Dielman Injury Changes Protocols for Concussions

The NFL Injury and Safety Panel met this week to discuss the head trauma and subsequent seizure suffered by San Diego Chargers guard Kris Dielman on October 23, and what measures the league can take to improve identification of concussions and head injuries.  The league wants to get referees more involved in looking for concussions to help better identify injuries like Dielman’s on the field.

“We are taking the step on officials to make them alert to obvious concussion symptoms,” Greg Aiello, the NFL’s vice president of public relations, said. “We’re not trying to train the officials to be doctors, but we’re asking them to treat it like other injuries that may make it necessary to stop the game and get them medical attention, either on the field or by getting them off the field.”

The league plans to include instruction on identifying concussion symptoms in the weekly training tape that crews review with the referees before each game.  Longer term plans include bringing doctors in to speak on the subject next year at the NFL officiating clinic.  Other protocols and procedure changes remain in discussion.

Dr. Thom Mayer, the NFL Players Association’s medical director, commented on the changes.  “Closer vigilance of the player on the field is needed,” Dr. Mayer said.  “We’ve got to educate the officials.”  He added that educating the officials should happen as soon as possible, rather than waiting for next year, and “it needs to involve the Players Association.”

Dr. Mayer went on to explain that he feels that this is a good step, but it’s just one more step in an ongoing process to continually improve the safety of the game, and the treatment of concussions specifically.  “The whole [handling of] concussions is a process, we have to continue to refine it,” Dr. Mayer said.  “We will continue to discuss how to improve this to meet the needs of the players.”

Dr. John Sullivan, a clinical sports psychologist who has worked in the NFL for 12 years, also believes that this is a good next step, but ultimately much more needs to be done.

“We need to continue to work towards a better comprehensive program for dealing with concussions, including identification, diagnosis, recovery and return-to-play decisions.  Improving education is always a good step, and it should include referees as well as coaches and players,” Dr. Sullivan said.

Dr. Sullivan also points out that concussions need to be treated differently than other injuries because of the nature of the injury.  “We’re dealing with the brain.  Orthopedic injuries are obvious when they occur – if a player is limping or can’t stand, the game is stopped and the medical team is brought in,” Sullivan went on.

“With concussions, the fact that an injury has occurred is not always obvious to the casual observer.  Plus, since a concussed player has impaired decision making ability, we can’t rely on self-reporting.  NFL players are tough guys, and will do anything they can to stay in the game.”

The toughness required and the pressure to perform in the NFL can encourage players to make decisions about staying in the game that they shouldn’t, and there needs to be a process to ensure that the players are properly protected.

“Kris [Dielman] is a tough guy.  He’s always been a warrior, and he’s played with injuries before,” Dr. Mayer said.  “We’ve improved the system, improved the process, and we’re better off than when we’ve started.  But it didn’t work.  He clearly had a concussion.”

In the Dielman incident, the Chargers lineman was visibly staggering after the play.  The game’s umpire, Terry Michalek, stopped and checked with Dielman but was waved off.  Michalek went ahead and got set for the next play and Dielman remained in the game.  Chargers team doctors didn’t have a clear view from the sidelines and were attending to another injured player at the time.

The team was alerted to Dielman’s condition in the postgame locker room by an unidentified teammate, but Dielman flew home with the team from New York to San Diego, and suffered a serious seizure upon landing in California.  He is undergoing additional evaluation, and it remains unclear when he will be able to return to action.

“There are many instances when a player has suffered an obvious concussion and he’s lying on the ground and game officials do get the medical people on the field,” Aiello said. “In this case [with Dielman], he never went to the ground but it was pretty clear he had symptoms and it’s now just another step to further educate and sensitize everybody to take a closer look and exercise the proper caution and action.”

Dr. Sullivan further explained the difficulties of concussions compared to other injuries.  “Some people think that unless a player passes out, they don’t have a concussion.  The vast majority of concussions do not involve a loss of consciousness.  Many concussions don’t exhibit any obvious physical symptoms, but the injured player may have impaired balance, impaired decision making, and be more susceptible to an additional, more serious injury.”

Detroit Lions running back Jahvid Best highlights the need for protocols for recovery and return-to-play decisions as well.  Best suffered a concussion in the preseason, and a second concussion in a game against the 49ers.  His status for the rest of the season remains in doubt.  It’s impossible to know when he will be fully recovered, as well as if he was fully recovered from the first concussion, without more detailed, objective evaluations.

“We’re also fighting the stigma of mental health,” Sullivan went on.  “The idea that a broken leg is an acceptable reason to leave the field but a brain injury is not.  We need to view the player as a complete person, not just focus on if they can still run and tackle.”

“This isn’t about changing football, but it is about better protecting the players.  We need to do a better job of identifying these types of injuries, but also improve diagnosis, treatment and return-to-play decisions.  We need better protocols and more objective assessments throughout the whole treatment and recovery cycle.”

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