No more ‘dings;’ protocols in place

It happens dozens of times in every NFL game.

There is a fierce collision, or perhaps a running back is slammed to the ground. Most of the time, all the players rise to their feet uneventfully.

Other times, as the pileup unravels, a player gets up slowly. His gait may be unsteady.

For decades in the NFL, the operative term for the situation was that someone “got dinged.” It was a cute, almost harmless-sounding description of what was often a concussion or a worrying subconcussive blow to the head.

But with the NFL agreeing to pay hundreds of millions of dollars to settle a lawsuit brought by about 5,000 former players who said the league hid from them the dangers of repeated hits to the head, a backpedaling league has corrected its lingo and hastily amended its methodology. The NFL now has a concussion management protocol, outlined in an inches-thick document that commands teams to institute a specific, detailed game-day and postconcussion course of action.

Once, the treatment of players with head injuries varied from team to team and could be haphazard. Beginning last season, all players suspected of having a head injury — should they lose consciousness from a collision or experience symptoms like a headache, dizziness or disorientation — were required to go through the concussion protocol system. It features a broad cast: a head-injury spotter in the press box, athletic trainers on the bench, doctors and neuro-trauma specialists on the sideline and experts in neuro-cognitive testing in the locker room.

The system is far from foolproof and players with serious symptoms remain in games. But as the NFL grapples with a sobering threat to the welfare of its workforce, not to mention a public-relations nightmare, the new concussion protocol is meant to establish a systemic, itemized policy on how potential brain injuries should be handled.

“Before the season begins, I make it a point to tell the players that we’re never going to use the word ‘dinged’ again,” said Ronnie Barnes, the New York Giants’ senior vice president for medical services, who has been with the team since 1980. “It’s a traumatic brain injury. I say to the players, ‘Each time you get a concussion, you’ve injured your brain.’ ”

In the 1980s, when Barnes suspected that a player had a concussion, he would lock the player’s helmet in a trunk to keep him from re-entering the game. Some other players rested on the bench for a quarter or a half and, if cleared by doctors, they would resume playing.

“We don’t do that anymore, which is good,” Barnes said.

Under the new concussion protocol, a player suspected of having a head injury is interviewed and put through a battery of tests on the bench by a team doctor. Joining the examination is a neurologist or neurosurgeon hired by the league and not directly affiliated with the team. There are two of these league doctors, known as independent neuro-consultants, assigned to every game — one on each sideline.

The initial questioning of the player is fairly standard:

What quarter is it? Who scored last? Do you have a headache? Dizziness? Nausea?

The doctors also put the player through exercises meant to test his balance and cognitive skills.

Dr. Philip Stieg, the neurosurgeon-in-chief at New York-Presbyterian Hospital, often works Giants games at MetLife Stadium as one of the NFL neuro-consultants. He said that the sideline exam was not that different from one he would give patients in his office.

“The major difference is that 80,000 people are in the background,” Stieg said.

As the game progresses, a decision has to be made whether the player should re-enter the game or be taken to the quiet of the locker room, where he would receive a more thorough neuro-cognitive examination. The decision is known as the “Go” or “No Go” verdict.

“Because if someone is taken back to the locker room, he’s probably not going to go back into the game,” Stieg said.