Tuesday, 1 December 2015

Do We Need A Protocol?

The discussion arose almost immediately after Nathan Beaulieu staggered from the punches that Nick Foligno threw. You could clearly see Beaulieu take the shots on the button, and he was dazed in so much that he had a hard time standing on his own two feet for the next few seconds. Nathan Beaulieu did not go to the quiet room, however, and would resume his normal tour of duty once more despite his head being somewhere else just minutes before. It wouldn't be unreasonable for him to spend ten or fifteen minutes going through the process to check for a concussion, so perhaps the players and teams need to be forced into exercising this safety measure.

Let's be honest when we look at hockey fights: they're as close as any of the four professional major sports leagues get to being the UFC. The major difference is there are less body shots and arm bars, and far more targeting of the head when it comes to throwing bare-knuckled punches. NFL players suffer concussions often as well, so it might be time that the NHL looked at what the UFC is doing with respect to the NFL's ongoing concussion issues both on the field and in the courtroom.

UFC CEO Lorenzo Fertitta sat down with Marissa Payne of The Washington Post to discuss the difference between the UFC's concussion protocols and the NFL's ongoing concussion issues on January 15. Fertitta said, "Unfortunately sometimes in competitive team sports, whatever it might be — could be basketball or NFL or whatever — there is always that competitive push and desire to say, 'Hey, we need this person to play this Sunday; we need this person to play this weekend because we want to win. I think that's where the difference lies. [UFC] is a singular sport; it's not a team sport. You're not relying on one person for the rest of your team. It's just a different animal that we deal with."

Hockey falls into that same catch-22 where players are needed on a nightly and weekly basis, and sitting out long-term isn't a recommended course of action in winning. The problem, though, is that the UFC provides a 90-day window with no activity if a concussion is diagnosed whereas the NHL doesn't have any mandated recovery period.

"I think part of the difference here," Fertitta told Payne, "is that in the UFC there is no urgency to play. If you happen to fight and compete and let's say the doctor says, 'Okay, you have a concussion,' you are automatically suspended for 90 days. No contact in the gym. Obviously you can't compete, you can't fight," Fertitta said, adding that the enforced three month vacation gives UFC fighters "enough time to heal the right way."

So how does this affect hockey? As you know, there is an NHL concussion protocol that is in place, but the question has to be asked if it was followed with respect to Nathan Beaulieu?

According to the document linked above, the evaluation of a player to see if he has a concussion reads as follows,
A player suspected of having sustained a concussion is typically evaluated by the team athletic trainer and/or team physician on the bench or in the locker room. There is no standardized rinkside evaluation that has been adopted by the NHL although the recent SCAT2 published by Concussion in Sport Group (attached) may be very useful. The SCAT2 is most useful if baseline SCAT2 data are available on players. The SCAT2 contains a section that assesses balance using a modified version of the Balance Error Scoring Systems (BESS). There are currently no validity data available for players tested on skates.
Where things get murky about Beaulieu is that he skated to the penalty box after the fight with Foligno rather than the bench or dressing room, and was then made unavailable for comments after the game as he was "receiving medical treatment". Canadiens head coach Michel Therrien told reporters Beaulieu sat for the final 50 seconds of the second period after returning to the bench from the penalty box. He passed the concussion protocol tests administered by doctors during the second intermission and was cleared to play the third period.

The NHL independent spotters are supposed to notify a team's training staff if a player exhibits any of the following criteria: slow to get up following a hit, clutching head following a hit, suspected loss of consciousness, lack of coordination or balance issues, or a blank or vacant look. All of these criteria would require the training staff to run a concussion test with the last three requiring immediate removal from the game. Beaulieu, who already is suspected of having a concussion in last season's playoffs, should have been examined based on his past medical history as concussions are exponentially worse with each one received.

Dr. Robert Cantu, one of the world’s foremost authorities on concussions and brain trauma in sports, gave an interview in October 2012 where he pointed out something that most sports people take for granted. He stated,
"I think the number-one most serious misconception is that you have to be rendered unconscious to have suffered a concussion. More than 90 percent of athletic concussions occur without any loss of consciousness. There are 26 symptoms associated with concussions, and loss of consciousness is only one of those.

"Another very common myth is that concussions become exponentially worse as you accumulate them, so that your first one will be more mild than your second, and your third will be worse than your second one. That's just not reality. The concussions happen to be whatever they are based on the forces involved. I've seen many individuals whose first concussion was much more severe than subsequent ones."
Dr. Cantu makes a compelling argument for Beaulieu being tested with his statement of "whose first concussion was much more severe than subsequent ones". Just because Beaulieu didn't exhibit the symptoms for a more severe concussion doesn't mean he didn't sustain one when his legs turned to jelly after being punched in the jaw. This is one of those cases where being overly cautious might save a career. Even a life.

With fighting already way down in the NHL compared to previous years, this might be a good time to really step forward and protect the players who want to engage in fisticuffs. To do this, I propose the NHL ups the five-minute major for fighting to a ten-minute misconduct where both players have to return to the dressing room, not the bench, and be concussion-protocol tested. If a player is cleared and there are no signs of a concussion whatsoever, the player may return to the bench after his ten-minute misconduct expires. No harm, no foul, right?

However, if there is a concussion suspected or diagnosed, the concussion protocol will be maintained in that the player is barred from returning to action until he has returned to his cognitive baseline that was measured prior to the season starting. While I respect the 90-day ban on activity by the UFC, Dana White told Adam Guillen Jr. of MMA Mania, "You lose Tom Brady for three months and your whole season is wiped out." The same could be true from some NHL teams, so there will always be a push from owners and management to put the best players back out on the ice as soon as possible. We lost Sidney Crosby for the better part of two seasons with a concussion, and I'm not sure the NHL wants that kind of question mark for one of its most marketable stars.

Regardless of star power, though, the safety of every player should come first before any other consideration. Make the concussion test part of the fallout for fighting. Not only will the number of fights seen continue to decrease, but the health and safety of all players will be increased immensely.

When protecting the brain, this idea seems like a no-brainer.

Until next time, keep your sticks on the ice!

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