Concussion spotters a step in right direction

New England Patriots wide receiver Julian Edelman scored a touchdown in February’s Super Bowl minutes after taking a helmet-to-helmet hit that appeared to leave him momentarily stunned on the field. AP Photo/Bob Leverone/File

Julian Edelman’s performance in Super Bowl XLIX appears to have had longer lasting effects than just bringing the New England Patriots a fourth championship.

With about 11 minutes left in the fourth quarter, Edelman took a helmet-to-helmet hit from Seattle Seahawks safety Kam Chancellor. Fans watching on TV saw the receiver stumble after the hit, but he stayed in the game. Edelman ultimately caught a 3-yard touchdown pass during the same drive.

According to Ben Volin of The Boston Globe, reporters heard the concussion spotter call down to the Patriots’ sideline, but due to the team’s hurry-up offense, Edelman remained on the field.

Shortly after an earlier scary incident involving Cleveland Browns quarterback Colt McCoy in 2011, the NFL appointed independent athletic trainers to serve as “spotters” during games. They watch the action on the field and monitor video to identify players who might have sustained concussions. They can call down to the sideline and speak to the doctor or athletic trainer, provide information about the incident and even send video to the medical staff.

In what many have nicknamed “the Julian Edelman rule,” these spotters can now use a medical timeout to remove a player from the game so that doctors can perform a neurological assessment. A spotter can stop play if he sees signs that a player is unstable or disoriented and if the player avoids attention from the team’s medical staff.

The spotter can contact the game official with the concussed player’s jersey number as well as notify the doctor or athletic trainer to have the player evaluated.

The NFL requires that the spotter has at least 10 years experience as an athletic trainer with current board certification by the National Athletic Trainers’ Association in addition to experience in professional or collegiate sports. He or she must also never have served as an NFL team’s head athletic trainer or have worked for an NFL team in the past 20 years.

The NFL recently settled a lawsuit over concussions filed by former players. The National Hockey League also faces a similar lawsuit filed by former players who claim to have long-term issues resulting from concussions they suffered in their pro hockey careers. Like the NFL suit, the players allege that the NHL didn’t do enough to protect the athletes and inform them of the long-term neurological consequences of these brain injuries.

The NHL has taken steps to improve safety, including implementing a Department of Player Safety, restricting contact to a player’s head, and adopting a concussion protocol in 2011. This season, the league will place independent spotters at every game in the 30 arenas.

The plan differs from the NFL’s in several ways. First, the home team doesn’t have to use them. They can hire their own spotters who can communicate with the athletic trainer for the team. If so, the independent spotters then only log the injuries they see. Plus, a spotter will only work in one arena. The NHL team in that city will pay the spotter.

The NHL spotters also might not have medical experience. According to NHL Deputy Commissioner Bill Daly, “They aren’t evaluating the players or diagnosing whether or not they have a concussion. That’s the job of the doctors and trainers. All they are doing is alerting team medical staff where they witness or identify an incident where there is a visible sign of concussion. Those signs aren’t ‘medical’ — they are objectively observable and they have already been precisely defined in the protocol.”

Generally I think that the NFL’s plan, and to a lesser extent the NHL’s, are steps in the right direction. The action is often too fast and there is too much going on for an athletic trainer and doctor to see every player and every possible injury. Plus we know many players will hide or deny symptoms to stay the game.

The spotters need to be independent, though. In theory, officials paid by the home team could call for a player from the visiting team to be pulled out and examined at key moments of the game. That might be a far-fetched conspiracy theory unlikely to actually occur, but fans and the media might rally against the potential conflict of interest.

The spotters also need to have medical experience. While I agree that they aren’t making the diagnosis but instead looking for signs of an injury and relaying information, certified athletic trainers and doctors can better recognize injuries. They have years of training and hands-on experience covering games and evaluating athletes with head injuries. If safety of the athletes is the goal, we should put qualified personnel in place to watch and protect them.

Again, these are still worthwhile moves. We will soon see what kind of impact they have on injuries and the flow of the games. Expect to see some version of these concussion spotters in every professional collision sport in the near future.

Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston. For more information about concussions and other sports medicine topics, go to his blog at drdavidgeier.com.