Most of the hockey-savvy crowd at the London Hockey Concussion Summit in London, Ont., on Saturday immediately recognized the video from the 2003 Stanley Cup final, showing Paul Kariya knocked out in an open-ice hit by Scott Stevens.
The images of the Anaheim Ducks captain lying unconscious on the ice, his breath fogging his visor when he wakes up, record some of the enduring moments of the series.
And not necessarily for the huge collision with the New Jersey Devils defenceman that preceded them, but for what happened soon after, when Kariya returned to the bench, then to the ice and scored a goal to lock up Game 6 for the Mighty Ducks.
It was inspiring, people said, even heroic — and that’s the problem, a panel of experts and players said at the London conference on Saturday.
Kariya probably should not have returned to the game, they said.
Players who have their "bell rung" have no business coming back during the same game in 99 per cent of cases, said Dr. Margot Putukian, the director of athletic medicine and head team physician for Princeton University.
"This is one of the most challenging issues I face," she said.
‘Part of the bravado’
But sometimes pro players do come back onto the ice minutes after a massive shot to the head. Parents, coaches, volunteers, and young players see them come up off the deck, so many people think it’s fine to send a kid back out on the ice after a possible concussion.
"All the other levels are watching what the pros do, and they’re going to do what their heroes do," said Mark Moore, a former pro who had to retire after a concussion, and still suffers its effects.
"It seems like it’s part of the bravado," said Alyn McCauley, who suffered multiple concussions in his more than 10 years in the NHL playing for the Leafs, Sharks and Kings.
As an assistant coach with the Queen’s University hockey team, McCauley saw one of his skaters play with a concussion and not tell the coaching staff.
"I think we’re improving [on concussion awareness], but there’s an instance where we still have no idea," he said. After the concussion was discovered, the player was immediately out of the lineup.
The panel says the choice is clear-cut: a kid should never return to the game after getting "dinged."
"Everybody wants to prove they are tough, [but] when it comes to a head injury, you can’t play through it," said Dr. Michael Czarnota, the neuropsychological consultant for the OHL and the WHL.
Staying away from the rink is especially for concussed youngsters. Coming back while still hurt could have disastrous consequences on a developing mind: long-term developmental problems, permanent personality changes, and physical ailments — or worse.
"Second impact syndrome" is the "600-pound gorilla in the room when we’re dealing with youth," said Czarnota. A second shot to the head while still recovering from a previous concussion can be fatal.
"We need to be responsible for our actions," said Dr. Kevin Guskiewicz of the University of North Carolina.
Culture change needed
The panel said that being responsible means changing the hockey culture that idolizes toughness and "playing through the pain."
"What’s the rush in minor hockey [for players] to come back? These are your kids," said Eric Lindros. The former NHL superstar was plagued with concussions throughout his career, and his brother Brett was forced into early retirement by head injuries.
"There’s so much pressure [in minor hockey] to perform," said Jeff Beukeboom, the former Edmonton Oiler who now coaches in the OHL. "It’s all about winning."
With this in mind, the panel said that the first step in changing the culture is getting people more educated on the injury.
"Not enough people know about concussions, especially at the lower levels," Beukeboom said. "I think that's our biggest problem."
In a 2007 study cited by Czarnota, only half of 156 minor hockey coaches passed a test recognizing concussion-like symptoms.
Doug Stacey, a physiotherapist with Hockey Canada who’s been a trainer for many national teams, gave some practical advice to the audience when it comes to recognizing kids who might be concussed.
"Know your athletes," he said. Changes in personality come along with most concussions, he says, and coaches need to be concerned if a player is not acting like himself or herself.
"That’s the sign," Stacey said. "Talk to your athletes, get to know them."
Knowing your kids is the most important tool when it comes to recognizing concussions, Stacey said, because standardized concussion tests don’t work on their developing minds.
"Children and teens are not necessarily adults," he said.
And if there’s any little sign that the kid is acting strange, the message is clear — and it was a refrain spoken throughout the summit : "When in doubt, sit them out," Stacey said.