Last season, Cleveland Browns quarterback Colt McCoy took a crushing hit from James Harrison in Pittsburgh during a Thursday night game. He sustained a concussion on the play but did not complain of symptoms. He did ask team personnel to look at his injured hand. McCoy was sent back into the game. The Browns didn't give him the standard concussion test until Friday morning.
As a direct result of the Browns' failure to test McCoy on the sideline during a game, the NFL now puts an independently certified athletic trainer in the booth who can call down to alert the medical staff on the sidelines to players who may be concussed.
Last weekend three quarterbacks -- the Bears' Jay Cutler, the Eagles' Michael Vick and the 49ers' Alex Smith -- suffered concussions. Now the NFL Players Association wants a specialist even closer. In a push to improve the process of getting injured players off the field, the NFLPA is asking the league to have a dedicated neurologist on the sideline.
In the past three years, the NFL has made serious attempts to make the game safer. In addition to having a doctor in the booth, tougher rules have been set to protect the quarterback and deter tacklers from leading with the head. Every Friday the league announces fines and, in egregious cases, suspensions for illegal hits.
But even with rule changes and independent trainers, can the game ever really be safe?
"We're not declaring victory," NFL commissioner Roger Goodell said during an interview on ESPN's "Mike & Mike in the Morning." "There's still work to be done."
Dr. Vernon Williams, the medical director for the Kerlan-Jobe Orthopaedic Clinic's Sports Neurology department in Los Angeles, said the NFL has made tremendous strides. The recognition of symptoms and new medical protocols are better protecting players, but it's a fast game played by big guys.
"It is impossible to completely eliminate concussions from the game," Williams said.
The brain is a tricky organ. Williams said symptoms might not appear immediately after impact. At times, a player might exhibit signs of brain injury 20 minutes after the event and may have been playing the whole time. The risk of a second impact is real, and it's the one that would cause more damage.
Players may know what repeated impact can do to their brain, but many will opt to stay in a game despite injury. It's hard to balance the security of this week's paycheck against possible memory loss and reduced mental function later in life. It's the same reason some players go broke; in short term vs. long term, short term wins.
For the players' association, the request for sideline scrutiny is as much to assist team doctors as it is to protect players from their own worst instincts. There is a fear team doctors might let competitive interest cloud judgment, keeping a player in the game despite a possible concussion. The flip side of that, Williams said, is a relationship between a team doctor and a player may allow that doctor to pick up subtle signs of head trauma.
Because of these new measures, teams are no longer supposed offer a diagnosis of "he got his bell rung." Yet, the Washington Redskins did just that when they said quarterback Robert Griffin III was "shaken up" earlier this season when he first sustained a concussion. Griffin did leave the game but played the next week.
McCoy's experience last season and hearing a player characterized as "shaken up" this year, indicates there is still room for improvement in the efforts to keep concussed players off the field.
"There's a lot of work that needs to be done to change the culture," Williams said.
Players have to be rewarded for honestly reporting symptoms, even if they seem as nebulous as being off balance or losing the car keys. And the league and players' association need to keep working together to make the game as safe as possible.
There may never be a way to completely remove the risk of head injury. But adding a neurologist on the sideline could be the next step in keeping players from taking an unnecessary risk.