NFL sideline concussion management

NFL’s Sideline Concussion Management

Sunday night during Super Bowl 50, Carolina Panther’s wide receiver Corey “Philly” Brown left the biggest game of his career in the third quarter with concussive like symptoms after he went for a pass from Cam Newton. Before I try to shine some light on the NFL’s sideline concussion management I just wanted to comment on how the NFL and the Carolina Panthers did the right thing. Too many times in minor sports concussed athletes return to competition before they are fully recovered because they have a big game on the weekend. If the best wide receiver on a Super Bowl contending team gets pulled for safety reasons, then there is no reason little Johnny should return before he’s fully healed.

In the fourth quarter the commentators announced that Corey Brown had failed to pass the NFL’s sideline concussion management program and was not returning to the game.

What is the NFL’s sideline concussion management?

I was unable to find the step by step process they use but I can shed some light on what is involved. This season, the NFL had on average 27 medical personnel at a stadium during a game. The medical staff includes team doctors, athletic trainers, an independent neurological consult and an expert “eye in the sky” – NHL also has this.

The “eye in the sky” is a non-medical personnel in a stadium box that scans the field and TV replays to help identify potentially concussed individuals. The “eye in the sky” is authorized call a medical timeout and stop the game if needed to provide a player with immediate attention. Nevertheless, It is the job of the entire medical staff to identify potentially concussed individuals.

What Signs and Symptoms of a Concussion are the Spotters Looking for?

The NFL Head, Neck and Spine committee outlined the signs (observable impairments) that medical staff should be looking for when identify athletes with a potential concussion. These include loss on consciousness, slow to get up following a hit, coordination and balance problems, blank or vacant stares, disorientation, clutching the head after a contact and a visible facial injury in conjunction with any of the other signs.

What is the Protocol if an Athlete Displays Signs and Symptoms of a Concussion?

If an athlete displays any of the signs listed above then they are immediately removed from play and assessed on the sidelines first and if they have any symptoms (player reported impairments) then they are sent to the locker room for further evaluation.

The symptoms the medical staff are looking for include headaches, dizziness, balance or coordination difficulties, nausea, amnesia (either before or after the event), cognitive slowness, sensitivity to light and sound, disorientation, visual disturbance and ringing in the ears (tinnitus).

NFL’s Sideline Concussion Management and Return to Play

If an athlete with a suspected concussion has any of the previous symptoms, then it is the responsibility of the team medical doctor and an independent neurological consult to evaluate the athlete. The neurological consult collaborates with team physicians to carry out in game neurological assessments on players who have concussive like symptoms. The athlete must be independently cleared by the neurological consult before he can return to the field.

What Tests are Involved in the NFL’s Sideline Concussion Management?

As I mentioned previously I do not know the exact concussion protocol but I can comment on a majority of the tests that are involved.

Impact and the NFL’s Sideline Concussion Management

The NFL uses a scaled down version of the Impact test in their sideline protocol. The NFL Head, Neck and Spine committee point out that neuropsychological testing (Impact) should not be used in isolation to diagnose an athlete with a concussion and that it should just be considered as one component of the assessment.

SCAT 3 and the NFL’s Sideline Concussion Management

The sideline assessment also consists of components of the Standardize Concussion Assessment Tool (SCAT 3). The SCAT 3 incorporates coordination, balance, orientation and memory tests.

King Devick Test and the NFL’s Sideline Concussion Management

The NFL has also recently started using the King-Devick test, which is an objective test that was originally designed to identify individuals with dyslexia. The King-Devick test takes about 2 minutes to complete and requires an athlete to read single-digit numbers displayed on cards. After suspected head trauma, the athlete’s sideline scored is compared to their preseason baseline time. The King-Devick test has been shown to be 90 percent (sensitive) accurate in ruling out a concussion in isolation and 100 percent if combined with other tests.

Does the NFL do Baseline Concussion Testing?

Prior to the start of the season every NFL player completes a baseline assessment and their sideline results are compared against their baseline scores. The NFL mandates that an athlete’s baseline history travels with a player wherever he goes in the league, so that it’s always close at hand.

Summary on the NFL sideline Concussion Management

Although the NFL has been criticized for their concussion management in the past, they have gotten much better at identifying, testing and removing injured players. Nevertheless; no system is perfect and currently there is no test that can detect a concussion with 100 percent certainty. The real problem now is in the minor league sports where over 50 percent of concussions are never reported. All minor league sports organizations need to incorporate proper sideline concussion management strategies similar to the NFL. This is where Complete Concussion Management can help.

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