Over the last two years, the NFL has done plenty to improve the procedures that apply after a player has been diagnosed with a concussion. The next frontier will be improving the procedures for determining that the player has a concussion in the first place.
The league’s various measures, which came promptly after Congress rattled the antitrust exemption sword in Octoer 2009, include the requirement that a player with a concussion be cleared by an independent neurologist before being allowed to practice or to play in a subsequent game. More recently, the league promulgated the “Madden Rule,” which provides that any player diagnosed with a concussion “must leave the field and be immediately escorted to the locker/training room, and a member of the medical staff . . . must remain with the player to observe him if his injury does not require immediate hospitalization.”
But while the league also has generally mandated that if there is “any suspicion” that a player has suffered a concussion, he must be pulled from the game, the league has yet to implement specific procedures for ensuring that such suspicions will be acknowledged before a given game ends. There is no independent neurologist available during games -- there isn’t even a requirement that the teams have neurologists present. Also, the NFL has no system in place for flagging players who may need to be evaluated for the presence of a concussion.
As a result, we’ve heard terms lately like “dirt on the face” and “concussion-like symptoms,” and we saw Chargers guard Kris Dielman stumble and bumble and ultimately remain in the game after giving a quick “I’m good” wave to the sideline.
Improvements also are needed as to the process of evaluating players who may have concussions. As Dr. Julian Bailes, Chairman of the Department of Neurosurgery at the NorthShore University HealthSystem, told PFT via email this morning, “Making the diagnosis of concussion on the field or sideline has always been difficult. Lately I’ve come to think that the safest way if an athlete has ‘concussion-like symptoms,’ is to remove them to the locker room where you can be away from the noise, cold, and distractions. If there is any suspicion that a concussion has occurred, then they are not put back in the game.”
Dr. Bailes, who has been instrumental in the detection of Chronic Traumatic Encephelopathy, used that approach during his time as the on-field neurologist at West Virginia University. And it makes plenty of sense. It’s loud and it’s hectic and teammates are milling about and coaches are sticking their noses into the situation, hoping that their guys will get back on the field. The better approach is to get the player into a more calm environment, get his shoulder pads off, let him sit and rest and try to collect his wits, and then engage in an assessment of his condition.
Of course, before it ever gets to that point, the league and its teams need to have a quicker trigger for conducting the review. But these various steps must be taken by the NFL as soon as possible. If another Congressional hearing is needed in order to make that happen, then another Congressional hearing should be held.