Clarifying procedure in the NHL's concussion "quiet room"

Given the murky nature of the injury, perhaps it’s only appropriate there’s a little fuzziness surrounding concussion protocol.

When the NHL board of governors moved to implement new regulations with regard to the treatment of head injuries in late March, the term “quiet room” quickly gained prominence. So, too, did the notion any players taken to that area were required to spend a minimum of 15 minutes there. Not so, according to Dr. Ruben Echemendia, chair of the NHL’s Concussion Working Group, the body that initially made the so-called quiet room recommendation to the league.

“The 15 minutes that has been talked about in the media is a fallacy,” Echemendia said, a fact that was confirmed by the league office. “It really is the amount of time that’s necessary to conduct a thorough evaluation.”

The most significant purpose of the quiet room is simply to remove players who may have sustained a head injury to a location that is free of distractions, where the team physician can conduct a variety of tests. The area itself is often the trainer’s room or perhaps even the coach’s room.

“At the bench, it’s very difficult to assess the kinds of factors that are associated with concussions, like learning and memory and attention and concentration, with all the distractions that go on in a playing environment,” Echemendia said.

Philadelphia Flyers trainer Jim McCrossin is also a member of the Concussion Working Group. He said, typically, a trainer will make an initial evaluation on the bench, which could lead to further inspection at an isolated location. There, a player will be put through the SCAT 2 exam, which stands for sport concussion assessment tool. He’ll be required to perform small motor skills tests, such as standing on one leg, and asked a number of questions, from “Who hit you?” to “Can you say these four numbers back to me in reverse order?”

“All those little things that an athlete would be able to do normally, are they able to comprehend everything you’re asking and do it for you?” McCrossin asked.

NHL protocol dictates the SCAT 2 be administered by the team physician, but not because trainers aren’t capable of giving the test, rather because another player might need their attention on the bench.

Concussions are notoriously tricky to diagnose, but the sooner one is detected, the better the chance a player will avoid further damage from sustaining a second.

“Are we going to be 100 percent all the time? I don’t believe so,” McCrossin said. “Everybody is a little bit different when they present with these things. But we’ve got to start somewhere and it’s a pretty darn good start.”