NFL finds Texans did not violate the concussion protocol with Tom Savage

The NFL has finished its investigation into whether or not the Texans followed the league’s concussion protocol with quarterback Tom Savage. The league found that the team lived up to its expectations with the way Houston handled Savage’s injury, the league and NFLPA announced in a joint statement on Friday.

The NFL launched its investigation after Savage suffered a head injury in Week 14 against the San Francisco 49ers.

The league determined that Savage was appropriately pulled from the game and thoroughly examined. But the outcome did not align with the league’s expectations for the concussion protocol. There will be immediate changes to the protocol going forward to prevent this type of situation in the future.

What happened? Savage went down after a hit from 49ers defensive end Elvis Dumervil and was clearly and obviously suffering from symptoms that can indicate a concussion. His body went stiff, and he appeared to be shaking.

That play ended the Texans’ series, and Savage was taken into the injury tent to be examined. He was cleared to return, but he was pulled from the game after Houston’s next offensive series and examined once more. At that point, he was diagnosed with a concussion and replaced by backup T.J. Yates.

Head coach Bill O’Brien said that if he had seen the video of the hit and Savage’s immediate reaction, he would have pulled him from the game.

When Savage was examined by team doctors and the independent neurotrauma consultant, they had only reviewed video of the incident at full speed. The slow-motion replay showed more clearly that Savage was impaired. But Savage was still able to pass the sideline concussion evaluation.

The fact that he showed such obvious symptoms before the initial examination but returned to the field is the reason the league investigated. It also spurred the NFL to make the following changes to the protocol, effective immediately, per the league’s release:

Implemented a pilot program utilizing a centralized UNC based at the league office to monitor the broadcast feeds of all games. The UNC will contact the team medical staff on the sideline should they observe any signs or symptoms warranting further evaluation.

Defined impact seizure and fencing responses as independent signs of potential loss of consciousness, representing "No-Go" criteria under the current Protocol. Players who display either of these signs at any time shall be removed from play and may not return to the game.

Require a locker room concussion evaluation for all players demonstrating gross or sustained vertical instability (e.g., stumbling or falling to the ground when trying to stand).

Officials, teammates, and coaching staffs have been instructed to take an injured player directly to a member of the medical team for appropriate evaluation, including a concussion assessment, if warranted.

Require all players who undergo any concussion evaluation on game day to have a follow-up evaluation conducted the following day by a member of the medical staff.

Added a third UNC to all playoff games and the Super Bowl to serve as a backup who can step in immediately should one of the original two UNCs be absent from the sideline for a time to attend to a more severely injured player.

What is the league’s concussion protocol? The NFL has specific procedures in place to diagnose concussions and make sure players get appropriate care. It’s complicated by the fact that concussions affect everyone differently.

The first step is for team personnel and officials to know how to identify the potential observable signs of concussions. According to the league’s protocol, those are:

• Any loss of consciousness.
• Slow to get up following a hit to the head (which can include hitting the head on the playing surface).
• Motor coordination/balance problems.
• Blank or vacant look.
• Disorientation.
• Clutching of head after contact.
• Visible facial injury combined with any of the above.

There are other symptoms teams need to be mindful of, but medical personnel have to rely on players to report them. Those include headache, dizziness, nausea, amnesia, sensitivity to light and sound, and others.

Every play is monitored by a concussion spotter in the booth. Referees also have the authority to take a player out of the game if they see signs of a concussion, and the team’s medical staff reviews video of plays that may have caused concussions on the sideline.

If any of these people decide that a player shows any signs of having a concussion, this is the process they follow:

• They remove the player from the game immediately.
• The team doctor and an unaffiliated neurotrauma consultant will review video of the play.
• Team medical staff and the independent neurotrauma consultant will conduct a concussion evaluation.
• If there are any signs or symptoms of a concussion, the player will be taken to the locker room for additional assessment.
• If the player is diagnosed with a concussion, he’s out for the rest of the game.
• If the player is cleared to return, he can play.

Once diagnosed, a player can’t return to the field until he fully clears the protocol. There are five steps he has to complete to get to that point.

1. Rest and recovery.
2. Light aerobic exercise.
3. Continued aerobic exercise and introduction of strength training.
4. Football-specific activities.
5. Cleared to return.

The NFL updated its consequences for violating the concussion protocol last offseason. Now, if teams are found to have violated the league’s rules for diagnosing and handling concussions, they will face hefty fines, mandatory remedial education for their training staffs, and potentially even the loss of draft picks.

The league also investigated the Seahawks after Russell Wilson was removed from a game to be checked for a concussion. Wilson spent seconds in the medical tent and returned to the field immediately. The NFL fined the Seahawks $100,000 for violating the concussion protocol.

Anyone who was watching Texans vs. 49ers when Savage went down had to be shocked that he was cleared to return to the game, even for one series. He was definitely slow to get up after the hit and had obvious motor coordination problems right after the hit. Medical staff and the independent neurotrauma consultant should have clearly seen that when they reviewed video of the play.

But the league says the Texans followed the protocol. This highlights how imperfect the process is and the need for immediate changes.