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All levels of football must strive to avoid “second impact syndrome”

Mike Florio and Peter King explore how the NFL can evolve its protocol so players are protected from second impact syndrome, including adding a specific rule for gross motor skills.

Apart from the potential long-term effects of suffering two concussions in a short period of time, there’s a much more important short-term concern that arises from the possibility of a player suffering a concussion before he has recovered from a prior one.

The phenomenon is known as “second impact syndrome.” That term was trending on Thursday night, after Dolphins quarterback Tua Tagovailoa suffered an obvious head injury against the Bengals. If he had suffered a concussion on Sunday that had not yet fully resolved itself, he could have experienced second impact syndrome.

Here’s an explanation of the condition, from the National Library of Medicine: “The generally accepted cause relates to sustaining a second concussion before the brain has a chance to recover from the initial insult fully. The athlete will rapidly develop altered mental status and a loss of consciousness within seconds to minutes of the second hit resulting in catastrophic neurological injury. The catastrophic injury results from the dysfunctional cerebral blood flow autoregulation leading to an increase in intracranial pressure. The pressure rapidly develops and eventually results in brain herniation. The herniation may occur either medially across the falx cerebri or inferiorly through the foramen magnum, resulting in brain stem injury and rapid deterioration and leading to death within 2 to 5 minutes.”

The term was coined in 1984, after a football player suffered a head injury, returned to play again four days later, suffered another head injury, collapsed, and died.

The NFL has never experienced a player dying on the field from a head injury. In August 2001, Korey Stringer died due to heat exhaustion at training camp. In October 1971, Chuck Hughes died during a game, from a heart ailment.

In 2009, not long before Congress forced a concussion epiphany upon the NFL, quarterback Carson Palmer predicted that someone will eventually die on the field.

“Everyone talks about the good old days, when guys were tough and quarterbacks got crushed all the time,” Palmer said, “but back in the day, there weren’t defensive ends that were Mario Williams -- 6-7, 300 pounds, 10 percent body fat, running a 4.7 40

Although the NFL has avoided an on-field fatality due to head trauma, high school players die every year. Last month alone, at least two died: Xavier McClain in New Jersey, and Yahir Cancino in Texas.

In 2009, the state of Washington enacted the first law aimed at protecting high school players from suffering a second head injury before the first one healed. The NFL was instrumental in getting all states to adopt similar legislation named for Zachary Lystedt, who experienced a catastrophic brain injury after two head injuries in the same game.

The NFL’s obvious goal is to prevent second impact syndrome. That’s why the investigation regarding Tagovailoa’s return to play on Sunday after displaying gross motor instability has become so important. The loophole that allowed doctors to clear Tagovailoa could lead, in the wrong set of circumstances, to the worst-case scenario for the player.

It’s critical that the NFL get this right. There’s no hope for lower levels of the sport ever fully and properly protecting football players if the NFL can’t. (Even if the NFL can figure it out, the lower levels remain woefully behind the curve.)

The easiest fix, in the aftermath of the Tagovailoa controversy, would be to immediately make gross motor instability a “no go,” with no exceptions or loopholes. We’ve asked the league whether that change will be made before Sunday’s games. Hopefully, it will be.

If a player who has shown obvious wobbling can be cleared to return to an NFL game, he can be cleared to return to a high-school game, too. The sooner the NFL sends a loud and clear message that what we all saw last Sunday should never happen at any level of football, the message will be received by every level of football.