The NFL Head, Neck and Spine Committee鈥攁 board of independent and NFL-affiliated physicians and scientists, including advisors for the NFL Players Association鈥攄eveloped 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.
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 suggestive of a concussion or stinger (a nerve pinch injury); or,
- the team Athletic Trainer, booth ATC spotter, team Physician, NFL game official, coach, teammate, sideline Unaffiliated Neurotrauma Consultant (UNC) or booth 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:
- (October 2022)
Improvements to the Concussion Protocol
For the 2018 season, the Head, Neck and Spine Committee made additional improvements to the Concussion Protocol:
- Added a third UNC who will monitor the broadcast video and audio feeds of each game from the spotters鈥� booth, and notify on-field UNCs of possible head, neck or spine injuries.
- Defined impact seizure and fencing responses as independent signs of potential loss of consciousness, representing 鈥淣o-Go鈥� 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.
- Required an evaluation for all players demonstrating ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech) to determine the cause of the instability. If the team physician, in consultation with the sideline UNC, determines the instability to be neurologically caused, the player is designated a 鈥淣o-Go鈥� and may not return to play.
- 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.
- Required 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.
To read the full NFL Game Day Concussion Diagnosis and Management Protocol, .
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鈥檚 current concussive injury, as well as past exposures and medical history, family history and future risk in managing a player鈥檚 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.
To learn more about the Return to Participation Protocol, click here.
Training, Collaboration and Standardized Care
Sideline medical professionals meet over the summer to review the latest protocols and train for the upcoming season. In 2018, the NFL is holding three medical trainings in Los Angeles, New Orleans and Chicago, and the league has expanded the number of attendees to include all Team Physicians, Athletic Trainers, booth ATC spotters, Unaffiliated Neurotrauma Consultants (UNC), Independent Neurological Consultants (INC) and neuropsychologists.
These trainings are 鈥渁n opportunity for us to learn, to discuss together, to figure out how we can improve our communication and our collaboration,鈥� said Dr. Allen Sills, the NFL Chief Medical Officer and a practicing neurosurgeon. 鈥淭he 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.鈥�
Robb Rehberg is a booth ATC spotter who works home games for the New York Jets. 鈥淕athering all the people responsible for the health and safety of players in one place means we can talk about our specific roles, he said. 鈥淲e can talk about how our roles are supposed to interface, and make sure there鈥檚 no miscommunication.鈥�
Dr. Javier Cardenas is an Unaffiliated Neurotrauma Consultant for the Arizona Cardinals and member of the NFL Head, Neck and Spine Committee.
At the medical trainings, 鈥渨e get to see our [Head, Neck and Spine] Committee work translated from protocols into implementation,鈥� Cardenas said. 鈥淚n 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.鈥�
James Collins is the Head Athletic Trainer for the Los Angeles Chargers and President of the Professional Football Athletic Trainers Society (PFATS).
鈥淥n game day, it鈥檚 all about everybody being on the same page,鈥� he said, 鈥渏ust like players and coaches are on the same page because they practice. We do the same thing.鈥�
鈥淭he player鈥檚 health and safety is the most important thing, and we鈥檙e educating each other in sessions like this so that we can give the player the best care possible,鈥� he said.