The Pro Football Concussion Report

A Fan's Look at Head Injuries and the Concussion Crisis in Football

Neurologist on sideline called “not feasible”

neurologist or ipad


Commissioner Roger Goodell has been insistent that the NFL and the team owners are focused on player health and safety. Top priority. They’ve pledged millions of dollars to universities for research into the science of brain injuries. They’ve joined forces with GE and the U.S. Army to develop better equipment to reduce the incidence of concussions.  They even introduced an iPad app for diagnosing concussions. And recently, the NFL’s in-house counsel Jeff Pash announced that beginning with the 2013 NFL season, each game will have an “unaffiliated neurological consultant” on the sideline.  The neurological consultant will assist the medical staff (typically orthopedists, internists, and certified athletic trainers) in spotting, diagnosing and caring for players with possible concussions.

Even under the bright lights of last season’s concussion publicity, one area of player safety that seemed to stay in the shadows is the actual make-up of the medical staff of each team. Does the medical staff include neurologists, are the doctors paid by the team or do the doctors pay the team, are the athletic trainers part of the team or part of a hospital group, do the doctors attend practices or only games, etc?  And what about the “independent” neurologists that are required to sign off regarding a player’s return-to-play (RTP) following a diagnosed concussion.  Who are these independent neurologists?  And who pays them? The owners may not even know who’s on the sideline evaluating brain injuries. In an interview last season, Robert Kraft said “now we have neurologists on the sideline . . .” We do? We didn’t.

As a matter of fact, the NFL has made a concerted effort to promote the use of athletic trainers along with whatever specialty the the team doctor  is to diagnose concussions on the field.  Dr. Richard Ellenbogen, co-chair of the NFL’s Head, Neck and Spine Committee (and a neurosurgeon) told USA Today last season that “no one knows the players as well as the athletic trainers, period.” He added, “having said that, some teams already have neurosurgeons on the sidelines. Having a doc show up just for a game takes away from the all-important baseline exam and continuity of care.”

A video produced by the National Athletic Trainers Association includes testimonials on behalf of Certified Athletic Trainers for the diagnosis and management of concussions. Dr. Margot Putukian, Dr. Stanley Herring, Dr. Robert Cantu, Dr. Kevin Guskiewicz all speak convincingly about using ATCs for on-field concussion work. Interestingly though, Dr. Putukian mentions that it is “not feasible to have physicians on-site to evaluate all these injuries.” Perhaps not at the Pop Warner and high school level, but why not at the college level and in the pros? Certainly the NCAA and the NFL generate enough money to pay for a neurologist to be on-site. And according to some reports, most NFL teams don’t even pay for their medical staff. It is provided by a local hospital group as part of a contracted marketing arrangement. (Dr. Putukian and Dr. Herring appeared together at the NFL Combine in February to introduce the NFL’s new iPad sideline concussion app , and they also both contributed to the recently published Zurich Concussion Consensus Paper)

So why isn’t a neurologist a more integral part of the typical medical staff of an NFL team? Is it the money, or is a neurologist not the best choice as a medical specialist to diagnose concussions? Maybe eventually, the NFL’s game day “neurological consultant” will evolve into a full-time neurologist for every team, present at every practice and on-site at every game. Did anybody ask in-house counsel Jeff Pash about that?


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