NFL concussion protocol: Protocols in need of stronger guidelines following Tua Tagovailoa debacle

When 24-year-old Miami Dolphins quarterback Tua Tagovailoa got up from a hit against the Buffalo Bills in Week 3, it was immediately clear that something was wrong. The star got to his feet, took a few seemingly normal steps forward down the field, then stumbled awkwardly before collapsing completely. Even to the average NFL fan, it was abundantly clear that Tagovailoa had sustained a head injury, his dizziness and lack of coordination being dead giveaways.

He immediately exited the game and was put into the league’s concussion protocol to be evaluated further. But just four days later, with the Dolphins playing in the early Thursday night football game against the Cincinnati Bengals, Tagovailoa was the designated starter for the Dolphins, as if he hadn’t missed a beat. In the second quarter, as Tagovailoa scrambled wildly to avoid a sack, he was slung to the ground by a Bengals defensive lineman, collapsing to the turf where he lay motionless. His arms and fingers extended up in a senseless manner, a reaction referred to as the "fencing response," which often occurs following a traumatic brain injury. Fans and players alike are now demanding answers, specifically ones to the question of why the quarterback was even in uniform that Thursday night. That’s where it gets tricky.

The NFL’s concussion protocol wasn’t always a component of the league. In fact, it only came to conception following numerous studies and player statements concerning head injuries, specifically worries over concussion and chronic traumatic encephalopathy (CTE), a brain condition that results from numerous head blows. One study cited in the New York Times found that about 320 former NFL players have reported CTE. For these reasons, the NFL Players Association (NFLPA) and the league joined forces to create a commission of sorts that would tackle the issue at a higher level. The task force includes medically trained professionals and neurologists whose primary objective is to diagnose injured players and make decisions on their ability to play in subsequent games. This means that doctors are not only present on the field and sidelines during live games, but they’re also in constant communication with NFL and team personnel regarding player safety. For Tagovailoa, the process that occurred in the week leading up to the Dolphins game concluded that he was good to go, allegedly passing all the tests necessary to be deemed medically approved to play. Head coach Mike McDaniel doubled down on this evaluation, noting that Tagovailoa passed tests with an independent neurologists, including those that were more football-related like recalling strings of words in playcalls.

In McDaniel’s defense, he’s not entirely wrong. Prior to the Dolphins game, Tagovailoa checked off every concussion guideline constructed by the NFLPA. However, in the follow-up investigation that was initiated, it was decided that ataxia, or neurological malfunction involving a lack of balance and stability, should be added to the list of necessary precautions. If this had existed prior to Tagovailoa's incident, the NFL noted that he would not have been cleared to play. In the wake of this investigation, a neurotrauma consultant for the NFL who was heavily involved in Tagovailoa's diagnosis was promptly fired.

For the NFL, they’ve unsurprisingly received a significant amount of backlash since the event, and it's the league’s turn now to come up with answers and solutions. While the investigation into Tagovailoa's injury and the revision of protocol standards are certainly plusses, there is still significant work to do. The fix can’t be firing individual doctors or making after-the-fact protocol changes in hopes that they will remedy the situation long term, especially when careers — and, more importantly, lives — are at stake.