Inside the NFL Concussion Protocol

football-pro-21561452_1920You hear it every Sunday, watching an NFL player escorted to the locker room after taking a big hit to the head: “He’s in the NFL concussion protocol”.

Concussions increased by 58% in the 2015 regular season games compared to 2014.  There were 182 reported concussions in NFL regular season games last season.

Game Day Concussion Questions

How are the players evaluated in such a chaotic environment? Who makes the call to determined if the player returns to the game or to hit the showers?  These questions remain a mystery for most NFL fans.

Let me share with you what the NFL game day concussion management plan looks like from inside the NFL medical departments.

Player takes a concerning hit the head….

Step 1:  Intervene

The team medical staff is notified of a potential head injury by themselves, the player, the ATC Spotter(s) in the skybox, teammate, game official, or coach.

Step 2:  Screen

Player is removed from the game and a sidelines evaluation is initiated.  This involves at least one of the team physicians and the Unaffiliated Neurotrauma Consultant (UNC).  The UNC is easy to spot, sporting the now mandatory blue hat.  Typically a team athletic trainer is included in this discussion as well.  The medical staff has access to the sideline Injury Video Review System monitor.  This allows the medical staff to visually review slow-motion angles of the injury play.

Step 3:  Decide

If no concussion, neck injury or concerning injury is confirmed, the player is cleared by the team physician to return to the game.  If the medical staff and UNC have any concern for a potential concussion, the player is escorted to the locker room with the UNC.  When the injured player leaves the field with the UNC for a concussion evaluation, by definition, he is now “in the NFL Concussion Protocol”.

Step 4:  Evaluate

Now in the quiet team Athletic Training Room and away from the stimulus-heavy game field, the UNC and team medical staff performs a more comprehensive neurological evaluation.  This phase of the assessment includes a sophisticated concussion tablet-based test.  This test takes approximately 10 minutes to complete.  Every NFL player has taken this test previously during the non-contact off-season.

This tablet concussion test grades key brain variables such as visual memory, processing speed and reaction speed along with assessing concussion-like symptoms.  The player’s new game day grades are compared to his previous baseline test scores to quickly determine if his brain functions have been altered in any way.

Step 5:  Diagnose

Based on the results of the tablet concussion test scores, physical examination tests such as balance, eye tracking and verbal recall and the subjective feedback from the player, the team physician and UNC will answer one simple question: “Does the player have a concussion?”

  • If the answer is YES:  The player is ruled “Out” for the game and he remains in the locker room area accompanied by a medical staff member.
  • If the answer is NO:  The player is allowed to return to the sideline for continued evaluation, skill drills and discussions with the medical staff about his symptoms and his play status.

Return to Play?

The ultimate decision on the NFL player’s return to play status is not made solely by the Unaffiliated Neurotraauma Consultant.  The final call on whether the player is given back his helmet and allowed to return to the game is made by the Head Team Physician and, ultimately, the player himself.




Author: Mike Ryan

After 26 seasons as a full-time certified athletic trainer and registered physical therapist in the National Football League, Mike Ryan has outstanding first-hand experience. His unique professional and athletic background has sharpened his skills in the arts of sports injury management, elite rehabilitation, performance enhancement and injury prevention. Mike is now taking his experience to mainstream America. His mission is simple: Sports Medicine advice that is easy to use and brings fast results. Learn more about Mike Ryan

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