IN-GAME CONCUSSION PROTOCOL MANAGEMENT
In two disturbing cases, it hasn’t mattered that the NFL this season upgraded both its sideline and locker-room ingame concussion-diagnosis protocols to be in line with the world’s newest and best practices in these areas (SCAT 5, or fifth incarnation of the Sideline Concussion Assessment Tool).
If these, or any, well-intentioned protocols aren’t being properly followed, you get what has happened: two more egregious cases this NFL season of seemingly concussed players allowed right back in to continue playing.
It happened in November with Seattle quarterback Russell Wilson, and two Sundays ago with Houston passer Tom Savage. The league is still investigating both cases.
From a PR standpoint alone, such continuing outrages destroy all the good the NFL is trying to do on this front. Hundreds of concussed players this season might well have been properly diagnosed and carefully tended to, in part thanks to the improved protocols, but until the league eliminates the egregious, unforgettable oversights still occurring every dang season, then its many critics can, and will, continue to howl. They’ll keep concluding the league’s sincerity in concussion care is a gross sham.
The best way for the league to prove its sincerity would be to introduce a centralized concussion-clearance control centre. Call it the 5C. It would operate along the lines of the centralized replay operation, whereat a qualified, unaffiliated neurotrauma professional (UNP) with extensive experience, and approved by both the league and players union, would be assigned to closely watch each game, via real-time, fibre-optic TV video feed, at a one-room operation in New York City. All such UNPs would, in turn, be overseen on each game day by the NFL’s chief medical officer Dr. Allen Sills.
Much like chief replay officials in New York can communicate directly with the ref- eree on the field, so Sills and each game-appointed UNP would communicate with (a) the team doctor overseeing treatment of the potentially concussed player, as well as (b) the unaffiliated neurotrauma consultant (UNC) assigned to that sideline.
Crucially, the UNP would ensure the team doctor and sideline consultant are made aware of any concerning onfield incident or behaviour the player might have shown on TV, such as when a FOX camera closeup showed Savage seemingly convulsing two Sundays ago, with stiff, raised arms after the back of his head smashed on the ground following a blistering hit. Apparently, no one on the Houston sideline – medical personnel, coaches or players – was made aware of Savage’s ghastly symptom when doctors quickly cleared him to return to play.
In this suggested new protocol, the UNP in New York would converse with both the team doctor and sideline headtrauma consultant before a player is cleared, either after a sideline symptoms check or full locker-room assessment. And only he or she in New York — with CMO Sills’ knowledge and approval — would provide final clearance for the player to return to play.
The “eye in the sky” athletic trainers’ function at each game would be limited to observing what happens on the field from above, and stopping play as necessary, as before; New York would now handle TV video observation.
That said, New York could only overrule a team doctor and deny a player’s return based on the visual presence of a probable primary concussion symptom, such as the three currently on the mandatory remove-fromgame list: Loss of consciousness, confusion or amnesia.
Perhaps that list should be expanded to include at least one other: Seizure or convulsion-type symptoms.
This system would ensure that in-game concussiondiagnosis protocols are followed to a T, should eliminate any tempting cornerrounding a team’s medical staff might feel pressured into employing in a big game to get a key player prematurely or improperly back onto the field, and in so doing would remove the appearance of medical conflict of interest from the shoulders of team-employed doctors, who, as it is now, solely determine whether a player may or may not return to a game, with only input from the unempowered sideline neurotrauma consultant. (It is in the return-to-play protocol only, days or weeks later, where an independent neurological consultant possesses the power to approve or disapprove a concussed player’s return to competition.)