The NFL Head, Neck and Spine Committee—a board of independent and NFL-affiliated physicians and scientists, including advisors for the NFL Players Association—developed the NFL Game Day Concussion Diagnosis and Management Protocol in 2011.

The Concussion Protocol is reviewed each year to ensure players are receiving care that reflects the most up-to-date medical consensus on the identification, diagnosis, and treatment of concussions.

Read More: See the full 2017 NFL Concussion Diagnosis and Management Protocol.

Concussion Game Day Checklist

When a player receives an impact to the head, the player goes into the Concussion Protocol if:

  • the player exhibits or reports symptoms or signs of concussion or stinger (a nerve pinch injury); or,
  • the Athletic Trainer, booth ATC spotter, Team Physician, NFL game official, coach, teammate or Unaffiliated Neurotrauma Consultant (UNC) initiates the protocol.

Then the player must be immediately removed to the sideline or stabilized on the field to undergo the concussion assessment, outlined in the checklist below:

game day

Improvements to the Concussion Protocol

In December 2017, the Head, Neck and Spine Committee made additional improvements to the Concussion Protocol:

  • Implemented a pilot program utilizing a centralized UNC based at the league office to monitor the broadcast feeds of all games. The UNC will contact the team medical staff on the sideline should they observe any signs or symptoms warranting further evaluation.
  • Defined impact seizure and fencing responses as independent signs of potential loss of consciousness, representing “No-Go” criteria under the current Protocol. Players who display either of these signs at any time shall be removed from play and may not return to the game.
  • Require a locker room concussion evaluation for all players demonstrating gross or sustained vertical instability (e.g., stumbling or falling to the ground when trying to stand).
  • Officials, teammates, and coaching staffs have been instructed to take an injured player directly to a member of the medical team for appropriate evaluation, including a concussion assessment, if warranted.
  • Require all players who undergo any concussion evaluation on game day to have a follow-up evaluation conducted the following day by a member of the medical staff.
  • Added a third UNC to all playoff games and the Super Bowl to serve as a backup who can step in immediately should one of the original two UNCs be absent from the sideline for a time to attend to a more severely injured player.

Return-To-Participation Protocol

Every NFL player diagnosed with a concussion must follow a five-step process before being cleared to fully practice or participate in an NFL game. This process, developed from internationally accepted guidelines, ensures that each player receives consistent treatment.

Each player and each concussion is unique, and there is no set time-frame for return to participation. Team medical staff consider the player’s current concussive injury, as well as past exposures and medical history, family history and future risk in managing a player’s care.

After a player has progressed through the five-step process, and is cleared for full participation by his club physician, he must be seen and separately cleared by an Independent Neurological Consultant (INC), jointly approved by the NFL and NFLPA, who is not affiliated with any NFL club. Until cleared by this independent physician, a player may not return to contact practice or play in an NFL game.

game day

Training, Collaboration and Standardized Care

Sideline medical professionals—including Team Physicians, Athletic Trainers, booth ATC spotters and Unaffiliated Neurotrauma Consultants (UNC)—met in New York City over the summer to review the latest protocols and train for the upcoming season.

“This is an opportunity for us to learn, to discuss together, to figure out how we can improve our communication and our collaboration,” said Dr. Allen Sills, the NFL Chief Medical Officer and a practicing neurosurgeon. “The spirit is really how can we leverage our skills and our experience as a group, to improve player health and safety for our 32 clubs.”

Ronnie Barnes, Senior Vice President of Medical Services and Head Athletic Trainer for the New York Giants, has been caring for NFL players for 33 years. “The protocol has evolved over the years,” he said, “but the most important thing that I could tell anyone is, ‘if in doubt, keep them out.’”

Robb Rehberg is a booth ATC spotter who works home games for the New York Jets. “Gathering all the people responsible for the health and safety of players in one place means we can talk about our specific roles, he said. “We can talk about how our roles are supposed to interface, and make sure there’s no miscommunication.”

Dr. Javier Cardenas is an Unaffiliated Neurotrauma Consultant for the Arizona Cardinals and member of the NFL Head, Neck and Spine Committee.

At the training, “we get to see our [Head, Neck and Spine] Committee work translated from protocols into implementation,” Cardenas said. “In medicine, we know that the more you standardize a protocol, the better off the patient population is, because you eliminate a lot of the variability.”

James Collins is the Head Athletic Trainer for the Los Angeles Chargers and President of the Professional Football Athletic Trainers Society (PFATS).

“On game day, it’s all about everybody being on the same page,” he said, “just like players and coaches are on the same page because they practice. We do the same thing.”

“The player’s health and safety is the most important thing, and we’re educating each other in sessions like this so that we can give the player the best care possible,” he said.

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