Concussion and injuries: the protocols and the research.

Each summary below gives the body, the document and its date, so you can check whether your association has published something newer. The research section reports what studies found, with their authors and years.

The international consensus

The recognition and assessment tools named in Hockey Canada's 2025 protocol come from the International Consensus Statement on Concussion in Sport. The 6th statement came from a conference in Amsterdam on 27 to 30 October 2022 and was published by Patricios and colleagues in the British Journal of Sports Medicine in 2023, replacing the 2017 statement. The process produced the Concussion Recognition Tool 6 (CRT6), the Sport Concussion Assessment Tool 6 (SCAT6, with a child version) and a new office tool, the SCOAT6, and added a focus on para athletes. The journal page could not be opened for this site, so these details come from summaries of it.

Hockey Canada: Concussion Protocol, effective 6 May 2025

Hockey Canada's protocol is adapted from Parachute's Canadian Guideline on Concussion in Sport (2nd edition, 2024). It covers recognition, medical diagnosis and management for all Hockey Canada participants, on-ice officials included. Its main requirements:

• Education first. Every player, parent or guardian, coach, trainer, safety person and team staff member reviews and signs a pre-season concussion education sheet, or a provincial or territorial equivalent, before the first practice. Officials do so before their first game.
• Everyone recognises and reports. Because many rinks have no healthcare professional on site, everyone in the hockey community is responsible for recognising and reporting a suspected concussion, using the Concussion Recognition Tool 6.
• Remove, then assess. A player with a suspected concussion is removed from the activity immediately and should have a medical assessment as soon as possible. The protocol lists warning signs that call for emergency medical assessment; read them in the protocol itself.
• No sideline clearance for youth. The SCAT6 tools are for licensed healthcare professionals only and must not be used to make sideline return-to-play decisions for players under 18, who may not return to that game or practice.
• Diagnosis by a doctor or nurse practitioner, with some provincial variations noted (for example physician assistants in Manitoba). The player or family passes the medical letter to the team.
• Return to school and to sport. A diagnosed player follows a Return-to-School strategy and a hockey-specific Return-to-Sport strategy, both supervised by a doctor or nurse practitioner, with at least 24 hours at each step. A written Medical Clearance Letter is needed before any activity with a risk of contact or falling.

The protocol notes that most players recover fully within four weeks, but that roughly 15 to 30 percent have longer-lasting symptoms and may benefit from specialised interdisciplinary care.

An older Hockey Canada document differs. Hockey Canada's Concussion Card, revised in August 2021 with Parachute, describes a six-step return to play that begins only after a doctor's clearance. The 2025 protocol instead starts the return-to-sport steps after diagnosis and requires medical clearance before the contact steps. The 2025 protocol is the newer document. The 2021 card's prevention advice for players is a snug helmet with the strap fastened, a custom-fitted mouthguard, respect for opponents, and no hits to the head or from behind; it asks coaches, trainers, safety people and referees to eliminate checks to the head and hits from behind.

Hockey Canada's 2026-28 Playing Rules also carry a goaltender rule (Rule 6.18): in U13 and below, play is stopped when it is safe if a goaltender is struck in the head by the puck, so that team staff can check on them and concussion protocols can be applied.

USA Hockey

USA Hockey's own current concussion page was not found by the research for this site. Its policy is summarised here as Massachusetts Hockey, a USA Hockey affiliate, describes it on its safety page (undated; it refers to USA Hockey's Team Up Against Concussions Week of 23 to 27 October 2023, run with the Concussion Legacy Foundation):

• A player with a suspected concussion is removed from play, and coaches should not try to judge how serious it is.
• The player returns only with a health care professional's permission and a completed USA Hockey Concussion Management Return to Play form, filled in by the player's primary care physician. Parents who are health care professionals may not clear their own child.
• USA Hockey requires concussions to be reported, without identifying the player, to district Player Safety Coordinators so trends can be tracked.
• Massachusetts Hockey treats ignoring the concussion policy as a SafeSport violation.

Players in other USA Hockey districts should check their own affiliate's version.

The NHL

The research for this site did not find the text of the NHL's concussion protocol for 2026-27; the NHL Official Rules 2026-2027 do not set it out. Two dated descriptions were found:

• 2016-17 changes (Jared Clinton, The Hockey News, 12 October 2016): Central League Spotters watching from the league's Player Safety Room could require a player to be evaluated, on-ice officials could order an evaluation after visible signs, and no player could return until club medical staff cleared him. Referees could remove a player if a team ignored the call, and clubs that failed to remove a player faced escalating league sanctions.
• The 2020-22 seasons (Riegler, Echemendia, Meeuwisse and colleagues, Orthopaedic Journal of Sports Medicine, 2024): the protocol's visible signs were slow to get up, balance or coordination problems, lying motionless, and a blank or vacant look; clutching the head was dropped after 2021-22 because it did not predict concussion well. A risk-based approach used discretionary checks rink-side with the team's athletic trainer and mandatory full evaluations away from the playing area, with team physicians making the diagnosis. Only about half of the concussions diagnosed by club medical staff showed visible signs.

The IIHF

No IIHF concussion policy was found by the research for this site. Players in IIHF competitions should ask their national federation or the event organiser.

Body checking and youth injury: the Calgary research

A research programme led from the University of Calgary by Carolyn Emery compared leagues with and without body checking:

• Emery, Kang, Shrier and colleagues (2010, JAMA) followed 2,154 Pee Wee players aged 11 to 12 in the 2007-08 season, comparing Alberta, where body checking was allowed, with Quebec, where it was not. Alberta recorded 241 injuries including 78 concussions over about 85,000 player-hours; Quebec recorded 91 injuries including 23 concussions over about 82,000 player-hours. Game injury rates in Alberta were about 3.3 times higher for all injuries and 3.9 times higher for concussion, with no difference in practice injuries. A previous injury or concussion raised the risk of another.
• Goulet and colleagues (2016) cite a 2011 CMAJ study of Bantam players as prospective evidence that body-checking experience at Pee Wee does not reduce later injury or concussion risk. Their own video study of 31 Bantam games from 2009 found Calgary teams, which checked from Pee Wee, had more very light trunk contacts, slashing and holding than Quebec City teams, while heavier trunk contacts did not differ significantly.
• A University of Calgary release (13 November 2019) states that after the Pee Wee checking bans, concussions fell by 64 percent and overall injuries by 50 percent, citing a 2017 evaluation of Hockey Canada's national policy change. It also reports a 2019 study led by Emery finding a 56 percent lower injury rate in non-elite Bantam leagues (ages 13 to 14) that banned checking, with a roughly 40 percent lower concussion rate that was not statistically significant. Emery recommended banning checking in the lower 60 percent of Bantam divisions.

The same release says Emery's research informed the Pee Wee checking bans by USA Hockey and Hockey Canada, dating them 2010 and 2013. Sources disagree on the USA Hockey date: a contemporary report (United States of Hockey, 13 June 2011) says USA Hockey's board passed the rule removing body checking from Pee Wee on 11 June 2011, effective from 2011-12, with 88 percent approval. The current rules are on the body-checking rules page.

Women's college hockey

Agel, Dick, Nelson, Marshall and Dompier (2007, Journal of Athletic Training) analysed NCAA women's ice hockey from 2000-01 to 2003-04. Game injury rates were about five times practice rates, 12.6 against 2.5 per 1,000 athlete-exposures. Concussion was the most common injury, 21.6 percent of game injuries and 13.2 percent of practice injuries, and the game concussion rate appeared to be rising. About half of game injuries came from player contact even though women's hockey has no body checking. The authors cautioned that only about 15.6 percent of eligible schools submitted data.

Check the certification sticker on your helmet and your association's current equipment rules; the helmets page explains the standards.