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NHL concussion protocol weaknesses continue to come to light

By Derek Helling

May 1, 2017; Pittsburgh, PA, USA; Pittsburgh Penguins center Sidney Crosby (87) is helped off of the ice by Pens trainer Chris Stewart (R) after Crosby suffered an apparent injury against the Washington Capitals during the first period in game three of the second round of the 2017 Stanley Cup Playoffs at the PPG PAINTS Arena. Mandatory Credit: Charles LeClaire-USA TODAY Sports
May 1, 2017; Pittsburgh, PA, USA; Pittsburgh Penguins center Sidney Crosby (87) is helped off of the ice by Pens trainer Chris Stewart (R) after Crosby suffered an apparent injury against the Washington Capitals during the first period in game three of the second round of the 2017 Stanley Cup Playoffs at the PPG PAINTS Arena. Mandatory Credit: Charles LeClaire-USA TODAY Sports /
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The NHL revamped its concussion protocol for the current season. Details that have recently emerged strongly suggest that the league still has work to do.

The NHL added in-arena as well as television spotters for all games this season as a way to enhance player safety and reduce instances of concussed players remaining on the ice. While the intention may have been noble, flaws in the NHL concussion protocol have prevented the desired results from following those intentions.

A systemic deficiency recently came up in a scenario involving Pittsburgh Penguins star Sidney Crosby. After Crosby, who has suffered multiple concussions in his career already, hit his head against the boards in Game 6 of the team’s Eastern Conference semifinal series against the Washington Capitals, he wasn’t removed from the contest to be evaluated for a concussion.

That’s because the NHL concussion protocol as currently written only gives spotters authority to pull a player from a game if he is punched in the head, is hit in the head by another player’s shoulder or upper torso, or makes secondary contact with the ice on his head. Since Crosby’s head made contact with the boards, the spotter was unable to utilize her/his authority.

That language shows the poor understanding of the medical science behind concussions that the NHL currently displays. Concussions can be produced by cranial impact on any surface which is strong enough to make the brain shift in the skull. Whether or not the impact was strong enough to cause the brain to move is the important point, not whether the surface impacted was made out of human flesh, frozen water or plywood.

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Other information that supports the argument that the NHL’s comprehension and attention to concussion prevention and treatment is lacking has surfaced. In a recently-published Harvard study, it’s revealed that the NHL does not require that independent neurologists be on hand to diagnose potential brain trauma during games. Team medical personnel are charged with that task instead.

What’s resulted from these oversights in the NHL concussion protocol is questionable effectiveness of the program. There are potential conflicts of interest, not only with team medical staff being the only ones to provide evaluations of players, but with the league providing spotters with limited authority as well.

In both cases, there could be pressure from the league and/or team to keep certain players on the ice regardless of symptoms displayed. Larry Lage of the Associated Press presented the case of Pittsburgh Penguins forward Patrick Hornqvist, who was missed by spotters in a regular season game that shortly thereafter he was diagnosed with a concussion. Whether that was a genuine oversight by the spotters or intentional negligence is speculative, but the fact that the concussion was missed raises questions as to how many others might go unnoticed or neglected.

It may be nearly impossible for the NHL to ever create a perfect system, as it’s possible that players may lie or try to hide symptoms to stay on the ice. Giving spotters expanded authority to remove players regardless of how head impacts occur and requiring independent medical personnel to be present to evaluate players are two steps that the NHL can take toward creating a better system, however.

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