Tua Tagovailoa And The Concussion Protocol

I have purposely waited several days to comment on what happened last Thursday night in the Dolphins/Bengals game.  Of course, I am referring to Tua Tagovailoa being carted off the field after being slammed to the ground – in a perfectly legal tackle – and demonstrating a neurological response that is often very serious.  He was taken to a local hospital in Cincy, and it was announced after the game that he had been released and that he would fly back to Miami with the team.

That was a scary situation, one that was guaranteed to generate commentary about the brutality of football and the dangers associated with concussions sustained in the process of playing football.  That would not be news; that song has been atop the hit parade of sports commentary for years now.  The situation last Thursday had an important new ingredient.  Just 4 days before Thursday’s need for hospitalization, Tua had another incident in the first half of the Dolphins earlier game against the Bills where he hit his head on the ground and then stumbled/wobbled when he got to his feet after the play.  He was taken out of the game and into the locker room for the concussion protocol.  The conclusion then was that he suffered a back injury; that caused the stumbling/wobbling; he was cleared to play, and he returned to the game in the second half.

That prior incident made last Thursday’s injury different and there was a tsunami of accusatory commentary that flowed from it.  The general flow of the commentary followed this line of thinking:

• Tua was concussed in the game against the Bills 4 days prior to Thursday’s event; that was “proven” by his stumbling/wobbling.
• The league and union have negotiated a concussion protocol which should have kept Tua out of last Thursday’s game against the Bengals – – but he played in that game.
• Ergo, that shows a callous disregard for player safety by the team and the league, and someone has to be “accountable” for such a situation.

Maybe – – I said maybe – – all of that is perfectly correct.  And maybe not…

Let me begin here by saying that I have no specific expertise in neurology or neuroscience.  Let me also humbly suggest that few if any of the commentators on ESPN or FOX Sports or in newspapers/magazines around the country who followed that line of thinking in their comments last Friday and Saturday have any specific expertise in neurology or neuroscience.  There is a danger here of falling into a logical trap known as Post hoc ergo propter hoc.  That translates to:

• After that, therefore, because of that.
• Example:  If every morning at 8:00 AM, I go out to the curb in front of my home and stomp my feet three times on the ground, I can claim that because I do that, I keep elephants from coming into my neighborhood.  I do that every day; no one ever sees any elephants; so of course, my morning ritual works perfectly.

Here is the issue.  Tua was taken to the locker room in the game against the Bills and we presume he was examined under the NFL/NFLPA concussion protocol.  We don’t know that, but we assume that took place.  There is the first potential flaw in that line of righteous indignation commentary.  If Tua told the trainers/team doctors and the “independent neurological consultant” that he hurt his back and that is why he was stumbling/wobbling, perhaps he was not examined for a concussion.  Maybe he was allowed to play in the second half because he and any/all of the medics who saw him in the locker room thought he had a back injury not a head injury.

That scenario is possible but not probable.  The reason I say that is that the Dolphins claim that Tua was tested for concussion symptoms on the days leading up to the Thursday night game.  If there were no concerns about that kind of injury, why all the testing?  Again, I do not know the answers here, but there is ambiguity that causes me to think there was some sort of concern by someone involved in that locker room examination that Tua may have been concussed.

The reaction of the NFLPA was – in my opinion – way over the top.  They accused the league and the team of putting Tua in harm’s way and that the protocols were violated and they would take every legal action to right this wrong and so on and so on.  Of course, that was the stance they took; that is what unions do because that is what unions are created to do.  But there is an atonal sound in the union’s song here on several counts:

• The morning after Tua’s second injury – – the one last Thursday night that landed him in the hospital in Cincy – when the union was most strident, no one in NFLPA HQs at the time knew what happened in the locker room examination four days prior to the Thursday incident.  At that point they did not know enough to make such declarative and accusative statements.  [Remember, all of the union’s accusations may turn out to be correct, but last Friday morning, they could not have known them to be true.  Better to be lucky than smart?]
• It is possible Tua was not examined for a concussion at all.
• It is possible that he was examined and found not to have suffered a concussion.  And if this is what happened in the first incident, then having him play in the second half against the Bills and starting the game against the Bengals would seem to be a logical outcome.
• It is also possible that Tua was examined for a concussion and was suspected to have suffered a concussion, but he characterized the problem as a back injury and the examiners “looked the other way” and cleared him to return to the field.

I submit that the conclusions one might draw from those possibilities above are very different and the actions one might take once it is clear what happened would be very different as well.  However, such information was not available last Friday or Saturday – – and is not known even now after Tua’s second injury.  To be clear, I do not know if the injury in the Bills game was a concussion or a back injury – – or both.  Nor can I say that I know whether the two incidents are related.

As I understand it – – and I have no expertise in neurology or neuroscience – – concussions are diagnosed with a brain scan using X-Ray tomography to determine if there has been bleeding or swelling of the brain.  I do not know this, but I am reasonably confident that there are no such diagnostic instruments in every NFL locker room at every NFL venue.  So, I am confident in thinking that even if Tua were examined under the existing protocol, the diagnosis of concussion/no concussion would have to be less than perfect because the medical folks involved in his examination would not have a brain scan in their possession to examine as part of their diagnosis.

That uncertainty in such a diagnosis leads folks to rave about the inadequacy of the concussion protocols in place and how they need to be improved.  That is the story here; that is the story that should have been front and center last week not jeremiads about the callous disregard for humankind that was on display last Thursday night.  The need for improvement also points out everyone who needs to be “held accountable” because:

• The existing protocol – the one everyone now considers to be insufficient – exists because it was agreed to by the NFL and by the NFLPA.  [By the way, I suspect that none of the execs on either side of the bargaining table that set up the existing protocol had significant expertise in neurology or neuroscience.]
• The ”independent neurological consultant” who was there for the game against the Bills has been “fired” by the NFLPA.  What happened is that (s)he had previously been accepted as one to fill out that role by both the league and the union, but the union now chose not to accept him/her as fit to discharge such responsibilities.  Given the uncertainties that existed at the time of the union’s “firing” of the “independent neurological consultant”, that smells like a rush to judgment to me.

There is an “investigation” ongoing about what exactly happened in that locker room in Miami during the Dolphins/Bills game.  The NFL has promised “transparency” with regard to the results of that “investigation” but suffice it to say that “transparency” and “NFL investigations” are not exactly normal bedfellows.  However, until I know what happened there, I cannot assign blame, nor can I assume evil intent on the part of anyone involved here.

• If Tua passed the existing protocol in that locker room, the Thursday night incident was horrible but unavoidable under the existing rules.
• If there were any “shortcuts” taken in his locker room examination or if there were any data purposely overlooked in that examination that led to Tua being cleared when that was a questionable conclusion, that would be a totally different set of circumstances.

The missing data in all this involves the actions of the people who examined Tua in the middle of the Bills game who decided that he had not suffered a concussion and therefore was eligible to return to the game.  If and when that information becomes publicly known, that will signal the time for analysis and/or criticism – – and perhaps some apologies from those who “shot from the hip” last Friday and Saturday.  If indeed such apologies are necessary, I shall not hold my breath awaiting them.   What I await is the transparency promised by the NFL – and the NFLPA – about the findings of their joint investigation.  I shall not hold my breath awaiting that either.

The outrage expressed proximal to last Thursday’s injury was not confined to the sports pages.  You guessed it; politicians jumped into the fray feet first.  Bill Pascrell is a member of the US House of Representatives from New Jersey, and he Tweeted last Friday:

“I want to know how the hell he (Tua) was on the field last night.”

The Congressman went on to say that this raises questions about the NFL’s commitment to player safety and about how much progress has been made on that front.  In response to that sort of political outrage, I would respond along these lines:

• The NFL and the NFLPA have jointly negotiated the existing protocols.  If those protocols are insufficient in your view, both the league and the union are “guilty” of being insufficient in your view.
• If you – and the rest of your Congressional colleagues – know of improvements in the protocol that would be acceptable to both the NFL and the NFLPA, why have you not shared them with the league and the union?
• If you – and the rest of your Congressional colleagues – are as ignorant as I am of neurology and neurological science, why not wait until all the facts of the matter are uncovered?

I think the most important questions for the NFL and the NFLPA to analyze as they move forward to create a new and better concussion protocol are these:

1. While it is impossible to protect someone from himself, how can we better protect NFL players who may have suffered a concussion should they seek to circumvent such a diagnosis which would prevent them from getting back on the field?
2. What level of “invasion of privacy” is acceptable to record for examination all of the testing and interactions done in accordance with the new and improved concussion protocol to assure no shortcuts are taken and to assure that the examination is carried out by a person with specific neurological/neuroscience expertise?

Finally, the general reaction to seeing Tua carted off the field last Thursday night brought to mind this statement made by Aristotle about 2500 years ago:

“It is the mark of an educated mind to be able to entertain a thought without accepting it.”

I think too many folks accepted a thought because they entertained it…

But don’t get me wrong, I love sports………