The more you watch Rams quarterback Case Keenum get slammed to the ground, clutch his head, and wobble back to his feet, the harder it becomes to understand how he was allowed to continue playing.

The first failure lies with the Rams coaching staff, which had plenty of time to attend to Keenum and make the decision to get him out of the game while the officials sorted out the penalty situation. Rams head athletic trainer Reggie Scott even had a few moments to talk to Keenum before sending him back onto the field:

The second and more egregious failure, though, was that of the independent athletic trainers who were at the stadium. These trainers, called ATC spotters, are at every NFL game for the specific purpose of stopping the game and removing any player who may be concussed. The spotters are empowered to call a medical timeout when a player “displays obvious signs of disorientation or is clearly unstable” and it “becomes apparent that the player is attempting to remain in the game and not be attended to by the club’s medical or athletic training staff.”

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Both of those things clearly, obviously happened with Keenum, who had trouble gathering himself and getting back onto his feet and did not receive any meaningful attention from his training staff. The NFL has reportedly taken notice of the failure, and will look into it:

The big question is what accounted for the ATC spotters’ failure. It’s easy to understand why the Rams coaching staff would be reluctant to pull Keenum in the final minute of a tie game. That’s the point of having the spotters, who are independent. This was the precise moment in which they were supposed to take action, and going by the available evidence, they either weren’t paying attention or didn’t care enough to do their jobs.