychological impairments in information processing, problem solving, planning, and memory. These impairments are worse with multiple concussions.
With the exception of the unconscious individual or someone who is severely dazed, it is often very difficult to identify who has sustained a concussion and who has not. This is a problem because if a player continues to play with a concussion they run the risk of making the injury worse from repeated blows to the head.
Concussions can trigger a chemical chain reaction in brain that leaves an athlete disoriented, unconscious, or even dead. They can also impair learning over a period of years. More recent research is linking concussions to long term health issues such as dementia.
“Josh came off the ice after a monstrous head-on collision at centre ice with a player much taller than him. He appeared alright and was keen to get back out for his next shift, so I let him go back out. That shift he got tripped and fell head first, hard into the boards. This time he came off the ice and vomited behind the bench. I then realized I should have had our trainer check him out after the previous hit.”
Dr. Montelpare: “Concussions are hard to notice, especially when players are not forthcoming with their symptoms. Many players are so eager to get back on the ice that they will lie about injuries. Do not fault yourself fully for his injury, you did the proper thing in checking up on him after the initial hit. He very well may have hit his head hard enough on the boards to induce the concussion. Next time if you are unsure don’t hesitate to have your trainer asses the player to determine any injuries.”
It is your job as a coach to determine if any of your players have suffered an injury and to make sure to inform the family and medical personnel of the injury.
What To Do
What do you do if you suspect one of your players has sustained a concussion?
You must assess the player further to see if any of these signs are present
- Visual acuity (how clearly they see) and eye movement
- Facial movement
- Ringing in the ears
- Behavioural changes (unlike normal personality)
- Amnesia (retrograde/post-concussive)
You must send your player to emergency if:
- There is coming blood out of ears and or nose (from an injury to the head)
- There is any unconscious episode
- Symptoms continue or increase during a 20 minute waiting period or when activity resumes
“Mary took an elbow to the head, and was complaining of feeling sick to her stomach. I told her to sit on the bench for a few minutes. Mary sat watching the game on the bench for 20 minutes, but complained that she was feeling even worse. I had our trainer bring her to the dressing room and told her parents that they needed to take her to get checked out at the hospital”
Dr. Montelpare: “Picture perfect handling of the situation. When a player comes to you complaining of any injury it is important to take precautionary measures and further assess the injury. With an injury to the brain, it is imperative that the player does not return to the ice, and you continue to monitor them. If their symptoms worsen, they must receive further medical attention.”
It is crucial to assess your players after an injury and make sure qualified medical personnel clear them for play before they go back out on the ice.
Return to Play
A seven-day waiting period should likely result in resolution of symptoms and normalized cognitive function. Do not let your play back on the ice unless they are completely symptom-free.
Steps to Tell Your Players to Do Before They Return to Play
These steps are guidelines and only apply if the player is symptom-free. If the symptoms reappear, they should see their doctor again.
- No activity, complete rest until no symptoms remain
- Light aerobic exercise (walking)
- Sport-specific training
- Light activity and training drills
- Full training (only after medical clearance)
Don’t let a player participate in game play or practice if any signs persist or if you are unsure of their health,. Never take a risk because there is no cure. Once a brain is damaged, it is very difficult to heal if it has had multiple hits.
“Brandy had followed all the steps to recover from her concussion, but still had occasional headaches. After an assessment from out trainer, we told Brandy she would have to sit out for a few more days”
Dr. Montelpare: “Great decision. It is important to ensure the steps are followed and not taken lightly. The fact that your player began to suffer headaches again means she is likely not ready to return to that level of activity. Returning too early would not allow full recovery and likely result in further injury.”
Sometimes it’s hard to tell for sure if you have a concussion because what you’re feeling can feel like other things you have experienced. Here are some others things that might happen if you hurt your brain:
- Don’t know time, date, place, score in game, opposing team, etc.
- Just feel confused
- Can’t remember what happened before or right after you were hurt
- Knocked out or blacked out
- Feel like in you’re in a fog
- Feel like your head’s been “dinged” or stunned (e.g. “bell rung”)
- You see stars, flashing lights, two of everything or everything is fuzzy
- Can’t see anything
- Your ears are ringing
- You have a Stomach ache or pain and like you want to throw up
- You have a tough time sleeping, or you’re not sleeping the way you usually do (less or more than usual )
- You feel clumsy and have trouble with your balance
- You find yourself staring a lot
- You’re throwing up
- You can’t seem to talk properly
- You find it hard to answer questions or follow directions
- You’re easily distracted
- You have trouble concentrating
- You may find yourself laughing, crying or getting mad more than you use to
- You’re not playing the way you usually d
Please note: The above list is not exhaustive nor does having one or more of these symptoms mean that someone has a concussion. It is merely a guide to possible concussive symptoms. It is important to seek medical attention immediately to receive a diagnosis.
*The symptoms that an athlete experiences after a concussion are often unique to the individual. It is important to consider that every injury is different (symptoms and time to recovery).