Keeping Score

Why the NFL Needs a Concussion Ref

This week, the NFL announced a new policy that puts an independent trainer in the press box, charged with spotting injured players. Good move. But why not gives these trainers as much power as a referee?

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Don Wright / AP

Trainers tend to Cleveland Browns quarterback Colt McCoy after taking a helmet-to-helmet hit from Pittsburgh Steelers linebacker James Harrison in an NFL game in Pittsburgh on Dec. 8, 2011

The NFL has recently taken important steps to keep its players safer: from harsher penalties for helmet-to-helmet hits to stricter return-to-play guidelines, to now, the appointment of an independent athletic trainer to sit up in the press box and spot players who might be suffering the symptoms of a concussion or other injuries on the field.

These solutions are commendable. But they still fall short. To make certain that players are fully protected, the NFL should give these new trainers a referees shirt and let them make the calls that save a player down the road.

(See photos of NFL players return to training after a lockout.)

During the Dec. 8 nationally televised Thursday night game between the Pittsburgh Steelers and Cleveland Browns, Cleveland quarterback Colt McCoy absorbed a stinging helmet-to-helmet hit from Pittsburgh Steelers linebacker James Harrison, one of the most vocal critics of new NFL safety rules. (For the McCoy hit, Harrison, who has previously been fined for other hits, was suspended for a game.) But because McCoy did not immediately show concussion symptoms, and Browns trainers and doctors were attending to other players on the sideline and claimed they did not see the violent blow, he was not tested for a concussion, and returned to the game two plays later. By the next day, McCoy was in fact diagnosed with a concussion, and he missed last week’s game; he still has not been cleared to practice, and he’ll sit out Cleveland’s Week 16 matchup against the Baltimore Ravens.

In response to this embarrassing incident, the NFL implemented a new policy this week that places a certified athletic trainer in the press box. The trainer, who won’t be affiliated with either team playing in the game, will have access to video replay to better pick out players who might be woozy or showing other concussion symptoms. This vantage point gives this trainer a huge advantage for monitoring injuries: it’s hard to see everything from the sideline. This new policy also gives the trainers direct lines of communication to both sidelines, so they can advise team medical staffs.

This independent trainer, however, needs to be more than a consultant. The new NFL policy states: this individual will not diagnose or prescribe treatment, nor have any authority to direct that a player be removed from the game. But why not make these trainers a kind of concussion referee, replete with the black-and-white striped shirt and give them power to order injured players to the sideline, to at least be tested for a concussion? Let them wave the concussion flag. Aren’t head injuries as serious as holding?

(See the top 10 sports moments of 2011.)

Take it a step further. Once a player is ordered to the sideline, why not also have a neurologist down on the field, unaffiliated with either team, diagnosing concussion symptoms and ordering that dinged-up players be benched. And why shouldn’t they also have zebra stripes to send the message: they have the authority to make the right call. One more step: Why shouldn’t there be a neurologist in the press box as well? No offense to certified athletic trainers, many of whom are quite qualified to pinpoint concussion symptoms. But neurologists are specialists, and an extra set of eyes can only help.

These measures aren’t a condemnation of current team medical staffs. They are doing a better job than ever of pinpointing concussed players, diagnosing the injuries and keeping players out of games in line with NFL rules. But let’s be honest — these doctors and trainers are inherently conflicted, possibly subconsciously biased, since they work with team personnel whose livelihoods depend on playing, and winning. And you would hope that under the new NFL rule on the books, team personnel will follow the recommendation of the press-box trainer to remove players. But as the McCoy incident shows, costly slipups can happen.

Such a new layer of security further reduces safety risks, and both the NFL and its players need maximum protection. On Thursday former NFL players Jamal Lewis, Dorsey Levens, Fulton Kuykendall and Ryan Stewart filed a federal lawsuit against the NFL, claiming that before last year, the NFL tried to hide the concussion problem and mislead players about concussion risks. Brain injuries, these players say, have caused postcareer medical issues. Any allegation that the NFL intentionally sought to mislead players has no merit, the NFL responded in a statement.

(Read “Head Cases: NFL to Add Concussion-Only Trainers to Games.”)

When asked about the possibility of a concussion ref, NFL spokesman Greg Aiello responded in an e-mail: “We will continue to review our procedures and make any changes that would be beneficial. Our medical advisors are not recommending your proposal. Our team medical staffs are removing players from games when they are diagnosed with concussions, and they are not returning to play until they are medically cleared. ” Dr. Robert Cantu, co-director of Boston University’s Center for the Study of Traumatic Encephalopathy and one of the world’s leading concussion experts, is commending the NFL on its latest step but agrees that it’s not ideal. He’s disappointed, according to Aiello, that the press-box trainer will not have authority to send players to the sidelines for an assessment. “If it’s simply another set of eyes, it’s not as a big a step as I thought,” says Cantu. The NFL has done a really good job of trying to rectify weaknesses. Is this as good as a neurologist on the sideline? No. But you can understand why the NFL would be taking incremental steps.

We hope the next one comes before another Colt McCoy.