Inside the NFL's Medical Procedures

MINNEAPOLIS — The NFL cares about player safety. Really.

Criticized heavily throughout the season for high-profile failures of its concussion protocol, the NFL countered by taking a handful of reporters on a behind-the-scenes tour of its game-day medical procedures. From the communication between the spotters in the booth and the sidelines to whether coaches get a say in determining if a player can return to the game or not, all of it was up for discussion.

Here are things we learned.

Leaguewide training: For the first time, the NFL brought all game-day medical staff — the physicians and athletic trainers from each team, along with the unaffiliated neurotrauma consultants and concussion spotters in the booth — together last summer for uniform training on concussion protocols and procedures.

There were two sessions — there are 170 team physicians — and each lasted a full day. Allen Sills, the NFL's chief medical officer, said the training will be repeated this summer.

EAPs and 60-minute meeting: Every team has what's called an emergency action plan, detailing information that would be needed in case of a catastrophic injury. The location and distance to the nearest trauma center, for example. Or the signal to bring EMTs or the physician specifically trained to open airways onto the field. (At the Super Bowl, it will be a clap of the hands above the head.)

An hour before each game, there's a mandatory meeting for the head referee, unaffiliated neurotrauma consultants, EMTs and a physician and athletic trainer from each team. Introductions are made, radios are tested and the EAP is reviewed.

The 60-minute meetings are new this season, and Sills said they were a factor in getting Chicago Bears tight end Zach Miller to a hospital quickly after a dislocated knee left him with a torn artery. Had surgeons not performed "urgent vascular surgery," there was a chance Miller could have lost his leg.

"These are the kind of situations we're practicing for," Sills said. "They're incredible rare, but we want to be prepared for it."

Concussion spotters: Each city has a handful of certified athletic trainers who are hired by the NFL to spot head injuries from a booth in the press box. They must have at least 10 years of experience and can't have had any affiliation with an NFL team for 20 years.

At least two spotters are at every game, one assigned to each team, and each is paired with a video technician who, using the raw broadcast feed, runs back and tags plays where injuries occur. The spotters are connected to sideline medical personnel via a radio channel, hard-wired intercom and telephone and also can communicate with the head referee.

The spotter alerts sideline personnel to injuries and also has the authority to stop the game. This happened between eight and 10 times this season, Sills said.

Video of the play where the injury occurred is then sent to the sideline, where it is viewed by the team physician, trainer and/or unaffiliated neurotrauma consultant. They can ask the technician for additional angles or to replay the video at a slower speed.

"People like me might have looked at it (initially) with a crooked eye, Big Brother looking over your shoulder," said Eric Sugarman, the director of sports medicine and head athletic trainer for the Minnesota Vikings. "But it's been invaluable. You can't see everything. It's very protective to know they're looking out for you."

While head injuries are the primary focus in the booth, other injuries are tagged, too. Sideline personnel can also ask for video of a specific play to see where or how an injury occurred.

After the game, the team trainer gets a flash drive with all those videos.

"All of us are different, but I think the video monitoring system is the biggest advancement I've seen in my career," Sugarman said.

Unaffiliated neurotrauma consultants: There is one on each sideline to help determine if a player has suffered a concussion.

A third was added for this postseason in case one of the others has to accompany a player to the locker room, and Sills said the league will decide in the offseason whether to make that permanent. The UNCs can be identified by their red baseball hats, which are new this season to give them added visibility.

Locker room examinations: Each stadium has a designated space where concussion examinations are done, and both the unaffiliated neurotrauma consultant and team physician are in the room. While the presence of a team physician has raised eyebrows, Sills, who previously was at UNC, said it's helpful to have someone who knows the player and would notice changes in their personality.

The exam lasts 12-15 minutes and includes balance tests (walking on a straight line and standing on one foot) and questions that test short-term memory.

Even if it's clear a player will not be allowed to return to the game, the exam is completed so it's included in his medical record.

The video monitoring system on the sideline is not available in the locker room, but Sills said that is under consideration.

If a player is declared out with a head injury, he must remain in the locker room for the rest of the game — that's why you didn't see Rob Gronkowski for the rest of the AFC Championship Game — and is monitored by a member of the medical staff.

Some teams will take helmets away from players as soon as they're suspected of having a concussion, but that's not a league rule.

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