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Alex Velez

UAHA Safety Coordinator

USA Hockey Concussion Management Program

2023 Concussion Management Program

Michael Stuart MD / Alan Ashare MD /Kevin Margarucci ATC

 A sports concussion management program must be incorporated within each affiliate. All USA Hockey programs should follow this protocol as a minimum standard and also conform to their individual state concussion statutes.

            Accepted current medical practice and the law in most states requires that any athlete with a suspected Sports Related Concussion (SRC) is immediately removed from play.

  • A Sports Related 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 SRC- less than 10% of players actually lose consciousness.
  • A SRC can result from a blow to head, neck or body.  
  • SRCs 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 SRC.  
  •  SRC in a young athlete may be harder to diagnosis, takes longer to recover, and is more likely to have a recurrence, which can be associated with serious long-term effects. 
  • The strongest predictor of slower recovery from a concussion is the severity of initial symptoms in the first day or 2 after the injury.
  • Treatment is individualized and it is impossible to predict when the athlete will be allowed to return to play- there is no standard timetable.
  • Baseline or pre-season neuropsychological testing is not mandatory, but may be helpful for return-to-play decision making when an athlete feels normal.
  • The use of helmet-based or other sensor systems to diagnose or assess SRC require further research before implementation.

A player with any symptoms/signs or a worrisome mechanism of injury has a SRC until proven otherwise:

When in doubt, sit them out

Follow these concussion management steps: 

  1. Remove immediately from play (training, practice or game)
  2. Inform the player’s coach/parents or guardians
  3. Refer the athlete to a qualified health-care professional (as defined in state statute)
  4. Initial treatment requires physical and cognitive rest
  5. Begin a graded return to sport and school/work protocol
  6. Provide written medical clearance for return to play (the USA Hockey Return to Play Form is required)  


Players, coaches, officials, parents and heath care providers should be able to recognize the symptoms/signs of a sport related concussion. (See attached Concussion Recognition Tool 5)


  • Headache
  • “Pressure in head”
  • Neck Pain
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Drowsiness
  • Blurred vision
  • Difficulty concentrating/remembering
  • “Don’t feel right”
  • Sensitivity to light/noise
  • More emotional or irritable
  • Fatigue or low energy
  • Feeling like “in a fog”
  • Feeling slowed down
  • Confusion
  • Sadness
  • Nervous or anxious

Observable Signs:

  • Lying motionless on the playing surface
  • Slow to get up after a direct or indirect hit to the head
  • Disorientation or confusion
  • Inability or slow to respond appropriately to questions
  • Blank or vacant look
  • Slow movement or incoordination
  • Balance or walking difficulty
  • Facial injury after head trauma

Management Protocol

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

2.  If the athlete is not breathing: start CPR

3.  Assume a neck injury until proven otherwise

  • DO NOT move the athlete
  • DO NOT rush the evaluation
  • 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: Concussion Recognition Tool 5 or other sideline assessment tools

  • Ask about concussion symptoms
  • Observe for concussion signs
  • Memory Assessment
    • What venue are we at today?
    • What period is it?
    • Who scored last in this game?
    • Did your team win the last game?
    • Who was your opponent in the last game?
    • If a healthcare provider is not available, the player should be safely removed from practice or play and referral to a physician arranged.

6.  A player with any symptoms or signs, disorientation, impaired memory, concentration, balance or recall has a SRC and should not be allowed to return to play on the day of injury.

7.  The player should not be left alone after the injury, and serial monitoring for deterioration is essential over the initial few hours after injury.

If any of the signs or symptoms listed below develop or worsen: go to the hospital emergency department or dial 911.

  • Severe throbbing headache
  • Dizziness or loss of coordination
  • 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)
  • Difficulty in being aroused

8.  An athlete who is symptomatic after a concussion initially requires physical and cognitive rest.

  • A concussed athlete should not participate in physical activity, return to school, and 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.  A qualified health care provider guides the athlete through Graduated Return-to-School and Graduated Return-to-Sport strategies.

10. Written clearance from a qualified health care provider is required for an athlete to return to play without restriction (training, practice, and competition).  Only the USA Hockey Return to Play Form is acceptable:

Graduated Return-to-Sport Strategy




Goal of each step


Symptom-limited activity

Daily activities that do not provoke symptoms

Gradual reintroduction of work/school activities


Light aerobic exercise

Walking or stationary cycling at slow to medium pace. No resistance training

Increase heart rate


Sport-specific exercise

Running or skating drills. No head impact activities

Add movement


Non-contact training drills

Harder training drills, eg, passing drills. May start progressive resistance training

Exercise, coordination and increased thinking


Full contact practice

Following medical clearance, participate in normal training activities

Restore confidence and assess functional skills by coaching staff


Return to sport

Normal game play



  • After a brief period of rest (24–48 hours after injury), patients can be encouraged to become gradually and progressively more active as long as these activities do not bring on or worsen their symptoms.
  • There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step.
  • Resistance training should be added only in the later stages (stage 3 or 4 at the earliest).

Graduated Return-to-School Strategy




Goal of each step


Daily activities at home that do not give the child symptoms

Typical activities of the child during the day as long as they do not increase symptoms (eg, reading, texting, screen time). Start with 5–15 min at a time and gradually build up

Gradual return to typical activities


School activities

Homework, reading or other cognitive activities outside of the classroom

Increase tolerance to cognitive work


Return to school part-time

Gradual introduction of schoolwork. May need to start with a partial school day or with increased breaks during the day

Increase academic activities


Return to school full time

Gradually progress school activities until a full day can be tolerated

Return to full academic activities and catch up on missed work


  • If symptoms are persistent (more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.

While no concussion can prevented. Many things can be done to lessen the chance of a player or goalie suffering a concussion. The following are ways to prevent concussion injury and rules established by USA Hockey to help protect players and lessen the chance of injury. 

Proper Fitting Helmet

Having a properly fitting helmet is the first step to reducing the chance of a concussion. This means when either a player or goalie is wearing a helmet there should not be any gaps. 

The helmet of a player should fit snuggly around the player's head and not have any gaps between the side of the head or forehead. 

A goalie mask should fit snuggly around the player's face and head. There should be no visible gaps between the mask padding and the face, forehead, or head.

Helpful links:

How to fit a goalie mask,slippage%20with%20a%20proper%20fit.


How to fit a player helmet


USA Hockey Rule 304: Protective Equipment

All players are required to wear a HECC-approved helmet and HECC-approved full facemask for all games and practices. 

(c) All players, including goalkeepers, in all age classifications except Adults, are required to properly wear a HECC approved helmet as designed by the manufacturer and with no alterations and the chin strap properly fastened.

(Note) HECC certification includes an expiration date on the sticker and a helmet that has an expiration date that has expired is no longer considered certified. The player may not wear a helmet that does not have a valid and current certification sticker. (This sticker should be located on the back of the player’s or goalie’s helmet)

A helmet with a missing HECC certification sticker or sticker in which the date cannot be made out is considered expired and may not be worn. Players and goalies with an expired or removed HECC sticker are NOT allowed on the ice. 

Non-certified Cateye cages are not permitted or allowed to be used by goalies. Certified Cateye and straight bar cages are the only allowed cages to be used. 

How to report a concussion 

The first step to reporting a concussion is letting your coach and organization know. The next step is completing the required documentation as well as seeing a licensed medical provider. 

The following forms must be completed and/or signed by your primary care physician.

No matter if it’s a head injury or physical injury, no player or goalie is allowed to return to practice or a game until cleared by a medical professional as outlined by USA Hockey. Paramedics, EMTs, and RNs are not permitted to clear a player or goalie back to practice or play. A player or goalie who has suffered a concussion must complete a return play form prior to being allowed to return to practice or a game.

Remember to be patient, healing takes time.  


Concussion Signs and Symptoms

UAHA and USA Hockey understands that not everyone is a doctor, but it is important to recognize when a player may have suffered a concussion. All coaches, staff, and volunteers should familiarize themselves with the general signs and symptoms. 

General Concussion Signs and Symptoms

Signs Observed by Coaching Staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets sports plays
  • Is unsure of the game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can't recall events prior to hit or fall
  • Can't recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or "pressure" in the head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not "feel right"

Any time a player or goalie goes down and stays down requiring coaches, staff or players to respond after being struck in the head or hitting their head should be removed from play or practice and not allowed to return till they have been evaluated and cleared by a medical professional as designated by USA Hockey policies. 




USA Hockey Concussion Information and Acknowledgement

All sports and free play are associated with a risk for a concussion, including playing, officiating, or participating in ice hockey. It is important that all participants and parents learn about concussion prevention, recognition, treatment and return to play.

A concussion is a type of traumatic brain injury—or TBI— caused by a bump or blow to the head or by a hit to the body that causes the head and brain to move quickly back and forth. Bouncing or twisting of the brain in the skull can cause chemical changes and sometimes stretching of the brain cells. A concussion disrupts the way the brain normally works. Most concussions are mild, but all concussions should be taken seriously because permanent brain damage and death can occur from another injury. A concussion may be difficult to recognize. A person does not have to be “knocked out” to have a concussion. Less than 10% of persons concussed actually lose consciousness. Signs and symptoms may show up right after the injury or can take hours or days to fully appear.

If a person reports one or more symptoms or demonstrates any signs of concussion after a blow to the head or body, s/he should be kept out of practice, play, or training immediately and referred to a healthcare professional with experience in concussion management. A concussed brain needs time to heal and the person is much more likely to have another concussion if they return too soon. Repeat concussions are usually more severe and take longer to heal. Return to play, or officiating is allowed only after the individual is without symptoms, has progressed through the USA Hockey concussion protocol, and is cleared by the health care professional.

USA Hockey provides all participants with information and educational materials about concussions, including the risk of sustaining a concussion, how to minimize these risks, concussion signs and symptoms, and USA Hockey’s program for returning to play following a concussion. USA Hockey’s Concussion Management Program can be found on the USA Hockey website at: USA Hockey will be collecting de-identified data from concussion return-to-play forms into a database to track concussions in youth, girls, and high school hockey.

By checking the box and placing my initials in the box below, participant, and participant’s parent(s) or legal guardian(s) if participant is a minor, hereby acknowledges that (1) I have had the opportunity to review information on concussions provided by USA Hockey, including the signs and symptoms of a concussion, (2) participating in the sport of ice hockey involves the risk of sustaining a concussion and that I knowingly, freely and fully assume all such risks, (3) any participant suspected of possibly sustaining a concussion will be removed from practice or competition (and that I will remove myself from practice or competition) and not returned to practice or competition until cleared in writing by a licensed health care provider trained in the evaluation and management of concussions, (4) I shall follow USA Hockey’s Post-Concussion Return to Play Protocol and any applicable state law prior to returning to play, and (5) USA Hockey will enter de-identified data from the USA Hockey Concussion Return to Play form into a database to track concussions in youth, girls and high school hockey.


Concussion Resources


Graded Symptom Checklist : pre-season and post potential concussive event tracking to help Coaches, Family, and Medical Providers with symptom tracking

SCAT 5: contains information, screening for cognition and physical signs of concussion, includes a return to learn and return to play guidelines  : contains information for medical providers, parents and athletes.  Includes documentation to help you communicate your athlete's return to learn needs.

High School Specific:

PINK Concussions: specific information for females with brain injury, mild to severe, sport to abuse.

Baseline concussion testing is widely available via local health organizations including Intermountain Health Centers, University of Utah Clinics and a variety of local Physical Therapy Clinics.