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Armour: What the NFL Must Do to Find Flaws in Concussion Protocol

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Referee John Hussey checks on Texans quarterback Tom Savage following a hard hit during the 2nd quarter against the 49ers on Dec. 10, 2017. Photo: Kevin M. Cox / AP

The NFL’s best intentions aren’t enough.

Houston Texans quarterback Tom Savage has effectively been ruled out of this weekend’s game after a complete failure of the concussion protocol and the people who are supposed to protect him. Unfortunately, this wasn’t an isolated incident. Russell Wilson, Coby Fleener, Jacoby Brissett – it’s happened too many times this season to trust the NFL when it says it’s doing everything it can to improve the concussion protocol.

The NFL announced Monday morning that it would join the players association in investigating the Savage incident, which is a good start. But why stop there? If the NFL is serious about making the game as safe as possible, it will solicit opinions and advise from all comers.

And yes, that means the medical professionals and researchers who have been at odds with the NFL and the way it handles head trauma.

“The whole protocol needs to be blown up,” Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation and a vocal critic of the NFL’s policies and procedures, said Sunday after Savage was injured.

“I actually am shocked at how weak it is,” Nowinski added. “I thought it was stronger.”

Each year, the league sponsors contests that encourage technical innovation to make the game safer. It has produced, among other things, shock-absorbing liners for helmets and tackling dummies that are both mobile and virtual.

Why not do the same with the concussion protocol and anything else related to head trauma? Throw it open to the best and the brightest, and see what their ideas and suggestions are for what the NFL could or should be doing differently.

Set aside the turf wars and hostility toward people who have questioned the NFL’s genuineness about acknowledging the inherent dangers of the game and do right by the men who have to live with the consequences of the league’s actions and inactions.

When I asked Nowinski how the protocol could be improved, he immediately rattled off some ideas, including taking the players to the locker room rather than doing examinations on the sidelines, testing memory cognition and doing a formal test of eye movement, an early indicator of concussions.

“The protocol needs to be rewritten this week and strengthened to be more conservative. And I think all the doctors require stronger training,” Nowinski said. “And I think there needs to be fines and punishments when protocols are breached.

“It doesn’t appear,” Nowinski added, “that they’re trying hard enough to get better.”

In fairness, the NFL has made improvements. Rules changes designed to take the head out of the game. A steep decrease in the number of full-contact or padded practices. A strict return-to-play procedure that takes the decision out of the hands of GMs, coaches, even team medical personnel.

The concussion protocol calls for two athletic trainers working in the press box as spotters, along with an unaffiliated neurotrauma consultant on each sideline. Whenever a player is identified by medical personnel, the coaching staff, referees or teammates as possibly having a head injury, he’s immediately assessed to see if he’s lost consciousness, is confused or has amnesia.

If the answer is yes, he cannot play the rest of the day. If not, he’s taken to the sideline for an initial evaluation that includes asking about the incident, an evaluation of speech and gait, video review of the play where the injury occurred and the five Maddocks Questions, which include what stadium they’re in and what half it is.

If there’s any indication or suspicion of a head injury, the player is taken to the locker room for a more detailed evaluation that includes a complete neurological exam.

Despite that, too many players are still left in harm’s way. Savage was checked on the sidelines and deemed to be fine, despite being in such distress that some who watched video of his injury initially thought he was having a seizure because of the tremors in his hands.

“The medical people on the sideline, they come to me and say we’re going to check Tom for a concussion,” Texans coach Bill O’Brien said Monday before inadvertently revealing a significant flaw in the process.

“They take him into the tent, they check him maybe two, three minutes. Not a very long period of time,” O’Brien said. “I’m not sure what goes into that.”

Not enough, clearly. Either all the steps in the protocol are not being followed or there are gaps, and neither is excusable.

If the NFL has to consort with its critics to fix the concussion protocol, so be it. The health of the players is far more important than the league’s pride.

By Nancy Armour

This article was republished with permission from the original author and 2015 Ronald Reagan Media Award recipient, Nancy Armour, and the original publisher, USA Today. Follow columnist Nancy Armour on Twitter @nrarmour.

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