The NFL and NFL Players Association, in conjunction with their medical advisory committees, implemented the NFL game day concussion checklist protocol in 2011 to address the diagnosis and management of concussions. The parties consistently review the mandatory concussion protocols and make necessary changes to ensure that players are receiving care that reflects the most up-to-date medical consensus.

New Enforcement

NFL medical professionals on the sideline use a standard set of guidelines to assess whether a player has a concussion. Sean Sansiveri, Vice President of Business and Legal Affairs at the NFL Players Association, says these safety protocols are “the best in class.”

“I don’t know of any other sport or arena that does anything better than we do,” he says. The safeguards in place are evidence-based and we continue to make improvements.”

Now, there’s even more weight behind the NFL concussion protocol.

Starting this season, NFL teams could be fined or lose draft picks—if it’s proven that they failed to follow the checklist protocol. It’s an enforcement policy developed in partnership between the NFL and the NFL Players Association.

Potential disciplinary action includes:

  • A first violation will require the club employees or medical team members involved to attend remedial education; and/or result in a maximum fine of $150,000 against the club.
  • Second and subsequent violations of the concussion protocol will result in a minimum fine of $100,000 against the club.
  • In the event the NFL and NFLPA agree that a violation involved aggravating circumstances, the club shall be subject, in the first instance, to a fine no less than $50,000. The Commissioner shall determine appropriate discipline for subsequent violations involving aggravating circumstances.
  • In the event that the Commissioner determines that the club’s medical team failed to follow the protocol due to competitive considerations, the Commissioner may require the club to forfeit draft pick(s) and impose additional fines exceeding those amounts set forth above.

Quarterback Case Keenum’s Head Injury

Last season, Los Angeles (then St. Louis) Rams quarterback Case Keenum sustained a head injury in a game against the Baltimore Ravens. As reported on, “he remained in the game, though, and gave up a fumble that cost the Rams the game.”

NFL Commissioner Roger Goodell was asked about the diagnosis breakdown a few weeks later on SiriusXM NFL Radio’s “Opening Drive” program:

“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.”

Commissioner Goodell went on to say:

“We’re going to continue to tweak that until we get it right and try to prevent … make sure the game is stopped so the player has the right medical attention.”

Weeks after Keenum was hit, Pittsburgh Steelers quarterback Ben Roethlisberger sustained a helmet-to-helmet hit during a game against the Seattle Seahawks.

He exited the game with self-reported concussion symptoms.

“I didn’t feel right, it doesn’t make you less of a man or a football player to come out of the game,” Roethlisberger told

He added: “I think more guys should do it.”