NFL and NFLPA Issue Joint Statement about Panthers-Broncos game

The NFL and NFLPA have conducted reviews of the application of the Concussion Protocol in the September 8th Panthers-Broncos game and have determined the following. In the fourth quarter, Mr. Newton incurred a helmet-to-helmet hit which drew a penalty. Mr. Newton was slow to get up following that hit.  The Panthers medical staff and the Unaffiliated Neuro-trauma Consultant (UNC) were positioned together on the sidelines monitoring the game and were unable to see the point of contact and decided to review the play via the sideline video replay system. In order to facilitate the video review, the team physician and UNC initiated radio contact with the Booth ATC and asked to view the video. Under the current application of the Protocol, once contact between the Booth ATC and the club’s medical team occurs, the Booth ATC’s responsibilities end (including the ability to call a medical time out). The time it took to actually receive the video following this request was prolonged due to a technology glitch.  After reviewing the replay and observing Mr. Newton from the sideline, the Panthers’ medical staff and the UNC agreed that no further evaluation of Mr. Newton was necessary as they did not observe signs or symptoms of concussion.

The parties also conducted a review of the application of the Protocol in the September 15th Bills-Jets game. That review showed Bills quarterback Tyrod Taylor sustain a big hit that included helmet-to-helmet contact.  Mr. Taylor seemed to be unsteady on his feet.  Prior to any actions by the club physician, Booth ATC Spotter and/or UNC, referee Ed Hochuli directed Mr. Taylor to the sideline for the required sideline examination. The club medical team and UNC reviewed the video and conducted the required examination, cleared Mr. Taylor and returned him to the game.

Collaboration between the Team Physician and the UNC, who is jointly appointed by the parties, is a critical aspect of the Concussion Protocol and therefore bears emphasis.  In both instances, the reviews of the NFL and NFLPA determined that the club physicians and UNCs worked closely together to review the plays at issue and jointly made medical determinations regarding evaluation and diagnosis; in each instance, the medical determination made revealed that neither player had sustained a concussion. The Team Physicians and UNCs involved in each instance worked closely together to provide medical care for the players involved and their team work should be emulated across the League. Similarly, Mr. Hochuli’s decision to send Mr. Taylor to the sideline for evaluation after spotting an observable sign of possible concussion, demonstrates a conservative and therefore appropriate application of the Concussion Protocol.

The NFL and NFLPA, in conjunction with our medical advisors and the NFL Physicians Society, have also taken several steps to further clarify and enhance the Concussion Protocol in an effort to ensure that it is being applied uniformly in all NFL games and that everyone involved in its application understands their roles and responsibilities. Some of the agreed upon enhancements are set forth below.

The Concussion Protocol has been adopted by the parties in order to establish a conservative standard of care and ensure that competitive considerations do not influence healthcare outcomes. The objective of this Protocol is to provide medical staffs responsible for the care of NFL players with a standardized process for identifying and managing potential concussion. The parties recognize that concussion diagnosis and management is often a difficult and complex exercise, compounded by hectic game conditions. Accurate diagnosis and management of concussion requires experienced physicians coordinating with others on the sideline and within the field of play, each acutely aware of his or her responsibilities and all committed to the strict application of the policies implemented in order to protect players.


  • Concussion Protocol to require the Booth ATC Spotter to remain in contact with the club medical team and provide video support until the medical team confirms that a concussion evaluation has occurred;
  • The NFL Head, Neck and Spine Committee, together with the NFLPA Medical Director will conduct a conference call with all UNCs to review changes to the Concussion Protocol;
  • The NFL, in consultation with the NFLPA, will use Referee Ed Hochuli’s actions in Buffalo as an example of the appropriate application of the Concussion Protocol and proactive officiating in this realm as part of its continuing training of game officials;
  • The NFL and NFLPA are reviewing the merits of supplementing the Booth ATC program with a Booth UNC program as part of their continuing evaluation of the Protocol to ensure the best possible care of our players.
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Researchers Identify Concussion Treatment for Persistent Cases in Children

Researchers at Seattle Children’s Research Institute published a study in the journal Pediatrics showing a new intervention for adolescents with persistent post-concussive symptoms that improved health and wellness outcomes significantly. The approach combines cognitive behavioral therapy and coordinated care among providers, schools, patients and families.

“We were pleased to find that using an approach that adds a psychological care component to treating concussions and providing coordination of care in areas of the patient’s life significantly improved outcomes,” said Dr. Cari McCarty, a psychologist and researcher at Seattle Children’s Research Institute who led the study. “This new approach aims to improve the quality of life for patients who were otherwise left to deal with unrelenting concussion symptoms.”

A fall off a horse causes a persistent concussion

Carmen Einmo, 16, loves to ride horses. In November 2014, she fell off her horse and broke her arm. At first, she didn’t complain of typical concussion symptoms, but after a few weeks it became clear something was amiss.

“I developed really bad headaches and became very sensitive to light,” Carmen said. “I started having memory issues and would forget words in the middle of a conversation.”

As her symptoms persisted over a couple months, Carmen’s doctor at Seattle Children’s, Dr. Elaine Tsao, suggested she sign up for McCarty’s study. The family was excited to have found another treatment option to pursue.

“A lot of Carmen’s schoolwork had to be done on an iPad, and spending long amounts of time on it hurt her eyes and head,” said Diana Einmo, Carmen’s mom. “Some of the teachers didn’t understand that Carmen couldn’t spend a lot of time on an iPad, and they didn’t know what to make of how long her symptoms had been going on.”

Carmen’s grades had started to slip and she worried about how the persistent symptoms got in the way of schoolwork.

“I entered my second year of high school ready to start off strong, but the concussion set me back,” she said. “My PE class was especially challenging because I couldn’t run, so I would walk, and I got penalized for it in my grade.”

A coordinated approach to concussion care

As a participant in the study, Carmen got support from a research team member that created a coordinated care plan for her. The researcher worked with the school and family on a plan that would allow Carmen to continue school with accommodations as she recovered. The plan included a homework priority list, allowing her more time to finish work and access to another room if she became tired from light and sound in class.

In addition, Carmen received cognitive behavioral therapy that involved her parents and sister.

“Cognitive behavioral therapy involves changing both behaviors and thinking patterns,” McCarty said. “In our study that included relaxation techniques, teaching coping skills and offering pain management. We found that incorporating a psychological care component improved health outcomes and quality of life for these kids.”

Only 13% of patients who received the coordinated care and psychological intervention in the study reported high levels of post-concussive symptoms after six months, compared to 42% of patients who received standard concussion care. In addition, 78% of patients who received the specialized care reported reduction in depression symptoms, compared to just 46% of patients who received standard care.

Getting back in the saddle

Carmen is feeling more like herself now and has been cleared to ride horses again. She and her mom say one of the most important things they learned during this experience was to take concussions seriously, especially because the effects and symptoms might not be apparent right away.

“It’s especially challenging when a teenager gets a concussion because it’s hard to tell if a change in behavior is because of a concussion, or because a teenager is going through a growth and development phase,” Einmo said. “We found the therapy to be especially helpful in figuring some of this out.”

Carmen adds that having a plan and realistic expectations with school helped immensely.

“I would tell young people struggling with a concussion to stick up for yourself and what you need,” she said. “Take it one day at a time and do your best, and ask for the help you need.”

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NFL Announces ‘a New Commitment to Improve Player Health and Safety’

NFL Commissioner Roger Goodell today announced the launch of Play Smart. Play Safe. — “an initiative to drive progress in the prevention, diagnosis and treatment of head injuries, enhance medical protocols and further improve the way the game is taught and played.

“To begin the initiative, the NFL and its 32 club owners have pledged an additional $100 million in support of independent medical research and engineering advancements—building on the $100 million that the NFL and its partners are already spending on medical and neuroscience research—and they have committed to anything and everything to make the game of football safer.

“The Commissioner and the NFL owners said their primary interest is in keeping players and the public informed about important health issues. They acknowledged that while the NFL can never completely eliminate the risk of injury in football, the league will strive to make the game safer for professional athletes down to young athletes first learning how to play.

“To underscore how the NFL plans to achieve its goal of making the game safer, the Play Smart. Play Safe. initiative is organized under four pillars:

  1. Protecting Players: Making changes on and off the field to protect the health and safety of every player in the NFL.
  2. Advanced Technology: Championing new developments in engineering, biomechanics, advanced sensors and material science that mitigate forces and better prevent against injuries in sports.
  3. Medical Research: Supporting independent research to advance progress in the prevention, diagnosis and treatment of head injuries, and accelerate scientific understanding of their long-term impact.
  4. Sharing Progress: Sharing what the NFL learns across all levels of football—and to other sports and society at large.

“The new, long-term commitment builds on progress the NFL—working with all 32 clubs and the NFL Players Association—has made in recent years to improve health and safety.

“The NFL has made 42 rule changes since 2002 to protect players, improve practice methods, better educated players and personnel on concussions, and strengthen our medical protocols. The NFL has transformed the sideline, staffing each game with 29 medical professionals. Along with the NFLPA, the league recently announced a new policy to enforce the NFL Game Day Concussion Protocol. This new agreement makes clear that there will be serious consequences for any team that fails to follow the protocols.”

“For more information about the initiative, and to read the Commissioner’s letter to fans, please visit”


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