Here’s how the NFL’s concussion protocol works

An NFL player just took a big hit or landed hard on the turf.

He gets ups slowly, or sometimes not at all. If he exhibits or reports symptoms or shows signs suggestive of a concussion, a teammate, coach, NFL official or medical official initiates the league’s concussion protocol.

Then what?

A very detailed and dedicated concussion gameday checklist begins.

Dr. Allen Sills knows all about the NFL’s concussion protocol. In March, Sills was named the league’s chief medical officer by Commissioner Roger Goodell.

Sills, a neurosurgeon who has specialized in the treatment of athletes, joined the NFL from Vanderbilt University Medical Center where he serves as professor of neurological surgery, orthopaedic surgery and rehabilitation, and is founder and co-director of the Vanderbilt Sports Concussion Center.

“We have a head, neck and spine committee that is comprised of experts from around the country which are not affiliated team physicians with the NFL. That committee each year is charged with reviewing all our injuries and also helping us put together our concussion protocol,” Sills said. “Once every four years, all the experts in the world gather and they write guidelines and practice recommendations based on the best scientific literature that’s available.

“I happened to be a part of that. We met in Berlin last year. They [guidelines] were published in May 2017. Our head, neck and concussion gameday protocol is based on the new recommendations.”

A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull, according to WebMD.

There are a lot of people monitoring the players for concussions and for injuries in general during a game. On average, each team has four athletic trainers, two primary care physicians, two orthopedists, one unaffiliated neurotrauma consultant and one chiropractor.

“We have unaffiliated neurotrauma consultants, one on each sideline, watching all the players looking for any signs or evidence of concussion to be identified,” Sills said. “We have the ATC (independent certified athletic trainers) spotters in the booth who are looking at real-time game and video.”

Even with all the medical eyes, Sills said some of the key people in identifying a possible concussion situation are the officials on the field and the players themselves or teammates.

“I would say the officials are part of the team as well when it comes to this,” Sills said. “I spoke with them this summer. We do give them training. They’re the first line of eyes and ears on the field. They will at times, if they see a player or official that needs to be evaluated, they’ll stop the game and send that player off to the medical staff.”

“We have a motto that if you see something, say something. We want everyone in the equation.”

Here’s a basic look at the process of how the NFL handles a concussion:

The player is immediately removed to the sideline or stabilized on the field as needed.

Next comes the sideline survey.

The player’s helmet is removed, then the team physician and an unaffiliated neurotrauma consultant perform a sideline survey which includes:

▪ No-go. Did the player lose consciousness, act confused or have amnesia? If observed at any point, the player will not return to play.

▪ History of the event/how did it occur.

▪ Concussion signs and/or symptoms.

▪ The Maddocks Questions Test. These questions, in general, include: At what venue are we today? Which half is it now? Who scored last in this match? What did you play last week? Did your team win the last game?

▪ Video review

There’s also a focused neurological exam. This includes cervical spine exam (including range of motion, pain), evaluation of speech, walking in a straight line, eye movements and examination of the pupils.

If any elements are positive, inconclusive or suspicious of a concussion, the player is escorted to locker room.

In the locker room, another exam is performed.

▪ Complete NFL SCAT (standardized concussion assessment tool).

▪ Complete neurological exam.

If abnormal, the player will not return to play. He stays in the locker room with periodic evaluations by a medical team and follow-up neurological exam. Also, if at any time during the checklist a player demonstrates progressive/worsening concussion symptoms, he will not be allowed to return to play.

If normal, the player can return to play.

However, when diagnosed with a concussion, there are five steps that need to be completed before he can return. They are:

1. Rest and recovery until his examination tests return to baseline status.

2. Light aerobic exercise under the oversight of the team’s medical staff.

3. Continued aerobic exercise and introduction of strength training.

4. Football specific activities such as throwing, catching, running, and position-specific drills.

5. Clearance to return to full football activity. He must be examined by the independent neurological consultant assigned to the club. If the consultant and team physician agree, the player can participate in the the team’s next practice or game.

Dallas Cowboys wide receiver Cole Beasley was diagnosed with a concussion against Washington on Sunday.

Cleveland rookie defensive lineman and former Texas A&M and Arlington Martin standout Myles Garrett self-reported a concussion that kept him from traveling with the Browns for Sunday’s game in London. Garrett missed one game among his seven days in concussion protocol. He has returned to practice.

Sills said clearance to return can vary from player to player.

“Putting it (recovery) in terms of games is not the best measure. It depends on when it happened. All games are not uniform in timing,” Sills said. “It’s not always valid to say how many games are missed or how many days are missed.

“In general, our athletes are going to get back to playing in one or two weeks. Everyone is different. Those numbers are sort of meaningless to an individual player. There’s a lot of variability.”

This story was originally published November 2, 2017 at 9:25 AM with the headline "Here’s how the NFL’s concussion protocol works."