The Houston Texans will not be disciplined for mishandling quarterback Tom Savage’s concussion during the team’s Week 14 loss to the San Francisco 49ers because a joint review by the NFL and the NFL Players Association concluded that the medical staff followed protocol, which was ultimately found to be in need of improvements.
The protocol is the battery of tests a player must be cleared through if he is to return to a game after suffering a suspected concussion.
Savage lay twitching on the turf after being sacked by 49ers linebacker Elvis Dumervil on December 10. He was initially removed from the game by the officials, who suspected he suffered a head injury. Somehow he was cleared to re-enter for one series after sustaining what was later diagnosed as a concussion.
Replays showed Houston Texans quarterback Tom Savage looking dazed after his head hit the ground, with both of his arms shaking. Savage ultimately returned to the game briefly
“The review showed that following a hard tackle, Mr. Savage was immediately removed from the game and evaluated for a concussion,” read the joint NFL-NFLPA statement issued Friday. “The Unaffiliated Neurotrauma Consultant (“UNC”) and team physician reviewed the initial broadcast video, saw the play and Mr. Savage’s response and followed the Protocol by performing a complete sideline concussion evaluation on Mr. Savage, which he passed.
‘The Texans medical staff continued to monitor Mr. Savage after the initial evaluation and shortly after his return to the game, identified symptoms that had not been present during the sideline evaluation and took him to the locker room for further evaluation,’ the statement continued.
The incident exposed a blind spot in the NFL’s ongoing effort to diagnose concussions and help make the game safer after recent studies have linked the effects of playing football with chronic traumatic encephalopathy (CTE), a brain disease which triggers aggression, suicidal thoughts and dementia.
The changes include the addition of a centralized unaffiliated neurotrauma consultant (UNC) to monitor all games as well as defining ‘no-go’ criteria aimed at preventing concussed players from re-entering games.
And although the NFL began demanding medical tents be placed on every sideline, providing a place for players to be tested for a concussion, the new rules announced Friday require ‘a locker room concussion evaluation for all players demonstrating gross or sustained vertical instability.’
Houston Texans quarterback Tom Savage heads to the locker room in the second quarter against the San Francisco 49ers at NRG Stadium on December 10
NFL-NFLPA JOINT STATEMENT
Cleveland Browns defensive end Carl Nassib enters a pop-up medical tent on the sideline during an NFL football game against the New York Jets, in Cleveland. This year, the NFL mandated the tents on every sideline at every stadium. They’re used mostly for concussion testing or for quick medical work that doesn’t require a trip to the locker room. However, new rules announced Friday would require a locker room concussion evaluation for all players demonstrating gross or sustained vertical instability
The NFL and NFLPA have completed their joint review of the application of the Concussion Protocol involving Houston Texans quarterback Tom Savage during Houston’s game against the San Francisco 49ers on December 10. As detailed below, the parties have both concluded that while the medical staff followed the Protocol, the outcome was unacceptable and therefore further improvements in the Protocol are necessary.
The review showed that following a hard tackle, Mr. Savage was immediately removed from the game and evaluated for a concussion. The Unaffiliated Neurotrauma Consultant (“UNC”) and team physician reviewed the initial broadcast video, saw the play and Mr. Savage’s response and followed the Protocol by performing a complete sideline concussion evaluation on Mr. Savage, which he passed. The slow-motion video, which focused more directly on the fencing posture, was not broadcast until after the doctors had begun the sideline evaluation and thus was not seen by the medical staff prior to the evaluation. The Texans medical staff continued to monitor Mr. Savage after the initial evaluation and shortly after his return to the game, identified symptoms that had not been present during the sideline evaluation and took him to the locker room for further evaluation.
The NFL and NFLPA recognize that Mr. Savage’s return to the game did not reflect the expected outcome of the Protocol. As such, the parties have agreed that no discipline will be assessed, but have already implemented several improvements to the Protocol to prevent such an unacceptable outcome in the future. Working in conjunction with the NFL’s independent Head, Neck and Spine Committee, these improvements include:
- Implemented a pilot program utilizing a centralized UNC based at the league office to monitor the broadcast feeds of all games. The UNC will contact the team medical staff on the sideline should they observe any signs or symptoms warranting further evaluation.
- Defined impact seizure and fencing responses as independent signs of potential loss of consciousness, representing “No-Go” 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.
- Require a locker room concussion evaluation for all players demonstrating gross or sustained vertical instability (e.g., stumbling or falling to the ground when trying to stand).
- 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.
- Require 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.
- Added a third UNC to all playoff games and the Super Bowl to serve as a backup who can step in immediately should one of the original two UNCs be absent from the sideline for a time to attend to a more severely injured player.
In addition to implementing these changes to the Concussion Protocol, the NFL’s Chief Medical Officer and NFLPA’s Medical Director have hosted conference calls with every Unaffiliated Neurotrauma Consultant, Booth ATC Spotter and relevant team medical staff members to review the changes to the Protocol and the signs and symptoms of concussion. The NFL Head, Neck and Spine Committee, NFL and NFLPA will conduct a comprehensive off-season review of all aspects of the protocol with an emphasis toward continued improvement in detection and diagnosis.
Earlier this month, the Seattle Seahawks became the first team to be penalized for failing to follow the concussion protocol. The team was fined $100,000 for allowing quarterback Russell Wilson to return to a November 9 game against the Arizona Cardinals after suffering a suspected concussion.
WHAT IS CTE?
Chronic traumatic encephalopathy (CTE) is a degenerative brain disease that is caused by repeated hits to the head.
Over time, these hard impacts result in confusion, depression and eventually dementia.
There have been several retired football players who have come forward with brain diseases.
They are attributing their condition to playing football and the hits they took.
More than 1,800 former athletes and military veterans have pledged to donate their brains to the Concussion Legacy Foundation for CTE research.
CTE was usually associated with boxing before former NFL players began revealing their conditions.
Wilson was briefly sidelined midway through the third quarter of Seattle’s 22-16 win after taking a hit to the chin from Arizona linebacker Karlos Dansby.
Referee Walt Anderson then sent Wilson off the field for a test.
Wilson went into the medical tent on the sideline – TV cameras showed the quarterback was only in the tent for seconds – and sat out just one play before returning to the game.
Wilson was on the field for two more plays before the Seahawks punted. During the change of possession, he entered the tent and remained inside for a longer period of time.
The $100,000 fine represents the maximum punishment for a first offense under the protocol.
In addition to the fine, the Seahawks’ coaching and medical staffs will be required to attend remedial training regarding concussion protocol, the NFL and NFLPA said in its joint statement.
‘The results of the joint review determined that the protocol was triggered when Mr. Wilson was directed to the sideline for an evaluation after the referee, Walt Anderson, concluded that a medical examination was warranted,’ the NFL and NFLPA said in a joint statement.
Seattle Seahawks quarterback Russell Wilson (No. 3) is hit by Arizona Cardinals linebacker Karlos Dansby (No. 56). Wilson was sent in for tests, but returned only one play later
‘Nonetheless, the required evaluation was not conducted and Mr. Wilson was permitted to return to the game without an evaluation. Once it is determined that a medical examination is warranted, a player may only be cleared to return by the medical staff; Mr. Wilson’s return to the field without a sideline concussion evaluation was therefore in violation of the Concussion Protocol.
‘Subsequently the team medical staff did examine the player and clear him per the protocol.
‘As determined by the NFL and NFLPA, an immediate update will be made to the protocol instructing officials, teammates, and coaching staff to take players directly to a member of the medical team for a concussion assessment.’
The Seahawks released a statement shortly after the announcement.
‘We accept the findings of the NFL and NFLPA joint investigation into the Seahawks-Cardinals game on November 9,’ the statement read. ‘We did not knowingly disregard the Concussion Protocol. Any misstep was unintentional and the result of confusion on the sideline.’