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Latest NFL-NFLPA joint review of Tua Tagovailoa concussion exposes flaws in system

Mike Florio and Peter King review just what went wrong to allow Tua Tagovailoa to play through another head injury in Week 16 and argue that the QB should put on the shelf until next year at the earliest.

On the surface, the NFL and NFL Players Association exonerated the Dolphins and league employees ostensibly responsible for spotting possible concussions and ordering concussion evaluations.

At a deeper level, the decision that everything was handled properly exposes real flaws in the overall process, because it’s undeniable that: (1) Tua Tagovailoa suffered a concussion; and (2) he kept playing after suffering a concussion.

Those two factors set the stage for a potentially serious health outcome. It happens several times per year at the high-school level. Second impact syndrome. A second brain injury immediately after a first brain injury. Swelling of the brain that goes out of control and can be fatal.

If the system created by the league and the union for spotting potential concussions worked properly last Sunday, the system created by the league and the union for spotting potential concussions doesn’t properly work. Because a player with one concussion was continuously exposed to a second one.

The biggest flaw, as one source with knowledge of the overall process explained it on Saturday, continues to be the unwillingness of many players to not self-report a potential concussion. That happens for various reasons.

First, the player’s brain is potentially impaired. He may not even realize he’s having symptoms.

Second, very few players are comfortable with the idea of tapping out voluntarily. Remember when Ben Roethlisberger did it and everyone said, “The culture has changed!” It hasn’t. Some players have the luxury to raise a hand and say, “I may need to exit the game.” Most players worry that they may be Wally Pipping themselves.

For Tua, who already has become far more closely identified with head trauma that he wants to be, it’s even less likely that he’d voluntarily add another coat to the scarlet letter on his helmet.

So what can be done, beyond more aggressive training and urging of players to speak up when they think they may have been concussed? As it relates to players who have had at least one documented concussion in a given season, perhaps a different standard should apply regarding when a concussion evaluation will happen.

The current protocol mandates an evaluation when a player strikes his head and there is associated injury behavior. For a player like Tua, who previously suffered at least one and possibly (probably) two concussions this year when his head struck the turf, maybe the approach should have been that any time he strikes his head on the turf, he gets a sideline evaluation.

And maybe the broader approach should be that players will have individualized protocols based on their own specific histories. For some players, the spotters would watch for a blow to the head and associated behavior. For others, like Tua, a forcible blow to the head would be enough for a quick check, at a minimum.

Does that place too much of a burden on the professionals monitoring the game? If it does, get more. If two aren’t enough, get three. If there aren’t enough, get four. And so on.

If NFL players are going to be treated like patients, the league and the union should have the capacity in place to help ensure that every player-patient receives proper care and attention. While the player absolutely has an obligation to help himself, the league and the union need to recognize that many won’t, requiring extra steps to protect players against the potential development of second impact syndrome.