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Why The NFL's New Concussion Protocols Aren't Working

Illustration for article titled Why The NFL's New Concussion Protocols Aren't Working

In January, the NFL announced that, starting with the 2013 season, all games would be played with an independent neurologist on the sidelines to assist with the evaluation and treatment of head injuries. It looked like the league had done a good thing. It was establishing a new, unbiased procedure to promote player safety—an effort made all the better by the fact that it didn’t involve placing the burden on the players themselves.


But the fundamental problem with football safety is football, and the league’s new program is proving it.

Let’s start with some background on the new rule. The players union had long demanded that the league require the presence of independent neurotrauma specialists who could evaluate players without interference or influence from any teams. To wit: On the same day the NFL made its announcement, the NFLPA cited a poll indicating that 78 percent of players didn’t trust their own teams’ medical staffs.

The league’s decision to require these unaffiliated consultants was announced at a news conference held just before the NFLPA’s annual Super Bowl week news conference. Also on that same day, NFLPA executive director DeMaurice Smith said the union had not been notified of the league’s plan to make the change. And all this was at a time when the NFL was still preparing for a court battle against the concussion-related lawsuits involving thousands of former players who accused it of distorting information about the long-term effects of head trauma. Those suits have since been settled.

The two sides eventually smoothed over their differences, and soon the NFLPA was on board with the plan to have independent neurologists on the sidelines. An NFLPA spokesman told me the league and the union have since worked out an agreement by which they both have input in selecting those independent sideline consultants. Those consultants are picked from a list of experts in all 31 NFL cities. The consultants must not be affiliated with any NFL teams. The NFL’s concussion protocol also spells out that the each consultant must be “board certified or board eligible in neurology, neurological surgery, emergency medicine, physical medicine and rehabilitation or any primary care CAQ sports medicine certified physician and [have] documented competence and experience in the treatment of acute head injuries.” Since last year, the protocol also mandates that an athletic trainer must be present up in the booth serve as a “spotter” for both teams by reviewing video and replay technology.


So what could go wrong? Why would there be any problems with diagnosing and handling concussions? Let’s look at three situations involving three players in three games. Each one illustrates what the NFLPA spokesman told me was an “area of concern” for the players association after the first month of the new season.

The scenario: In Week 1, Jeremy Kerley of the Jets was concussed when he caught a pass over the middle toward the end of the first half against the Bucs. Kerley was hit by three different players, and Tampa’s Mark Barron was flagged for unnecessary roughness:

Kerley was taken to the locker room and given the concussion tests, but he later returned to the game. The following day, he was held out of practice when he was evaluated again and diagnosed with concussion symptoms. The Jets had a short week heading into their next game, and Kerley missed their Week 2 game against the Patriots before returning to play in Week 3 against the Bills.


The problem: Players don’t always show concussion symptoms immediately.

The scenario: In Week 3, the Raiders’ Terrelle Pryor took a helmet-to-helmet hit from the Broncos’ Wesley Woodyard. Pryor had tucked the ball and made himself a runner, and the hit occurred inside the tackle box, so Woodyard was not penalized:

Pryor lay on the turf momentarily but played two more snaps. After the Raiders turned the ball over on downs, he started showing symptoms during a sideline evaluation and was removed from the game. The next day, Pryor tweeted, “I don’t remember much!” He returned to practice in a limited role later in the week and was ultimately held out of Sunday’s game against the Redskins. The league’s concussion protocol says that “if the occurrence of a concussion is unclear, or a player sustains a mechanism of injury (‘big hit’) that is reasonably expected to give rise to a concussion... the player shall be removed immediately from the field by Club medical personnel.” The hit Pryor took certainly seems to fit that definition, and the NFLPA is investigating the Raiders’ handling of Pryor to determine why he remained in the game. Per Mike Florio, the NFLPA does not want the typical sideline chaos to be used as an excuse for any failure to be properly vigilant in following the mandated protocols. The union spokesman told me that, depending on the outcome of its investigation, the NFLPA could consider filing a grievance.


The problem: A possible breakdown in protocol.

The scenario: In Week 2, Steelers running back Isaac Redman was injured on the opening kickoff after taking a helmet-to-helmet hit from the Bengals’ Jayson DiManche. Redman was blocking on the play, and the collision happened away from the ball. Here, you can see Redman go down around the 30-yard line just as the action stops:

The Steelers announced during the game that Redman was undergoing a concussion evaluation. He later returned early in the second quarter and played a total of 19 snaps, and he then played sparingly the following week against the Bears. But last week, Redman told the Pittsburgh Post-Gazette, “I had a concussion. I was pretty much out of it the rest of the game. I just tried to go back in.” When asked how he managed to overcome the concussion procedure to return to the game, Redman answered, “I said I was all right.”


The problem: The tendency of players to not want to come out of the game.

These aren’t rare, exotic scenarios. They’re all things that come up normally in the course of play, like two-point conversions and onside kicks, and that’s the issue. The new program is designed to keep concussed players from playing, yet that’s not what’s happening. These are problems that can’t be solved via fiat and bureaucracy, and there’s a simple inference to be drawn from that fact: you can’t really fix football without turning it into another sport.


Photo: Associated Press