After an exciting weekend of Wild Card football, many people are still talking about one incident that took place during the Dolphins vs. Steelers game. For those of you watching the game, it would be hard to forget about the crushing blow that Dolphin’s quarterback Matt Moore took in the second quarter from Steelers linebacker Bud Dupree. As shocked as viewers were by the viciousness of the hit, most were left stunned by how quickly Moore returned to the game – just one play later. This has left people questioning whether or not the NFL’s Concussion Protocol was accurately administered. Shortly after, the league announced that it would be investigating the application of the concussion protocol by Miami officials following the hit. Now, for us to understand the rules of the protocol, we must go into detail about what a concussion actually is, as well as what the NFL has mandated must be done for player safety.
A concussion is a “complex pathophysiological process affecting the brain induced by biomechanical forces.” Unlike some other injuries, a concussion is difficult to diagnose on the spot. It takes many tests, some of which cannot be done at the stadium, to conclude whether or not a player is suffering from a concussion. The NFL has stepped up its game in a big way, and has said that it is determined to keep the players safe. Through their research, they have listed several symptoms that a player might show if suffering from a concussion. These symptoms are:
- Any loss of consciousness
- Slow to get up following a hit to the head (“hit to the head” may include secondary contact with the playing surface)
- Motor coordination or balance problems including stumbles, trips, falls, or slow or labored movement
- Blank or vacant look
- Disorientation (unsure of where he is on the field or location of bench)
- Clutching of head after contact
- Visible facial injury in combination with any of the above
If a player shows ANY of these symptoms, any of the 29 medical personnel (including Team Physician, Unaffiliated Neurological Consultant “UNC”, or either of the two “Spotters” at the game), coaches, or on-field game officials must remove that player from the game to run tests. During the preseason, each player is given a neurological test. This is done to get a baseline of answers for each individual player in the event that they might sustain a concussion. When taken to the sideline and checked for a concussion, they are given the same test they were given in the preseason. Medical officials will check to see how their answers align with their previous answers, when they were known to not have a concussion. If the answers are off, or if the response of the answers is delayed, the Team Physician can bring the player into the locker room for further testing. A player cannot return to the game without completing the concussion testing. If a player is diagnosed with a concussion, he is not allowed to return to the game. Although there is a lot of information to this, it seems pretty straightforward right? Unfortunately, concussion protocol can be anything but.
Team Physicians on the sideline as well as UNC’s are watching the game live to look for injuries. If they see a potential injury, their job is to get that player looked at. But because of the high intensity and speed of the game, it is possible for the personnel on the sideline to miss something. Because of that, there are two “spotters” in the booth who are watching the game and have access to video replay as well as communication with the medical personnel on the field, as well as multiple eyes from different angles to keep these players away from harm. As far as concussions go, when either on-the-field personnel or the spotters from the booth see any of the symptoms stated above, it is their job to get the player out of the game to run tests. That is where it gets tricky. It is up to the particular medical personnel at that game to decide whether or not a player is at risk for a concussion. What one spotter may see as a warning sign, the other may not. That leaves room for error or confusion in what is and is not a sign. Also, the NFL lists those signs as the “possible” signs of a concussion. That means that those are not the only signs that could be shown for a player to have a concussion.
So what happens when a player does not show signs or symptoms of a concussion? Is it possible for him to still have one? The answer is yes. The NFL has admitted that their protocol is not perfect, and just because a player does not exhibit warning signs, or may have even passed the test, does not mean they do not have a concussion. Because of this, the NFL created another test to try and become aware of concussions. They say that in the event the occurrence of a concussion is unclear, or a player sustains an injury such as a 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. This test along with the sideline test given when a player is showing symptoms seems great, and in fact, it probably would be if it was followed correctly, but unfortunately it seems to not be.
There are multiple problems with the NFL’s protocol. The first of which is that it seems to be not strict in regulation. The possible symptoms a player might have are not always followed by the UNC’s, spotters, or team physicians. Earlier in the season, Cam Newton was beat up pretty badly against the Broncos defense. Although many were concerned about if Cam was alright, the medical personnel at the game did not believe he had the symptoms of a concussion. Even though Newton had shown multiple symptoms, including getting up slow, he was not given the sideline test. In a statement released by the NFL, they said medical officials “concluded there were no indications of a concussion that would require evaluation and the removal of the player.” Really? A player who is doing what you have decided are the official symptoms of having a concussion is not reason to go into concussion protocol and give Cam a test to make sure that he is okay? One of the problems with the NFL’s concussion protocol is that the symptoms seem to just be guidelines. They may or may not test a player who has symptoms of a concussion. That is a huge problem.
The next problem with the concussion policy is that they don’t seem to be unbiased. Most players do not want to sit out because of injury – they want to tough it out. Most coaches are the same way. When a player would be asked questions, they would plead their case that they are okay and are ready to go back into the game. Although they are medical experts, team physicians have a vested interest in the team, what is best for the team could very well be what is best for them. They are supposed to be unbiased, but that seems like a difficult task, especially when most players will try and convince you they are fine, while some coaches will try and persuade you to get the player back in the game. For this reason, the NFL brought in UNC’s to make sure that that was not happening. However, the idea might not be working as well as expected. According to the NFL, when a player is given a concussion test on the sideline, it is the team physician who makes the determination on whether the player goes back into the game, giving the UNC no more power than a simple supervisor. What is his real job then? Yes, the UNC makes sure they follow procedure, but at the end of the day, it is the biased team physician who makes the call on re-entering a player into the game.
Now, a physician cannot simply not give a player a test when it might appear obvious that they need one. When the player wants to go in, it might be hard to go against him. Because of this, it might be simpler to give a player the test for when “the occurrence of a concussion is unclear” because that test is much shorter than the standard sideline test which lasts 6-8 minutes. The second test is a short series of question in which the team physician asks the players things such as; “What quarter is it?” “What is the score?” “Who are we playing?” Based on the players’ answers to these questions, the team physician may either put the player back into the game, or keep him out to give him the standard sideline test. This could be a clear loophole to keep a player out for as short amount of time as possible, as well as giving the medical staff the opportunity to say that they did test that player if they are questioned. And the NFL did say that their system is not guaranteed to work.
At the end of the day, Matt Moore showed symptoms of a concussion. Whether or not he had one is irrelevant. If a player shows any of those signs, they should be tested. This is not a challenge where you need clear and undisputable evidence. These are players’ lives. It should be treated with extreme care. Incidents like Cam Newton, Case Keenum, Matt Moore, or any others cannot happen. Players give their all to this game, and the NFL needs to give their all back as well. They are right to investigate the hit during the playoff game. It will be very interesting to see what they report. What is more concerning is not what the NFL does to the Dolphins, or what they find out happened, it is more concerning in what they are going to do to ensure that incidents like these do not happen again, because ultimately, that is what’s important.