The NFL and NFLPA have completed their joint review of the application of their concussion protocol following the injury to Miami Dolphins Quarterback Tua Tagovailoa during their game on September 25, 2022.
Background and Context and Evolution of the Protocols:
The NFL-NFLPA Concussion Evaluation and Management Protocol was formalized and adopted in 2013. Since that time, the parties’ medical experts have recommended and the parties have agreed to numerous modifications of the protocols to improve the health and safety of players (e.g., the creation of the ATC spotter program, Booth UNCs, Emergency Action Plans, mandatory post-game reports, and improved video surveillance). Rather than being simply a “check the box” process, the Protocol was designed to ensure that highly credentialed and experienced physicians – approved and paid for by the NFL and NFLPA – are available on game day and to create a standardized approach to concussion evaluation where competitive decisions never usurp quality care.
If a concern arises over compliance with the Protocol, either the NFLPA or the NFL can request an investigation into the actions of the medical staff which will be conducted jointly. The NFL-NFLPA CBA limits the scope of the parties’ review to an objective assessment of whether each step required by the protocol was undertaken when a potential head injury is identified.
The NFLPA initiated such an investigation in connection with the incident involving Mr. Tagovailoa. The NFL and NFLPA reviewed the relevant reports and video and jointly interviewed members of the Team’s medical staff, the Head Athletic Trainer, the Booth ATC Spotter, the Unaffiliated Neurotrauma Consultant (UNC), and Mr. Tagovailoa. Following the complete review, the parties concluded that while the step-by-step process outlined in the Concussion Protocol was followed, the outcome, in this case, was not what was intended when the Protocol was drafted. Specifically, the review established:
- During the play in question, the player was tackled and fell on his back, and then hit his head on the ground. The player grabbed his helmet, shook his head several times, and after he took several steps, he stumbled and fell.
- The Club medical team and the UNC properly viewed the video of the play in question as required by the protocol and engaged in a locker room examination of Mr. Tagovailoa before the player was cleared to return to play. The Team physician cleared Mr. Tagovailoa, following consultation with the UNC. The steps set forth in the Concussion Checklist were, therefore, conducted.
- Mr. Tagovailoa suffered and reported back and ankle injuries earlier in the game. Mr. Tagovailoa told the medical staff involved that he aggravated his back injury on the play in question and that his back injury caused him to stumble.
- Mr. Tagovailoa did not report or exhibit any signs or symptoms of concussion during his locker room exam, during the remainder of the game, or throughout the following week.
- The medical staff involved determined that the Gross Motor Instability (“GMI”) suffered by Mr. Tagovailoa was not neurologically caused. They concluded the player’s back injury was the cause of his observed instability. However, the team physician and UNC did not conduct an examination of Mr. Tagovailoa’s back during the concussion examination but instead relied on the earlier examination conducted by other members of the medical staff.