Canada's top youth hockey league taking concussions head-on

Hockey continues to evolve at rapid speed. Players are getting bigger, stronger and faster, and the quickening pace of the game means decisions have to be made in a blink of an eye.

The way in which injuries are identified, diagnosed and treated is also evolving as hockey's leaders try to keep pace with an ever-changing game.

This is especially evident when it comes to concussions. Mostly gone are the days when a player with a potentially serious head injury was dismissed as having "had their bell rung" and encouraged to play through it. Officials at various levels of the game are increasingly giving decision-makers the tools to remove possibly concussed players from the ice and ensure they are healthy before letting them return.

The world's biggest and most competitive youth hockey league has taken the lead in this area. Beginning last season, the Greater Toronto Hockey League partnered with Holland Bloorview Kids Rehabilitation Hospital, a leader in youth concussion research.

The goal was simple. The GTHL wanted to give coaches and trainers the ability to recognize a potential concussion. It also wanted to establish a clear set of rules that every player — and the player's family — must follow before returning to the ice.

"There is a clear path and it's laid out as a step-by-step return-to-play document that guides all parties involved," says GTHL executive director Scott Oakman.

Not playing doctor

Nick Reed, a co-director of Holland Bloorview's concussion centre, says the process starts when either a player reports experiencing concussion symptoms, or a trainer or coach sees visual signs of a head injury, such as a player clutching his head.

"First, we remove the player from play immediately and a suspected concussion report form is submitted to the league," Reed says. "Then they're directed to seek medical assessment to obtain proper diagnosis."

In order to help them identify concussion symptoms, more than 1,200 GTHL trainers and coaches received in-person training by experts from Holland Bloorview before last season. The league wanted the adults behind the bench to be able to identify a variety of things that could be linked to a suspected concussion.

Trainers, especially, have been given a key role in the process.

"We have laid the responsibility at the feet of trainer and tried to take it away from the coach," Oakman says. "Although [coaches] have a role to play, our position has been that the trainer is the decision-maker when it comes to taking a player out of action."

Reed and the GTHL want to make it clear that no trainer, coach or parent is being asked to play doctor. Their role is to ensure a player with a suspected concussion is removed from the ice and referred to an expert.

"We are not asking trainers and parents and players to diagnose concussions and make difficult return-to-activity decisions," Reed says. "We want them directed to a medical professional."

Buying in

The new rules are having an impact, according to the GTHL. Oakman says there has been a 235 per cent increase in the number of suspected concussions reported to the league, and about three quarters of those ended up being confirmed as concussions.

Johanna Carlo has worked as a trainer on GTHL benches for more than 20 years and is currently with the Toronto Red Wings Peewee AAA team. She says player safety and injury prevention are a main topic of conversation today but were barely mentioned when she started.

"We tried to follow best practices but at the same time there weren't any written best practices. It was left up to individual trainers' discretions," Carlo says. "I recall times where somebody could be concussed, passed out and could have been cleared to return to that game."

If the current guidelines are followed, that shouldn't happen anymore. Any player removed from a GTHL game with a suspected concussion cannot return to the same game.

"Back in the day, there wasn't the education around the top observable signs of a concussion," Carlo points out. "People would say 'Oh, you had your bell rung' or 'Where are you?' You didn't know what to look for.

"Erring on the side of caution is the thing right now. If you don't know, pull them out, let somebody else decide. That's a big thing. A lot of things used to get managed internally on teams."

Any GTHL player with a suspected concussion must see a doctor for a formal diagnosis. Medical sign-offs are required at various steps, demonstrating symptoms haven't returned and it's safe for the player to resume hockey activities.

The GTHL says the mandatory medical clearance process has resulted in a 300 per cent increase in the number of players receiving a doctor's clearance before returning to play.

Oakman says everyone appears to be buying in to the new rules — not a small feat among players and parents in the ultra-competitive GTHL.

"We are not getting a lot of push back," he says. "I think there is a greater understanding of the long-term effects of not dealing with concussions properly."