Referees Can Help With NFL's Concussion Problem

GREEN BAY, WI - AUGUST 19: Brandon Keith #72 of the Arizona Cardinals is attended to after an injury by Referee Jeff Triplette against the Green Bay Packers in a preseason game at Lambeau Field on August 19, 2011 in Green Bay, Wisconsin. (Photo by Scott Boehm/Getty Images)

NFL referees participated in a health and safety seminar which provided a frank discussion about concussions and how officials can help in treatment in the immediate aftermath of head injuries.

The NFL Players Association hosted a health and safety seminar for NFL referees in preparation for the 2012 season on Tuesday. The referees are currently being locked out by the league while they try and work out a new collective bargaining agreement, which means they can have no professional interaction with league officials.

The NFLPA decided to offer a training program in place of normal seminars offered by the league the week before training camp opens.

In recent years, the NFL has become more willing to acknowledge and accept the physical dangers involved in playing football. As concussions have become better understood and older players have acknowledged a variety of problems associated with concussions, the NFL has begun to make an effort to improve both concussion prevention and treatment. Last November, the NFL provided its referees with a list of things to keep an eye out for, including concussions. While that would seem useful, the NFL did not provide any additional training from medical personnel as it related to concussions.

NFL referees spoke with a designated medical expert for the first time on Tuesday, and it showed in the questions asked and stories presented. NFLPA Medical Director Dr. Thom Mayer led a two-hour session that provided the officials with some of the medical basics on concussions, symptoms to look for, and also gave officials a chance to ask any questions they had regarding concussions and what they could do to help in the league's efforts to improve player safety.

I had a chance to sit in on the meeting with a small group from the media, and what I witnessed was a frank, honest and open discussion about concussions. The 25 officials in attendance truly did treat the media like "flies on the wall" as they asked questions that showed serious concern for the issue. More importantly, the discussion might have opened the door for improved treatment in the immediate aftermath of concussions.

Dr. Mayer provided a variety of basic medical information on concussions, but the discussion opened up once he showed video clips of various concussions.

The most informative video showed a pair of concussions in the Philadelphia Eagles' 2010 Week 1 contest against the Green Bay Packers. Many people will recall Kevin Kolb started that game, but suffered a concussion midway through the second quarter on a hit from Clay Matthews. Although Kolb was diagnosed with a jaw injury and actually returned for one series, he had suffered a concussion and sat out the following week.

Photo: Eric Hartline-US PRESSWIRE

What many people might have missed, and what the Eagles trainers were unable to see while treating Kolb, was the concussion suffered by linebacker Stewart Bradley. While the trainers were looking at Kolb on the sideline, the Eagles defense had come on the field. On a play over the middle, Stewart Bradley hit his head against the hip of a teammate making a play on the ball. Bradley got up after the whistle, but immediately proceeded to stumble and fall down.

Bradley's teammates called for the trainers, who came out to check him out. Unfortunately, they had not seen the play, nor the subsequent stumble and collapse. Although Bradley did leave the game at that point, he returned to the field four minutes and forty seconds of real time later (as opposed to game clock time). Although he was subsequently diagnosed with a concussion, the team had no reason to know he had a potential concussion.

NFL referees could very well be considered the first line of defense in treatment of concussions. NFL trainers, like many people, are often inclined to follow the ball on a given play. As the Kolb/Bradley injuries showed, there are only so many trainer eyes, which means they are going to miss things on the field. Furthermore, trainers are often following the movement of the ball and can miss an injury happening away from a play.

This is where officials come into play. As one referee put it, refs are paid to watch specific parts of the action, as opposed to simply following the play. They will see when a guard is pulling on a running play, or making a block away from the ball. A quick word to a team trainer to check for a concussion, or simply that the official saw a player take a hit to the head and then stumble and collapse, could go a long way towards preventing concussed players from returning simply because the trainer did not know he was concussed.

While this would seem simple and obvious, there is a culture in football that needs to be changed in order to fully implement this. There is often discussion about changing the warrior mentality of the players, but there is also a culture within the team. One veteran NFL referee stated that from Day 1 of their professional career, referees are told that when there is an injury on the field, they are to get out of the way and let the trainers do their job. When they have offered any sort of information to the player or team, trainers have often barked at them to stay out of it. During the seminar, the referees stated over and over that the teams needed to be an integral part of this discussion so both sides can work together to improve treatment of concussions.

As the league has begun to take concussions more seriously, there has been a constant discussion about changing the "culture of football." Former Rams tight end Ernie Conwell currently sits as co-chair of the NFLPA's Mackey-White committee, which has been looking into brain injuries in the NFL. Conwell attended Tuesday's seminar and provided various examples of the warrior mentality. One incident that sticks out came when he suffered a concussion and had short-term memory loss all week. However, he was back on the field the next Sunday in spite of struggling to even know what players were being called in the huddle.

The seminar included video and anecdotes relating to other such instances. For example, Chargers offensive lineman Kris Dielman suffered what would prove to be a career-ending concussion against the Jets in Week 7 of the 2011 season. Dielman blocked New York Jets OLB Calvin Pace, and a helmet-to-helmet hit on the block resulted in Dielman suffering a concussion at the 12:33 mark of the fourth quarter. Dielman stumbled back and fell after the play. He quickly got up and waved off a trainer in part because, as he said after retiring, there were no other offensive linemen to replace him. His team needed him and so he was going to fight through the concussion. He subsequently suffered a seizure on the team's flight home and retired due to the concussion.

In a league dealing with a win-at-all-costs mentality, the NFLPA and referees plan on suggesting a rule change that would protect the players and coaches from themselves. The general idea is to provide referees the opportunity to call an officials' timeout when there is concern about a possible head injury. The timeout would allow for a certified concussion specialist to check the player on the field. The team would not be allowed to bring towels and water out to the rest of the team or have the coach speak with the other players. It would be a quick opportunity to try and determine if a player is been concussed. This stoppage in play would not require a 10 second run-off if a team is out of timeouts, and it would not necessarily require the player come off the field for a play if the player is clearly not concussed.

Although the referees are concerned about helping with this, they expressed a common concern about unduly influencing the competitive aspects of the game. If a player suffers a head hit in the final two minutes of a one-series game on a drive that could win the game for his team, an officials' timeout would have one team and its fans screaming bloody murder. The referees' biggest concern is calling an even matchup and making sure that it appears as such for players, coaches and fans. In spite of the fact that fans often think a referee is out to get their team, they are seriously concerned about providing a neutral front.

There was discussion about potentially adding more neutral observers in the booth, alongside the instant replay referee. These neutral observers could buzz down from the booth if they see something during the play. Additionally, during a post-seminar discussion, there was a suggestion of a black flag for coaches that would be for these kinds of injuries. The parties were still working out the ideas to present to the competition committee, but the idea is to provide referees with more power in helping to battle the NFL's concussion problem.

Although there are plenty of kinks to work out from a competitive standpoint, this seminar proved exactly how officials can be a significant part of concussion treatment. Calling a penalty for a helmet-to-helmet hit may change the habits of a player in the future, but it does not change the fact that the player on the receiving end of that hit may have received a concussion on the play.

Until there is a magic pill that can prevent concussions, treatment is just as important as prevention. NFL referees have a first-hand look at plays as they happen. NFL teams can go back and look at the tape to see what happened on every aspet of a given play, but they cannot see everything as it happens live. NFL officials can provide those needed eyes on the field and the league would be foolish not to recognize this.

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