Hey, Tennessee (and NCAA): Let’s Talk Concussion Protocol

Photo credit: APNews

Brian Maurer is a freshman at the University of Tennessee. At 19 years old, Maurer has been the University’s starting quarterback since early October. In his first start on October 5, Maurer left the game during the second half after he took a substantial hit from a Georgia defender, resulting in a sack. Maurer suffered head trauma, but started yet again in Tennessee’s next game against Mississippi State on October 12. Lo and behold, Maurer suffered a concussion late in the second quarter. Even after suffering the injury, Maurer remained in the game for a few additional plays. Even AFTER coming out of the game with a head injury, Maurer watched the rest of the game from the sideline with a towel around his neck and even participated in celebrations after the win. Then, Maurer practiced with the team the following day.

If you think this sounds horrific, you are correct. When asked whether Tennessee’s medical staff evaluated Maurer immediately after he suffered his second head injury in a week, coach Pruitt stated:

“I don’t know how you could. I mean, he hit his head on the ground, he jumps up and runs back in the next huddle, gets the call, calls the next deal. Every play, there’s a lot of people running into each other, and they’re hitting their heads. I mean, I guess we could stop the game and evaluate everybody out there, but I don’t think we have time for that.”

Repeat after me: “but I don’t think we have time for that.” Is that really a statement we want to hear from a head coach after his 19-year-old starting quarterback suffered two concussions in one week? To make matters worse, Pruitt allowed Maurer to practice Sunday night. In his defense, he did let the injured player sit out during Monday’s practice, but it was clear that he fully intended Maurer would be playing against (top ranked) Alabama on October 19. Pruitt did not fail to deliver – Maurer started on October 19 against Alabama – after having suffered head injuries in two consecutive games.

Spoiler alert: there’s not a happy ending to this story. Maurer didn’t make it through the first quarter of the game against Alabama. Maurer took a hit and ended up slamming his head against Alabama tackle Darnell Wright. Maurer looked dazed on the sidelines and later Pruitt confirmed Maurer suffered a concussion. Pruitt was back at it on Monday, stating that Maurer was in wait-and-see mode for Saturday’s game against South Carolina.

19-years-old. Three head injuries in three weeks. And there is a consideration of playing him in the next game? You’ve got to be kidding. However, despite how egregiously irresponsible this decision seems, rules governing the University, namely the NCAA, allow a situation where a freshman quarterback having suffered three consecutive head injuries may play yet again the following week.

The NCAA’s Best Practices state, “[i]nstitutions should make their concussion management plan publicly available.” Note how this indicates what an institution should do. The Best Practices goes on to list guidelines regarding diagnosis, post-concussion management, and return to activity. Despite this, the NCAA simply recommends certain procedures and clearly states that return to full activity is hard to project and that the guidelines have not been validated by evidence-based studies. The Best Practices elaborate:

“Sport-related concussion is a challenging injury for student-athletes and, unlike other injuries, the timeline for return to full activity (including return-to-play and return-to-learn) is often difficult to project. The psychological response to injury is also unpredictable. Once a student-athlete has returned to his/her baseline, the return-to-play decision is based on a protocol of a stepwise increase in physical activity that includes both an incremental increase in physical demands and contact risk supervised by a physician or physician-designee. It is noteworthy that all return-to-play guidelines are consensus-based and have not been validated by evidence-based studies. McCrea and colleagues have reported that a symptom-free waiting period is not predictive of either clinical recovery or risk of a repeat concussion.”

In compliance with the NCAA’s guidelines, the University of Tennessee’s protocol requires the following (along with other items):   

  • A process that ensures a student-athlete who exhibits the signs, symptoms, or behaviors consistent with concussion shall be removed from athletics activities and evaluated by a medical staff member with experience in the evaluation and management of concussion
  • A policy that precludes a student-athlete who is suspected of having a concussion from returning to athletic activities for at least the remainder of that calendar day.
  • A policy that requires medical clearance for a student-athlete diagnosed with a concussion to return to athletics activities as determined by a physician or physician’s designee.
  • A policy in which our athletics healthcare providers are empowered to have the unchallengeable authority to determine management and return-to-play of any ill or injured student-athlete, as he or she deems appropriate.

When questioned about Maurer, Pruitt stated:

“I trust our medical staff. They are the ones that make the decisions like that. I meet with our players throughout the week, but it is never about any kind of medical decision. I trust our staff and right now, they are still trying to determine where he is at.”

So, at the end of the day, as irresponsible as it seems to play a 19-year-old immediately after he has suffered three consecutive head injuries, it’s actually not irresponsible at all – at least under the NCAA and University guidelines.

Unfortunately, the saddest part of this tale is that the NCAA’s best practices and guidelines allow this behavior. Let me clarify. The current rules that govern collegiate football and their treatment of head trauma allow a 19-year-old to be put in a fourth game after suffering hits to the head in three previous games.

This is unacceptable. It is so unacceptable that the NFL revamped its own protocol to reflect the problems with this type of protocol. Team doctors may face a conflict as they are to provide medical assistance to the player, but are employees of the team. Therefore, in 2017, the NFL began requiring (1) a physician who is not affiliated with any NFL team assigned to each team must monitor games from the sidelines, identifying concussion symptoms, noting when hard hits warrant concussion evaluation and working with the team physicians to conduct those evaluations; and (2) athletic trainers must sit in stadium booths during all games to spot potential concussions in players from both teams. The spotters can review game film to identify plays potentially resulting in concussions and can call “medical timeouts” to relay that information to the medical personnel on the sidelines so that further evaluation can be conducted.

NFL players in concussion protocol cannot even speak at a press conference after the game. If Tennessee were bound by the NFL rules, Maurer would have been evaluated by an unaffiliated medical provider and there would have been booth review. The booth review is important – remember when Pruitt stated, “I guess we could stop the game and evaluate everybody out there, but I don’t think we have time for that” when asked about Maurer playing a few more plays after hitting his head on the ground.

Even more stringent are the protocols for boxers. Professional boxers are suspended for 30-90 days after suffering a knockout. Collegiate football might not be apt to demand such stringent requirements, but it is unheard of (for good reason!) to put in a player week after week when that player has suffered head injuries in three consecutive games. It is arguable that Pruitt has acted irresponsibly. However, it is the University and NCAA guidelines that have allowed these questionable decisions. Don’t blame the player, blame the game. Pruitt is simply playing by the rules of the game, which currently allow a 19-year-old with three weeks of consecutive head injuries to play in the next game.

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