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USA Hockey Concussion Protocol / Form

USA Hockey Concussion Return to Play

 

Concussion Signs and Symptoms

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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If there are any questions regarding this policy, please contact us.

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Concussion Return to Play Form

Symptoms Reported by Athlete

  • Headache or "pressure" in 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"

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Signs Observed by Coaching Staff

  • Appears dazed or stunned

  • Is confused about assignment or position

  • Forgets sports plays

  • Is unsure of 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

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