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Dr. Charles Tator is seen with MRI brain scans at Toronto Western Hospital on February 6, 2011.

JENNIFER ROBERTS/jennifer roberts The Globe and Mail

International rules penalizing all head hits should be applied to hockey in North America to prevent concussions, neurosurgeon Dr. Charles Tator said on Tuesday, as his ThinkFirst Foundation presented a newly produced educational video at a packed news conference in Toronto.

"I'm optimistic that the big attention to this issue will pay big dividends," Tator said. "We will save the game."

International Ice Hockey Federation rule 540 mandates that a penalty be immediately assessed to any player who hits an opponent in the head or neck area, or who drives an opponent's head into the glass or boards. The referee has the discretion to level a minor and misconduct penalty, a major and game misconduct, or a match penalty. If injury occurs, a match penalty is automatic.

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The NHL, meanwhile, continues to grapple with the issue and Hockey Canada won't address head shots until its annual general meeting in May.

"We [already]had rules that would look after hits to the head, like penalties for elbowing but, unlike the NHL, we decided to err on the side of caution and insisted the head-hitting rules be put in," said Ottawa-based Murray Costello, vice-president of the IIHF and chairman of the organization's medical committee. "We tell the referees if they don't call them [head hits]there'll be no more international assignments for them."

Stiffer rules may mitigate the volume of head shots in North America but the more daunting issue is a hockey culture that desperately needs reform, said former NHLer Keith Primeau.

"The parents are the biggest abusers of the injury [concussion]" said Primeau, himself a victim of concussion. "Players are not only put back in harm's way but it can be dangerous, catastrophic, even fatal. … It's more about understanding the game. It's a game; it's not that important."

Scott Oakman, executive director of the Greater Toronto Hockey League, said parents of today's players were brought up at a time when concussion awareness was lacking. After having your bell rung, the pressure was to get back on the ice. Today, he sees too many parents pushing their children to do the same thing.

"The kids get it," former national women's team captain Cassie Campbell, who moderated a panel discussion, told reporters. "The kids just want to have fun. But when I go to hockey arenas, the parents are yelling and screaming at their kids, 'Hit 'em!' And I hate to say it [but]it's mostly the moms."

According to statistics compiled by ThinkFirst, 12-to-14 per cent of hockey injuries are concussions and up to 25 per cent of young hockey players who have received concussions do not receive proper post-concussion treatment.

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"What was a tolerable hit 50 years ago is no longer tolerable," Tator said, citing the sport's increasing speed, bigger bodies and harder equipment. "The brain is very fragile and has to be protected better."

Players, parents, even doctors need to be better educated on concussions, Tator said. He said some doctors are not aware of the most current concussion information. His organization has observed players being sent back to play before their brains had healed.

In Europe, doctors at some levels of hockey are stationed at the bench, "whereas I see players [in Canada]whose mom took them home from the rink and they never saw a doctor," Tator said.

The educational video presented on Tuesday, Smart Hockey, is aimed at youth players. Produced with the backing of Scotiabank and Reebok-CCM Canada, it's available as a free download at the ThinkFirst.ca website.

While Canadian provinces, the federal government and Hockey Canada ponder the concussion issue, 13 U.S. states have adopted training requirements to address youth concussions. Colorado's new law reaches further than others by requiring training in sports with athletes as young as 11.

Gov. John Hickenlooper on Tuesday signed a bill that requires even volunteer Little League and Pop Warner football coaches to take free annual training online to recognize the symptoms of a concussion. The new law also requires coaches to bench players when it's believed they suffered a concussion. They would not be able to return to games or practice unless they have medical clearance.

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Oakman said that in spite of the persistent culture, building awareness is forcing change. While the organization has documented an increasing number of concussions among youth players, some of the increase is attributable to coaches and support staff being better able to recognize possible concussions. They pull a child out of a game to be examined by a doctor, he said.

Fran Rider, president of the Ontario Women's Hockey Association, said 96 concussions have been recorded this year. She said players have tried to sidestep the built-in the system by going to walk-in clinics and getting doctors unfamiliar with their cases to give them clearance.

"Everyone needs to understand their responsibility when it comes to concussions, and they need to understand the seriousness of the issue," Rider said.

Tator called upon the sport to instill "respect for the player's own body, brain, teammates, opponents, rules. Deliberate hits to the head have to be eliminated."

Better equipment won't be enough to do the job, he said. "Virtually every concussed player is wearing a helmet."



With reports from Rachel Brady and The Associated Press

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