The NFL's evolving concussion protocol moved into the spotlight Friday morning as the league explained the treatment of Carolina Panthers quarterback Cam Newton in Thursday night's 21-20 loss to the Denver Broncos.
According to the NFL, medical officials at Sports Authority Field reviewed video of a key hit late in the fourth quarter during the ensuing stoppage in play and determined that no further tests were needed. Newton said he was asked "a couple" medical-related questions in the locker room after the game but offered no other details.
To understand better exactly what did and didn't happen Thursday night, let's take a closer took at the NFL's 2016 in-game concussion policy.
What are the staffing requirements?
There are at least 29 medical officials at every game, a group that includes team physicians, athletic trainers, medical spotters and unaffiliated neurological consultants (UNC).
What is the job of the UNC?
The UNC works with team physicians to identify, evaluate and diagnose concussions, and must provide explicit approval for any player to return to the game. Because the UNC is unaffiliated, he or she shouldn't take into account the competitive implications of removing a player or keeping him on the sideline. This was an important point Thursday night, because removing Newton late in the fourth quarter could have severely hampered the Panthers' chance for a game-winning score. There is one UNC on each sideline.
What do the spotters do?
Spotters sit in a stadium booth and watch the field, via binoculars and video replay, to help identify injuries that might be missed by on-field medical observers whose views are blocked. In 2016, the NFL increased its staffing to two spotters per game. They have direct communication to the sideline to provide information and can call a medical timeout to ensure that a player is removed.
What tools can the medical staff use?
The NFL supplies dedicated video monitors to each sideline that allow team doctors and the UNC to review video of a play if there is a question about whether concussion symptoms are being displayed. The sideline staff also has tablets that help conduct concussion tests and provide a player's medical history.
What are the doctors and spotters looking for?
Quoting from the protocol, here are what the NFL considers "observable" concussion symptoms that could require a sideline test:
Any loss of consciousness
Slow to get up following a hit to the head ("hit to the head" may include secondary
contact with the playing surface)
Motor coordination/balance problems (stumbles, trips/falls, slow/labored movement)
Blank or vacant look
Disorientation (e.g., unsure of where he is on the field or location of bench)
Clutching of head after contact
Visible facial injury in combination with any of the above
What is supposed to happen next?
If anyone -- medical personnel, coaches or on-field game officials -- observe any of these symptoms, the player is to be removed and a sideline test administered. Results of the test are compared to a player's "baseline" results -- from a test taken previously when known not to be concussed -- to determine if the player is affected. If so, he is taken into the locker room for further testing. This happened Thursday night with Broncos linebacker Brandon Marshall, who eventually was cleared and returned to the game.
Why didn't this happen to Newton?
According to the NFL, medical officials communicated during about a two-minute delay while referee Gene Steratore was sorting out multiple penalties after the fourth-quarter hit on Newton. The UNC and team physicians viewed video on the sideline, as provided by the spotter, and "concluded there were no indications of a concussion that would require evaluation and the removal of the player from the game," according to the league statement.
But wasn't Newton slow to get up after the hit?
Yes -- and that is one of the observable concussion symptoms as listed in the protocol. The NFL did not detail why or how the UNC and team physician decided that Newton's initial reaction did not merit a sideline concussion test.
So is this over?
No. This summer, the NFL announced an enforcement policy to its concussion protocol in response to the St. Louis Rams' failure to remove concussed quarterback Case Keenum from a game last season. If a joint NFL/NFL Players Association investigation determines that the Panthers did not follow the policy, they would be subject to fines and/or forfeiture of draft choices.