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NFL Concussion Protocol - something is amiss!

"There is no such thing as a minor concussion."

"The whole concept of being "Macho Man" is now proven to be ridiculous."

The back of his head slams against the turf. He immediately grabs his head while on his back. He extends his arm and his teammate foolishly tries to help him up (has anyone watched a what do do when a concussion/head injury is suspected video?). It takes him a full 10 seconds to get up.

The announcer, upon observing the replay, says, "oh, boy, you can see him go down and hit the back of the head on the turf. And as the NFL works through the concussion issue in this game, helmet to helmet, secondary hits, have come down, but that helmet to the ground is still one of the troubling spots when we talk about concussions at the NFL level." And this observation and comment was made before the next play began.

The NFL Concussion Protocol lists "Potential Concussion Signs"

  1. "Any loss of consciousness

  2. Slow to get up following a hit to the head ("hit to the head" may include secondary contact with the playing surface)

  3. Motor coordination/balance problems (stumbles, trips/falls, slow/labored movement)

  4. Blank or vacant look

  5. Disorientation

  6. Clutching of head after contact

  7. Visible facial injury in combination with any of the above"

It further states under the heading: "Practice and Game Day Concussion Management"

"3. The Player presenting Signs/Symptoms of Concussion"

"If a player exhibits or reports signs or symptoms of concussion on the field and does not require emergent transport for more serious brain injury and/or cervical spine injury, he must be removed and evaluated by the Club medical team."

In addition to the Club medical team is an "Unaffiliated Neurotrauma Consultant." "During games, each team will be assigned an Unaffiliated Neurotrauma Consultant" who is "impartial and independent from any Club" is "board certified" and has "documented competence and experience in the treatment of acute head injuries." This person will "be present on the sideline of every game" and will "be focused on identifying symptoms of concussion."

And if this wasn't enough, there is a "Booth ATC" who serves as a "spotter" for both teams with "access to multiple views and replay in order to aid in the recognition of injury." "Communication" between the booth ATC and the medical personnel on the sidelines is available so that the athletic trainer in the booth can report any plays that appear to involve possible injury."

And finally there is the "Madden Rule." "On game day, per the Madden Rule, a player diagnosed with a concussion must be removed from the field of play and observed in the locker room by qualified medical personnel."

But wait, there is more! "Additional triggers for medical evaluation." "As set forth above, in situations which the player exhibits or reports signs/symptoms of concussion, the full NFL Sideline Concussion Assessment examination is mandatory. In the event the occurrence of a concussion is unclear, or a player sustains a mechanism of injury ("big hit") that is reasonably expected to give rise to a concussion, and/or a concern is raised by another player, coach, game official, ATC spotter, or Unaffiliated Neurotrauma Consultant, the player shall be removed immediately from the field by Club medical personnel."

If ever there was a damning statement, this is it!

Either everyone is in cahoots or they are utterly incompetent!

And if they cannot get it (or do not want to get it) right in the NFL, what about college, high school, and youth league football?

Parents, are you paying attention? Your child is on that field. Who is overseeing their health and safety? If all these "board certified" doctors and athletic trainers with "documented competence and experience" can't provide safe medical emergency care, do you think that coach (who may have watched a 25 minute concussion video and may have CPR certification) with whom you leave your child can really handle these situations? Do you want to risk that? Nike said "Risk Everything." As a sports medicine doctor, sports performance coach, sports coach, athlete, league board member, and parent, I say "Risk Nothing!"

Update: Case Keenum and the NFLs response to what (didn't) happen:

“Promptly after the conclusion of yesterday’s game, we began a review to determine the facts of the injury to St. Louis quarterback Case Keenum and why he was not removed from the game for the necessary evaluation by a team physician or the unaffiliated neuro-trauma consultant as required by our concussion protocols,” the NFL said in a statement issued on Monday. “We are continuing that review today, which includes discussions with the Rams and their medical staff, the ATC spotter, the game officials, our medical advisors and the NFLPA. In the meantime, prior to this week’s games, we will reinforce with all involved the need to ensure that these injuries are properly identified and addressed in a manner consistent with our protocols.” Ref

I know a great eye doctor to whom I can refer all these experts....

"For clarity, we have the spotter upstairs that is a former athletic trainer...." STOP! FORMER athletic trainer? The NFL Concussion Protocol document states, "Booth ATC" not former ATC!

"... and their job is, if they see a player that's in some type of distress, is to buzz down,"

"In the Case Keenum case, it was clear that there was somebody giving him medical attention and that that was already done. The problem we had was that the appropriate medical attention wasn't given and there were several gates that, frankly, failed and didn't do the right things for our protocol. So we're trying to make changes to that." So, poor Case was getting medical care, but it wasn't the correct medical care. Yikes!

"We're going to continue to tweak that until we get it right...." That is what is called planning Roger. You plan so you get it right BEFORE you implement!

"The independent neurologist is involved and will be always be involved once the player comes to the sideline." No, the Protocol states:

"During games, each team will be assigned an Unaffiliated Neurotrauma Consultant. Each Unaffiliated Neurotrauma Consultant shall be a physician who is impartial and independent from any Club, is board certified or board eligible in neurology, neurological surgery, emergency medicine, physical medicine and rehabilitation physician, or any primary care CAQ sports medicine certified physician and has documented competence and experience in the treatment of acute head injuries. An Unaffiliated Neurotrauma Consultant shall be present on each sideline during every game and shall be (i) focused on identifying symptoms of concussion and mechanisms of injury that warrant concussion evaluation,"

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