NFL goes the whole nine yards with new concussion protocol
From red hats to blue tents, fans will notice changes coming under global guidelines
The NFL this season has incorporated lock, stock and barrel the concussion-diagnosis tests included in the fifth and newest version of the international sport concussion assessment tool, known as SCAT 5, Postmedia has learned.
In a phone interview on Tuesday, the NFL’s new chief medical officer, Dr. Allen Sills, said lockerroom examinations for potentially concussed players across the NFL in 2017 are including all elements of the assessment tool.
SCAT 5 was published in April on recommendations made last October in Berlin at the fifth International Consensus Conference on Concussion in Sport.
An expanded locker-room evaluation that includes all SCAT 5 testing is just one of several important advancements in the NFL’s 2017 game-day concussion evaluations.
The whole-hog implementation of SCAT 5 might come as a surprise to many, for it belies the entrenched view that the NFL always drags its feet in incorporating the safest, most cuttingedge protocols for both concussion diagnosis and return-to-play policy. The NFL this century surely has provided such critics with ample evidence to fuel doubts about the league’s sincerity in always insisting it puts the safety of players first.
Previous NFL concussion evaluation protocols have not incorporated all elements of a current SCAT. This year’s does, for the first time.
“I think it demonstrates our commitment to let the science inform us and to make sure that we remain on the cutting edge of medical developments,” Sills said.
The Berlin conference’s twofold purpose was to present a summary of new evidencebased research into concussions, including diagnosis, management, investigations, treatment, return-to-play protocol, prevention and knowledge transfer, and to reach an agreement among many of the world’s top experts and researchers to develop a consensus statement to be used by physicians and health-care professionals involved in the care of concussed athletes in all sports the world over.
SCAT 5 is a standardized tool for medical professionals in evaluating potentially concussed athletes aged 13 and older. There is a SCAT 5 version for children as well.
The NFL’s executive vice-president of health and safety policy, Jeff Miller, had told Postmedia at the NFL’s annual meeting in March that it was possible the league would implement elements of the new SCAT.
“We want to be as up-to-date and relevant as we can be,” Miller said at the time, a month before SCAT 5 was published.
Sills, a neurosurgeon who has specialized in treating concussed athletes, was appointed by commissioner Roger Goodell as chief medical officer in March. Previously, Sills was professor of neurological surgery, orthopedic surgery and rehabilitation at Vanderbilt University in Nashville, Tenn., where he founded and co-directed the Vanderbilt Sports Concussion Center.
Sills not only attended the Berlin conference but co-authored SCAT 5, along with 23 other concussion experts.
“Our goal is to have the best possible care for our players,” Sills said. “We do that by listening to the experts in each subject area and asking them to help us create game-day protocols and routines that reflect best practices in every area of health and safety.”
Sills summarized what SCAT 5 entails as a discussion of how the injury occurred and a neck examination, then a “thorough neurological examination of the major cranial nerves, motor and sensory systems, gait assessment and then a cognitive assessment of immediate and delayed recall, as well as concentration.”
In one recall test, a potentially concussed player is asked to repeat sets of three single-digit numbers, but backward. If he hears 6,7, 3, he must say 3, 7, 6.
“SCAT 5 also has a (new) section for self-reported symptoms,” Sills said, “where the player actually takes the (electronic) tablet and will identify what symptoms he may be experiencing, and to what degree.”
It takes about 10 to 20 minutes for a team’s physician, along with an unaffiliated neurotrauma consultant (appointed jointly by the league and players union), to conduct SCAT 5 in the lockerroom. It is important to distinguish between an initial on-field concussion evaluation, a sideline assessment and a locker-room evaluation. They are markedly different, and occur in that order.
In perhaps the next most significant advancement in the NFL’s game-day concussion protocols, a player exhibiting or describing any of the following three symptoms — loss of consciousness, confusion or amnesia — is now immediately deemed to be concussed.
In such cases, no sideline assessment is given. If you ever see a head-hit NFL player taken directly from the field to the locker-room, and escorted by a neurotrauma consultant (all of whom, starting this year, wear a red hat), the player is concussed and his day is done. If a player examined on the field does not show one of the above three auto-remove symptoms, but still did not pass all concussion tests, he is taken to the bench for a sideline assessment, which usually can be conducted in less than five minutes.
SCAT 5 advises that a “neurocognitive assessment should be done in a distraction-free environment with the athlete in a resting state.” Sills wholeheartedly agrees, which is why blue injury-assessment tents have been introduced to NFL sidelines this season — and not just for concussion assessments, but any injury.
All such sideline concussion assessments now are to be recorded on tablet and submitted to the league.
If a player examined for a possible concussion is sent from the blue tent to the locker-room, that means a red flag went up. In most cases, that means the player — after further testing in the locker-room — likely will be diagnosed as concussed.
“We believe we’ve put in a lot of layers of safety and redundancy to be as thorough as we possibly can in detecting these concussions,” Sills said.