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ImPACT® Baseline Concussion Testing & USA Hockey-Pacific District Concussion Protocol

Welcome to the Anaheim Ducks High School Hockey League Baseline Concussion Testing and Protocol Page.  All ADHSHL participants MUST follow these instructions for ImPact Baseline Concussion testing and return-to-activity after a concussion:

1)  PRINT - ImPACT Testing Worksheet and Consent Form - Complete and Sign

2)  SCHEDULE - ImPACT Baseline Concussion Test

 

STEP 1 - MUST BE COMPLETED BY A PARENT/GUARDIAN - PRINT FORM

To sit for the testing you MUST bring the completed IMPACT Testing Worksheet on the scheduled day of testing.

STEP 2

ImPACT Baseline Concussion Testing Sign Up

Sign Up Now!

CONCUSSION AWARENESS

Pacific District Statement of Concussion Protocol

Statement of Protocol: When concussive activity is suspected, an athlete will be removed from participation until he/she can be evaluated by a medical professional trained in the diagnosis and treatment of concussions, then cleared to safely return to participation.

  • USA Hockey requires this signed acknowledgement at the time of registration for all members: Parents, athletes, coaches, volunteers, administrators and officials.

The Pacific District Concussion Protocol includes the additional terms and conditions:

  • An athlete who is suspected of sustaining a concussion or head injury shall be immediately removed from participation for the remainder of the day. Removal can be at the request of a coach, official, team manager, parent/guardian, program administrator, onsite EMT/ATC or the athlete. The one-day rule is the Pacific District Protocol and supersedes any state legislation allowing same day return to participation.
  • An athlete removed from participation for evaluation shall not be permitted to return to participation until evaluated and released by an appropriate medical professional (trained in the management of concussions, and acting within the scope of his/her practice). A written release or medical clearance must be provided to the team manager prior to return to participation.
  • If a concussion is diagnosed and concussion management protocol has been enacted for an athlete, there is no review period or negotiation as to the course of action and return to participation outside of the recommendations of the evaluating medical professional who has been selected to treat the athlete, in conjunction with the District protocol, national acknowledgement and applicable state laws.

CONCUSSION REPORTING

When a concussion occurs, it MUST be reported within 48 hours to the ADHSHL Concussion Testing & Management Program at concussion@adhshl.com

 

ADHSHL Concussion Return to Play

Any athlete held out for a concussion evaluation or who has been diagnosed with a concussion MUST provide a written Return To Play form from a qualified medical provider allowing them to return to any training, practice, or game activity with no restrictions.  The parent and coach both must sign the form acknowledging they received it.  

The form can be printed and filled out, and then must be signed by a qualified medical provider.  The parent and coach must then sign the form.  The form should be kept with the team coach or manager.

A copy with all signatures must also be submitted to the ADHSHL prior to any training, practice or game activity at: concussion@adhshl.com

Education Materials:


QUESTIONS?

Dr. Jason Galea

Program Director

Craig Kelsey

Program Coordinator