NFL Chief Medical Officer Dr. Allen Sills says Tua Tagovailoa was checked for concussion symptoms every day this week before an independent neurologist cleared him to play; NFL columnist Peter King: "If something doesn't come from this, a tangible change, I think the NFL is stupid"
Friday 30 September 2022 19:40, UK
The NFL has been urged to make 'tangible change' to their concussion protocols after Miami Dolphins quarterback Tua Tagovailoa was stretchered off the field and taken to hospital with head and neck injuries during their Thursday night defeat to the Cincinnati Bengals.
Tagovailoa was shaken up and looked wobbly on his feet during Miami's win over the Buffalo Bills on Sunday, following a hit by linebacker Matt Milano, leaving the field with what was initially described by the Dolphins as a head injury before subsequently returning to the game.
The 24-year-old quarterback was then listed as 'questionable' ahead of Thursday night's game, said to be suffering from a sore back and ankle injury, but he was cleared to start the game just four days on from the incident in the Bills game.
Tagovailoa exited the Bengals game with about six minutes left in the first half after taking a heavy blow to the head when sacked by defensive end Josh Tupou. His arms went into the 'fencing response' and he remained motionless on the ground for seven minutes in hugely concerning scenes before being carted off the field.
Addressing the incident on Pro Football Talk, NBC's Mike Florio said: "When a guy has had an issue on a Sunday, should he be back playing on a Thursday under any circumstance?
"When a guy shows any gross motor instability, is it automatic that he should be out of the game? Should it be a no-go, the same way it is if you show 'fencing'?
"Should there be an automatic one-game suspension for the player's own good, for the sport's own good, that you miss one game after you have been diagnosed with a concussion - especially on a short week."
Tagovailoa was taken to University of Cincinnati Medical Center for further evaluation, with the Dolphins confirming the QB was conscious, had movement in all his extremities and would be released from the hospital and fly home with the team that night.
"It's great news that he's okay," Florio added. "But that doesn't change the concern. Because the next guy may not be.
"There is too much of this 'oh, it's fine'... It's fine until it's not."
The NFL had earlier confirmed on Wednesday they are conducting a joint review with the NFL Players Association into whether the league's concussion protocol was followed after the blow to Tagovailoa on Sunday, with NFL executive vice president Jeff Miller adding there was "every indication" it had been.
After Tagovailoa's injury against the Bengals on Thursday night, the NFLPA tweeted: "Player health and safety is at the core of the union's mission. Our concern tonight is for Tua and we hope for a full and speedy recovery.
"Our investigation into the potential protocol violation is ongoing."
The NFL's protocol dictates that any player who "exhibits or reports symptoms or signs suggestive of a concussion" must be removed from the game, examined and "undergo a six-step evaluation by a team physician and unaffiliated neurotrauma consultant (UNC) to determine the severity of the injury and whether or not they're fit to return to the field."
"I wonder about this investigation now between the NFL and NFLPA, because it's going to become an exercise in PR," Florio said. "Are we really going to get to the truth?
"My concern is we may never get to the truth about Sunday now, because that looms so much more largely now because of Thursday.
"Do we see an overreaction? I'd rather see an overreaction than an underreaction, but the question is how much further do they go?
"How long is the mandatory absence for the player? And should there be a truly independent voice that is disconnected from the shield [the NFL]?
"The shield itself has motivations that are similar to the team and the player, which is to have the best players on the field for the best games as much as possible.
"That is something that is going to be very difficult for the league to strike the right balance on."
NBC's Football Morning in America columnist, Peter King, appearing on PFT as a guest, described Tagovailoa's injury as a "seminal moment" for the NFL.
"If something doesn't come from this, a tangible change, I think the NFL is stupid," he said.
"Everybody in America has seen in the last five days exactly what has happened, and so a nation turns its lonely eye to you [commissioner] Roger Goodell - what are you going to do?
"There has to be a significant reaction. This can't just go away in a flurry of statements.
"This is a seminal moment for the NFL, Goodell and for all 32 owners, 32 head coaches and for 1,696 players.
"There are times when you see something that truly is wrong, and you can't fall back on 'this is the process, we have to correct it'.
"The process didn't correct it, so now you need to add in another step on the ladder - maybe even more.
"But the first step that must be added is that any time a player has gross motor instability, that player's day is over.
"That, to me, is not an easy fix. But it has to be the first thing that happens here."
NFL Players Association president JC Tretter released a statement on social media outlining the need for changes to protocols as a means of reducing the 'potential risk of human error'.
"We are all outraged by what we have seen the last several days and scared for the safety of one of our brothers," said Tretter. "What everyone saw both Sunday and last night were "no-go" symptoms within our concussion protocols. The protocols exist to protect the player and that is why we initiated an investigation.
"Our job as the NFLPA is to take every possible measure to get the facts and hold those responsible accountable. We need to figure out how and why the decisions were made last Sunday to allow a player with a "no-go" symptom back on the field.
"Until we have an objective and validated method of diagnosing brain injury, we have to do everything possible, including amending the protocols, to further reduce the potential human error. A failure in medical judgement is in failure of the protocols when it comes to the well being of our players.
"We have come a long way over the past 15 years, but the last week proves how far we have left to go."
Tagovailoa appeared to be disoriented in Sunday's game against the Bills, with what the team originally said was a head injury after taking a hard hit from the Bills' Milano late in the first half.
He missed just three snaps and returned to the game after half-time, with Tagovailoa and the team saying a back injury was the reason for his instability after the hit and that he wasn't in concussion protocol.
He was 'questionable' to play on Thursday and before the game. Chris Nowinski, a founder of the Concussion Legacy Foundation who played football at Harvard, wrote on Twitter: "If Tua takes the field tonight, its a massive step back for concussion care in the NFL.
"If he has a second concussion that destroys his season or career, everyone involved will be sued and should lose their jobs, coaches included. We all saw it, even they must know this isn't right."
A player who exhibits or reports symptoms or signs suggestive of a concussion or stinger enters protocol.
During each game, independent certified athletic trainers (ATC spotters) monitor the players on the field. If they see an impact to the head, they call a timeout and the player must be removed from the game, examined and evaluated. Team trainers, coaches or physicians, teammates, NFL game officials, sideline unaffiliated neurotrauma consultants (UNC) or booth ATCs also can initiate the protocol.
Any player in concussion protocol undergoes a six-step evaluation by a team physician and UNC to determine the severity of the injury and whether or not they are fit to return to the field. The final step is a neurological evaluation featuring a cervical spine exam, including range of motion/pain, evaluation of speech, observation of gait, eye movements and pupillary exam.
If any elements are positive, inconclusive or suspicious of concussion, the player is escorted to the locker room. In the locker room, a team physician and UNC conducts a full neurological exam and complete NFL Standardized Concussion Assessment Tool.
If abnormal, the player does not return to play, undergoes periodic evaluation by a medical team and has a follow-up neurological exam.
The league instituted the system in 2011 after Cleveland Browns quarterback Colt McCoy took a helmet-to-helmet hit in a game and returned without being tested for a concussion. The Browns said that the teams trainers didn't see the hit because they were tending to other players and that no one told them about it. After the game, McCoy was diagnosed with a concussion.
According to healthline.com, "when a person experiences an impact that's strong enough to cause traumatic brain injury, such as a concussion, their arms often go into an unnatural position."
Tagovailoa appeared to take that position, his fingers flexed awkwardly in front of his facemask for several seconds as he laid on the turf after the blow that saw him stretchered off on Thursday night.
The fencing response is often seen when a player is knocked down or knocked out during full-contact athletic competitions such as football, martial arts, boxing, rugby, and hockey, per healthline.com.
It happened to Los Angeles Chargers tight end Donald Parham during a Thursday night game against Kansas City last December. Parham was removed on a stretcher and stayed overnight at a hospital for observation after being diagnosed with a concussion.
The severity of Tagovailoas concussion is not known, but it is seemingly encouraging he was allowed to fly home with the team.
He must undergo a five-step process before being allowed to take the field again. The fifth phase is a full practice followed by clearance from the team physician. After that, he must be examined by an independent neurological consultant.
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