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NFL Concussion Protocol: How is it Working Thus Far?

The National Football League’s regular season is more than half over. With just a few weeks left before the playoffs start, many are wondering how the NFL concussion protocol is doing. Is it working? Have there been any glaring failures?

Week 11 of the NFL season provided interesting answers to both questions…

Last Sunday afternoon, the St. Louis Rams were locked in a tight game with the Baltimore Ravens at M&T Bank Stadium. With only a few minutes left in the game, St. Louis quarterback Case Keenum dropped back for a pass when he was sacked by Baltimore defensive tackle, Timmy Jernigan. The impact of the tackle wasn’t severe, but as he fell backward, Keenum’s head slammed into the turf.

The young quarterback immediately put both hands on his helmet after the hit and remained on the ground for a few seconds. His teammates tried to pull him up off the turf, but his body was limp and he fell back to the ground in obvious discomfort. He finally made it to his knees, then wobbled on his feet.

The game’s referees had thrown a flag on the play, so St. Louis Rams head trainer Reggie Scott briefly walked onto the field to ask Keenum a couple of questions. It’s unclear what was said between the two, but Keenum ended up staying in the game for two more plays before the game ended.

How Does the NFL Concussion Protocol Work?

At all NFL games these days, there are spotters at the field level and in press boxes looking for one thing: head injuries. In the wake of the NFL’s billion-dollar lawsuit, one thing was clear—the league wanted the world to know that it was going to do everything possible to make sure that players weren’t going to play if they had sustained a head injury. So as part of the NFL concussion protocol, independent certified athletic trainers (called ATC spotters) were to be placed at all NFL games to watch out for players that show signs and symptoms of concussion.

Last Sunday afternoon, millions of eyes saw Keenum’s head bounce off the turf. But no one stopped the game—not the Rams sideline, not the trainers, not the medical staff, not even the spotters whose one job it is to make sure that players in Keenum’s condition are evaluated for a concussion.

The NFL concussion protocol has three steps in which a player must complete before they can return to the field. Because each player and each concussion is unique, there is no set timetable for a player’s return.

Below are the three steps:

  • Each player has a baseline neurological exam that is administered at the beginning of every NFL season. When a player is suspected of having a concussion, they can only be cleared to play after a period of rest and recovery, as well as demonstrating that they have returned to their baseline neurological condition established at the beginning of the season.
  • A gradual exercise program can begin after the player returns to the baseline condition. The initial exercise stage includes light aerobic activities (ex: riding a stationary bike). Once the player is comfortable, they can resume weight training. Later, the player can participate in non-contact drills at practice. A player’s progress through the exercise program is stopped if they begin to experience a recurrence of concussion symptoms.
  • Before they can return to games, the player must be cleared by the team’s medical staff and an independent neurological consultant.

In Keenum’s case, because he was never removed from the game for evaluation, he did not have to go through these steps and was able to stay in the game. It was only after the game that Keenum was evaluated and found to have a concussion. He was ruled out of his team’s Week 12 game in order to complete the above-listed steps.

What Did the Case Keenum Play Show Us About the NFL Concussion Protocol?

Since the concussion protocol was implemented in 2013, the NFL has made changes nearly every year. For example, the NFL added the ATC spotters at every game after last season’s Super Bowl. In that game, New England Patriots wide receiver, Julian Edelman, was visibly shaken after taking a hit. Those watching knew something had to be wrong with him, but Edelman was able to stay in the game without being evaluated because there was no stoppage in play (similar circumstances to the Keenum example).

In order to prevent players from remaining in the game when a team continued to march down the field without a play stoppage, the NFL decided to put spotters on the field and in press boxes so they could call a medical timeout if a head injury was suspected.

In last Sunday’s game, the St. Louis Rams failed its player, and the NFL’s independent ATC scanners failed to call a medical timeout and get Keenum off the field for evaluation. In the span of only a few seconds, Keenum became the test case for the NFL’s concussion protocol the league never wanted to see.

When asked what he saw of the hit, Rams head coach Jeff Fisher told the media that he didn’t notice whether or not his quarterback struggled to get up. Fisher was told by Rams head trainer, Reggie Scott, that Keenum “felt okay” after the play. The ATC spotter reportedly told team officials that the quarterback showed signs of brain injury, though by that time the Rams had lost the possession of the ball and the game was all but over.

So, who is to blame here? According to Fisher, because of the speed at which these events unfolded, no one is at fault…the incident was a “combination of unusual events.”

So What Should be Done to Keep NFL Players From Remaining on the Field After a Concussion?

This is an easy question to answer: fine the teams that fail to properly evaluate their players. When an NFL player violates league safety policies, they either get fined or suspended or both. When an NFL team fails to remove a player from the field, even when spectators can see that the player is noticeably wobbly on his feet, none of the above happen…at least that’s been the case for the Rams.

According to ESPN, the NFL announced over the weekend that it will not hold the Rams accountable for Case Keenum not being pulled from last Sunday’s game so he could be properly evaluated. Jeff Fisher has a point—the speed of the game can lead to mistakes like last Sunday. But mistakes have consequences, and someone needs to be held responsible.

The NFL had a chance to show how strong the league’s concussion policy is. It could have and should have disciplined the Rams. Instead, the league essentially agreed with Fisher—this was a freak occurrence that happened too fast for anyone (or any team) to be blamed.

But what about players that are fined tens of thousands of dollars for an illegal hit? Can they not make the same argument when they are fined for a split-second decision in which they lowered their head to make a game-saving tackle? They too are forced to react in milliseconds, but the difference is they get fined when that reaction puts player safety in jeopardy.

Football’s complexity and speed aren’t stopping the league from levying fines on the players themselves. Why should this standard be any different for teams that fail to remove players from the field when a concussion is even a possibility?

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