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Andy McDonald April 9, 2011

Blues forward Andy McDonald, during a game against Nashville on April 9, 2011. (Chris Lee / clee@post-dispatch.com)

LOS ANGELES • In the wake of Andy McDonald being cleared to return to a game in which he was concussed, there are concerns that the NHL's newly established protocol for evaluating a player's condition in-game may not be sufficient.

McDonald suffered a concussion at the end of the second period of Thursday's game in Dallas, but during the 16-minute intermission he successfully met the league's mandated requirements to resume playing and rejoined the Blues for the third period. The next day, however, McDonald experienced concussion-related symptoms and Monday the club announced he indeed has a concussion.

Considering the NHL has taken numerous steps in the past year to curb the growing number of concussions, it's not unreasonable to wonder if more could be done to prevent a player from returning to a game after sustaining a serious head injury. Medical experts have documented that simple exertion can exacerbate a concussion. And since the symptoms generally fail to register for a day or two, perhaps further damage could be avoided by missing part of a game and monitoring potential symptoms.

The NHL stands by its policy, introduced at the end of the 2010-11 season, which calls for the removal of a player who experiences a loss of consciousness; coordination or balance problems; slowness in getting up following a hit; or a blank or vacant look. It also requires that a team physician evaluate the player. McDonald passed the proper testing and said that he wanted to return to the game. But now 10 months after suffering his first concussion with the Blues, which forced him to miss 24 games, he is out again indefinitely.

"We are familiar with the circumstances surrounding Andy McDonald's case, and we are comfortable with how the case was handled by the medical care professionals from start to finish," NHL deputy commissioner Bill Daly said in an email. "Our protocol was fully complied with. It's important to recognize that sometimes the symptoms of a concussion don't manifest themselves until well after the event causing concussion, sometimes 48 to 72 hours later. In those instances, and where there are no other obvious reasons for concern, a return to play authorization is likely. I'm not sure anything more could or should be done in those cases."

Blues general manager Doug Armstrong said after Thursday's game that he was pleased with how McDonald's case was treated by the Dallas Stars' medical staff and Blues trainer Ray Barile, saying "they did an excellent job. (Barile) talked to (McDonald), they followed the exact protocol that's necessary and he passed all the necessary hurdles that he had to and then said he was ready to play the third period."

If a player passes the NHL's in-game testing procedure, the decision on whether he returns to the ice appears to be up to him. And since the symptoms don't show up instantly in most cases, at least one Blues player said that it's unlikely they would pull themselves from a game.

"You try and tell a player, 'Hey, you're coming out,'" defenseman Barret Jackman said. "He's going to say, 'Well, I don't feel any of the symptoms. You just checked me.' It's not the Blues, it's not the trainer ... it more lies on the player at that point. You could always say, too, that you don't give the player that choice, but ultimately it's our body. If you pass the test and you feel like you can go out there, then you do. You don't want to be the guy that says, 'No, I'm not going to go out there.'

"But a lot of times you're so caught up and your adrenaline is still pumping through your body, so you really don't know how badly you're injured. It would be a good protocol for some very serious cases, where a guy doesn't know where he is. But sometimes, the symptoms of concussions come on afterwards and you might not fully feels those until the adrenaline subsides."

The Blues have had three players return to games after suffering concussions in the past two years, but two of them, Tyson Strachan and David Perron, came before the NHL installed the new requirements. Strachan missed only a couple of weeks after his concussion, but Perron hasn't played since leaving the ice Nov. 4.

It's unknown how much Perron's return to that game against San Jose contributed to the length of his absence, and no one has accused the club's medical officials of making an improper decision to clear him to play. But Allan Walsh, Perron's agent, says that teams should be extremely careful.

"All decisions made with regard to in-game concussion testing and player safety should err on the side of caution," Walsh told the Post-Dispatch via text message. "We have the faith in qualified physicians and the concern players cleared to return to action are sometimes later diagnosed with concussions. There is no finite answer to the query right now. What we hope is that a sacred trust exists where club physicians always prevent players from returning to action whenever a shred of doubt exists as to whether the player suffered a concussion on the hit in question."

Some might suggest the NHL require any player who suffers a head injury to automatically be removed, but Jackman says that's not the answer.

"It's going to get to the point where anytime you have contact to the head, you're going to have to leave the game ... where OK, you got your bell rung, you're coming out of the game," he said. "You can't do that. It's hard to explain, but it's not a cut and dried situation. It's a fine line."