What’s happening to monitor players after suspected concussions?

Last week, the New York Times’ Jeff Z. Klein reported on Mayo Clinic research that found women’s ice hockey to be the most concussion-prone sport endorsed by the NCAA.

The results are certainly surprising, in no small part because women’s hockey is non-checking and therefore in theory less violent. While I don’t intend to delve into the specifics of the article itself, it does present a few interesting talking points.

The topic of concussions in college hockey, hockey in general, and sports at large is an immense one, well-worn but still of the utmost importance: New research emerges regularly dissecting the debilitating long-term effects of head injuries. I can’t begin to analyze the nature and impact of brain trauma on this sport, because (a) I’m not a doctor, (b) they’re only just beginning to be understood, and (c) I have to work this weekend, so I don’t have enough time to compose that tome.

What I do care to discuss is the immediate evaluation and treatment of suspected concussions in ECAC Hockey. In a rough, tough league, how do you minimize the kinds of events that lead to such injuries, and when those skull-rattling hits do occur, what happens next?

The conference’s concern

The NCAA and its individual member-conferences are certainly aware of the dangers of concussions, but there is little that such organizations are able to do once an injury has occurred. By and large, these authorities act in the interests of prevention, not rehabilitation.

“With regard to the league, from the standpoint of enforcing the rules and making sure players are safe, we have countermeasures … about hitting from behind as an example, and with women’s hockey and checking, we’re making sure that athletes who otherwise are unsuspecting a hit are not put in vulnerable positions,” ECAC Hockey commissioner Steve Hagwell said.

“If you’re talking about off-ice … [the league] can promote policies and enforce the rules set by those policies, but when it comes to day-to-day issues it’s really up to the institutions and the medical people who are on campus to determine [players’ situations].”

That said, there are issues about which leagues are in a position to make a positive impact.

“We’ve had discussions recently, as early as this past spring … about what are the guidelines and protocols we want to have as a league when a player is determined to be concussed,” Hagwell said. “For example, you have Player X who is on the road playing in a game, and suffers an injury that appears to be a concussion. The medical doctor on site, who is from the opposing team, looks at the player and says, ‘This player shouldn’t play.’ In the past we’ve had situations where the trainer — who is with the visiting team — says, ‘No, I know my players better, this player’s OK to play,’ so we talked about that aspect of, OK, who has final judgment: the visiting team’s trainer, who knows his players, or the home team doctor? We determined that … the physician should make the medical determination of whether a player should go back out there.

“So from that standpoint, again, it really falls into somewhat of a gray area, in that each player’s different, but we defer to the medical people on staff. We’re talking about the health and welfare of student-athletes, so hopefully we fall on the side of being cautious.”

The coaches’ caution

Coaches are in an odd sort of purgatory when a player gets hurt: They are responsible for the player’s well-being, but they are also absolved of (or powerless to, depending on your point of view) make the final call on that athlete’s game-readiness. That authority rests with the medical staff.

What a coach can do, however, is be proactive in his program’s ability to detect potential trauma in an accurate and expedient way. Most, if not all Division I programs now enjoy the use of a computerized diagnostic, known as a “baseline test.” This simple program compares each student-athlete’s “healthy” reaction scores, and so forth, to his post-incident scores to determine if there is a significant difference in the player’s cognitive performance.

“It’s been like that for quite some time now,” said Cornell coach Mike Schafer, who has turned to the computer test for some time now. “These last four years, kids would take the baseline test when they come in. I think everybody’s doing it now, but we’ve been doing it for quite some time.”

The test isn’t the end-all, be-all of concussion exams, as it does have its drawbacks.

“Sometimes it can be frustrating for the kids because they don’t have symptoms and they can’t pass the test,” Schafer said. “Other times, kids might have a little bit of a symptom, but the diagnostic test is fine; it can benefit and hurt you in both ways, but the bottom line is … it’s a procedure to take care of the athlete himself.”

That said, Schafer sings the praises of the diagnostic exam as it functions within the framework of a greater team protocol regarding head trauma.

“That’s just the start of it. The decision still ends up being our doctor’s, regardless of if they pass the test. If our doctor feels they’re not 100 percent, just by passing the computerized test doesn’t mean they’re back in the lineup. The doctor and the trainer have the ultimate decision.

“It’s the protocol that we follow, and it’s protocol that has obviously been proven to work,” he said. “Over the last five years — knock on wood — we haven’t had any kids with long-term concussions. There have been kids that have had to sit out a couple weeks, but it just goes to show you that kids aren’t going out there and getting that second concussion right away while they still have symptoms from the first … and that’s where the severity can come in.”

The trainer’s touch

One critique immediately prompted by the Times article was regarded reporting. To whit, do men report concussion-type symptoms as often as women? Perhaps women are less influenced by stereotypical competitive machismo than men, who may feel a greater compulsion to press on through obvious injury than their female counterparts.

No one would know the answer to that question better than an athletic trainer.

“Are the men under-reporting in hockey in general? I would probably speculate that yes, because when you take a look at the younger ages — high school, and maybe even at the junior levels — I think maybe those populations are under-reporting,” said Chad Krawiec, Harvard’s men’s hockey athletic trainer. “I think once you get into the college and pro levels, the support systems are there, so the reporting of concussion symptoms I think happens more regularly. Here in college, you still run into people who aren’t going to tell you, just like any other sport. I definitely think there is a male population that I would speculate still — even after getting educated on [such injuries] — won’t tell you.”

Apart from his duties as a multi-sport trainer, Krawiec is also a lecturer and clinical instructor in the athletic training curriculum programs at Boston University and Northeastern University, as well as Harvard’s site coordinator for clinical athletic training students from those programs. He preaches an aggressively proactive, two-pronged approach to catching injuries before they become chronic issues.

“A big part of noticing [potential injuries] is, one, watching the game. If a guy takes a big hit, or awkward hit even, or it doesn’t even have to be a big hit to the head … maybe getting blind-sided, or even twists his head around violently, I tend to watch that and notice that as much as I can. You tend to question those people after those hits. You can’t just wait for them to report; you have to be proactive and engage them. Ask them if they are feeling any symptoms. Then there’s also the part of just watching their habits, and seeing how they react.

“The other part is just the culture — education — trying to promote a, ‘Here’s the dangers of this, here’s the need to report these symptoms,’ and you just kind of front-load them on the fact that not reporting things really tends to prolong recovery and make things more dangerous to you. You might miss more time if you don’t report things than if you do.”

Krawiec said that despite the widespread publicity that concussions and other brain injuries are receiving, it can still be difficult for elite athletes to overcome their instinct to fight through the pain.

“It’s always hard to overcome that … especially in a game situation. [The players’] primary focus is the game. I think it’s becoming [that way] less and less now; in my career I’m finding that players are much more apt to tell you — they’ll admit it more now — than when I got into this. You can see the dangers now.

“[The players] have started to realize that, hey, this could really mess me up, and they’re certainly grabbing onto the idea that they probably should report. It always is hard to overcome that in the mix of things.”

Even if an athlete believes that symptoms should be reported immediately, Krawiec also pointed out that it can sometimes be hard for players to differentiate normal fatigue or wear-and-tear from true symptoms.

When a trainer witnesses a violent play, he will talk to that player as soon as possible. If there is reason to suspect that there might be something wrong, the trainer will administer a few quick tests right there on the bench or in the hallway.

“We try to standardize as best we can, but I think everyone will have something a little different,” Krawiec explained. “There are a few standardized tests out there that are … balance tests, simple memory recall, simple cognitive processing like addition/subtraction; mostly it’s based on symptoms. That’s your first go-to.”

Status report

Once again, go to the men and women in charge if you’re looking for answers. When the question concerns the frequency of suspected concussions, find the medical staff.

“I’d say we have about 30 games over the course of a season; at probably half those games you’re at least assessing or watching or evaluating somebody with the concern that they may have a concussion,” said Krawiec, whose season is only about 75 percent as long as most. “The number who end up having a concussion is obviously lower, but I’m always on the look.”

While he explained that the quantity of incidents varies from year to year, Krawiec advised to be on the lookout for rising numbers … but that that’s not necessarily a bad thing.

“I think we may see the numbers go up, just because we’re not willing to take that risk,” he said of borderline cases.

God bless him, because caution in the wind has wrought far too much despair devastation already. It’s high time for a spell of cautious calm.