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NFL to discuss adding independent medical timeouts during games

At this month's owners meetings, the NFL's competition committee is considering adding a "medical timeout" to evaluate players who appear concussed or injured on the field while play continues.

"After reviewing video of over 40,000 plays, we identified a handful of occasions where players who may have been injured remained on the field, largely because they were in the midst of two-minute offenses or the no-huddle," league executive vice president of operations Troy Vincent wrote in an email to Yahoo Sports.

Back in Week 2 of the 2014 season, Tampa Bay Buccaneers receiver Mike Evans was shaken up after a last-minute catch during what could have been a game-winning drive against the St. Louis Rams. Because Tampa Bay did not have any timeouts, the 10-second runoff rule was enforced and the Bucs had no time left. It's not clear if a medical timeout would have changed the outcome in that case, but it seemed at the time that Tampa Bay was hurt because a player was hurt.

There have been other examples where a medical timeout may have been applicable outside of a two-minute situation. In the Super Bowl last month, New England Patriots receiver Julian Edelman appeared to be dazed after taking a major hit from Seattle Seahawks safety Kam Chancellor in the fourth quarter of New England's title-clinching win. Edelman stayed in the game – which didn't go unnoticed by social media – and scored a touchdown.

When asked two weeks later by The New York Times if he had a brain injury, Edelman said, "Due to our team policy, I can't discuss that."

This is a large part of the problem the NFL and all contact sports face: secrecy and obfuscation. During the last stages of a game, no player wants to come out for any reason. And it's not always in the incentive of a coaching staff to remove a star player (or any starter) if he's contributing.

Pats wideout Julian Edelman took a big hit on this catch. (USA TODAY Sports)
Pats wideout Julian Edelman took a big hit on this catch. (USA TODAY Sports)

So the NFL is exploring the idea of "expanding the authority of the independent neurologist to activate a medical timeout if warranted," according to Vincent.

"If you have a system in place where you have somebody up in the press box whose job it is to screen for potential injury and they have the ability to buzz down to the team's medical staff, giving them the authority to stop the game is a good idea," said sports neurologist Jeffrey Kutcher at the University of Michigan. "Something needs to be done and a player needs to be evaluated."

The ensuing steps are much more difficult. Specifically: how long does it take to evaluate a player for a brain injury?

During the playoffs, Pittsburgh Steelers quarterback Ben Roethlisberger took a vicious sack and remained on the ground for an extended time during the fourth quarter. He was directed off the field by a referee, but returned three plays later. He later described the situation as "whiplash" rather than a concussion. Edelman was cleared by the Patriots' staff, according the Associated Press, but there too it's hard to imagine how he could have been evaluated thoroughly as the game went on.

The most widely accepted evaluation tool for in-game head injuries is the "SCAT3" – Sport Concussion Assessment Tool. There's a short checklist which would take roughly a minute or two to finish, including questions like "Disorientation or confusion?" and "Blank or vacant look?" But if those obvious symptoms are not present, the SCAT has a more intricate questionnaire that would take seven to 10 minutes for a trained neurologist to complete. The SCAT calls for this part to be done "in a resting state," which is fairly difficult on the sideline of a football game.

Then there are the situations when a player presents no symptoms of a concussion during a game, but then shows one or several troubling signs after hours or even days. When asked how long it takes to diagnose a concussion, Kutcher said, "Anywhere from five seconds to 48 hours."

This part of brain injury evaluation poses issues that may never be completely solved. And Vincent admits the "practical application" of how a medical timeout would work still needs to be thoroughly discussed not only among owners but also with the players' union.