Game Day Concussion Diagnosis and Management
Definitions/Responsible Parties
Unaffiliated Neurotrauma Consultant (UNC)
A UNC shall be a physician who is impartial and independent from any Club, is board certified in neurology, emergency medicine, physical medicine and rehabilitation, or any primary care CAQ sports medicine certified physician or board eligible or board certified in neurological surgery, and has documented competence and experience in the treatment of acute head injuries. UNCs are appointed by the NFL Head, Neck and Spine Committee in consultation with the NFLPA Mackey-White Committee and approved by the NFL Chief Medical Officer and the NFLPA Medical Director, and have undergone formal UNC training provided by the NFL and NFLPA. At each game, each Club will be assigned a UNC to be present on its sideline who shall be: (i) focused on identifying signs or symptoms of concussion and mechanisms of injury that warrant concussion evaluation, (ii) working in consultation with the Head Team Physician or his/her designee to implement the concussion evaluation and management protocol (including the Locker Room Comprehensive Concussion Assessment Exam) during the games, and (iii) present to observe (and collaborate when appropriate with the team physician) the Sideline Concussion Assessment Exams performed by Club medical staff. The UNCs also will be available to assist in coordinating which physician will accompany a player who is transported to the EAP-designated trauma center for more advanced evaluation and treatment. The UNCs will work with the Club's medical staff and will assist in the diagnosis and care of the concussed player. The Club physician/UNC unit will be co-located for all concussion evaluations and management both on and off the field. The UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussions. Regardless, the responsibility for the diagnosis of concussion and the decision to return a player to a game remains exclusively within the professional judgment of the Head Team Physician or his/her physician designee responsible for the diagnosis and treatment of concussion. A UNC will also be present for sideline evaluations for neuropraxia ("stingers" or "burners") and other potential spinal and peripheral nerve injuries.
Should the sideline UNC be unavailable to participate in the sideline evaluation (i.e., the sideline UNC is treating another player in the locker room or accompanying an injured player to the hospital in accordance with the EAP), the Club physician may request to conduct the assessment with the second sideline UNC who is present on the opposing team's sideline. In the event that the opposing team's sideline UNC is unavailable, the Visiting Team Medical Liaison (VTML; see section 1.d below) who has completed the formal NFL-NFLPA UNC training) may serve as a back-up.
A third UNC will be assigned to a stadium booth with access to multiple views of video (including the live broadcast feed and audio) and replay to aid in the recognition of injury (Booth UNC). This UNC will be co-located with the Booth ATC Spotter (see below). UNCs assigned to the booth are charged with monitoring all available video feeds and the network audio to identify players who may require additional medical evaluation. Prior to the start of the game, all UNCs will introduce themselves to the medical staffs for both teams during the Pregame Medical Team Meeting (see section 2.a below) to discuss protocol and confirm that all communication devices are operational.
When the Booth UNC observes a player who is clearly unstable or displays any other Potential Concussion Signs (defined in Section I.C. above) following a mechanism of injury (e.g., a hit to the head or neck), he/she and/or the Booth ATC Spotter will contact the Club physician and sideline UNC by radio to ensure that a concussionevaluation is undertakenon the sideline. The Club medical staff will then verify to the booth medical staff that the evaluation has been performed. The Booth UNC shall note the time of his initial contact with the Club medical staff and sideline UNC alerting them of the need for further evaluation and also the time of the communication from the Club medical staff and sideline UNC confirming that an evaluation has been performed. This information is to be conveyed in the Booth UNC report following the game. If the Booth UNC observes a player who he/she has flagged for medical evaluation return to the game prior to receiving the confirmation from the Club's medical staff that an evaluation was conducted, he/she shall notify the Booth ATC Spotter who shall call a Medical Time-Out (see below). For purposes of clarity, this is intended to serve as a redundant communication from the Booth ATC Spotter with the Club physician or sideline UNC to confirm that a concussion evaluation has been performed. If no such confirmation is provided, the Booth ATC Spotter is required to call a Medical Time-Out to assure the concussion evaluation occurs.
Booth UNCs shall file a report of their activities following each game for review by the Chairperson of the NFL Head, Neck and Spine Committee, NFL Chief Medical Officer and NFLPA Medical Director.
For the avoidance of doubt, the responsibility for the diagnosis of concussion and the decision to return a player to a game remain exclusively within the professional judgment of the Head Team Physician or the Club physician designated as responsible for the diagnosis and management of concussion.
Booth Certified Athletic Trainer Spotter ("Booth ATC Spotters")
A certified athletic trainer will be assigned to each Club and positioned in the stadium booth with access to multiple views of video and replay to aid in the recognition of injury ("Booth ATC Spotter"). Booth ATC Spotters are charged with monitoring the game, both live and via video feed, to identify players that may require additional medical evaluation. Prior to the start of the game, Booth ATC Spotters will introduce themselves to the medical staff for both Clubs and officials to discuss protocol and confirm that all communication devices are operational. The Booth ATC Spotters, UNCs, and the Club physician responsible for concussion diagnosis and management shall be connected by radio communication. The Booth ATC Spotters shall also be connected to the on-field game officials by radio communication. The Clubs' medical personnel may initiate communication with the spotter to clarify the manner of injury. The sideline medical staff will be able to review the game film on the sidelines to obtain information on particular plays involving possible injury.
When the Booth ATC Spotter observes a player who is clearly unstable, or displays any other Potential Concussion Signs (defined in Section I.C. above) following a mechanism of injury (e.g., a hit to the head or neck), he/she will contact the Club physician and sideline UNC by radio to ensure that a concussion evaluation is undertaken on the sideline. The Club medical staff will then verify to the Booth ATC Spotter that the evaluation has been performed. The Booth ATC Spotter shall note the time of his initial contact with the Club medical staff and sideline UNC alerting them of the need for further evaluation and also the time of the communication from the Club medical staff and sideline UNC confirming that an evaluation has been performed. This information is to be conveyed in the Booth ATC Spotter's and Booth UNC's report following the game. If the Booth ATC Spotter observes a player whom he has flagged for medical evaluation return to the game prior to receiving the confirmation from the Club's medical staff that an evaluation was conducted, the Booth ATC Spotter shall call a Medical Time-Out (see below). For purposes of clarity, this is intended to serve as a redundant communication from the Booth ATC Spotter with the Club physician or sideline UNC to confirm that a concussion evaluation has been performed.If no such confirmation is provided, the Booth ATC Spotter is required to call a Medical Time-Out to assure the concussion evaluation occurs.
Booth ATC Spotters shall file a report of their activity following each game for review by the Chairperson of the NFL Head, Neck and Spine Committee, NFL Chief Medical Officer and NFLPA Medical Director.
Visiting Team Medical Liaisons (VTMLs) are board-certified physicians licensed to practice medicine in the state in which the stadium is located and who work with the visiting team to provide medical care for its players, including access to leading medical centers for emergency care. As stated above (see 1.a), a VTML may serve as back-up UNCs if s/he has completed formal NFL-NFLPA UNC training.
|
NFLPA initiates investigation into concussion protocols after Tua injury
(https://chiefsplanet.com/BB/showthread.php?t=345337)