NFLPA to investigate the NFL, Dolphins’ handling of Tagovailoa concussion evaluation originally appeared on NBC Sports Boston

Dolphins quarterback Tua Tagovailoa left Sunday’s game after a heavy hit from Bills linebacker Matt Milano in the second quarter. He initially attempted to shake it off, but stumbled and was subsequently sent to the locker room for further evaluation. 

“It was sore when it did happen. But I mean, any competitor that would’ve never wanted to come out would’ve did the same thing,” Tagovailoa said. “So I was just trying my hardest to get back up and get the next play and run it.”

While backup quarterback Teddy Bridgewater filled in for the remainder of the half, Tagovailoa returned to the lineup by the third quarter and led the Dolphins to a 21-19 win over the Bills. 

In the hours since the game ended, the NFLPA reportedly launched an investigation into the Dolphins’ concussion protocol when evaluating the quarterback. 

Who determines the NFL Concussion Protocol?

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The NFL Head, Neck and Spine Committee -- a panel of physicians and scientists -- convene every year to determine the concussion protocol for the season. 

Who enters the NFL Concussion Protocol?

According to the league, a player enters concussion protocol if they: 

• Exhibit or report symptoms or signs suggestive of a concussion or stinger (nerve pinch injury) or,
• The team Athletic Trainer, booth ATC spotter, team Physician, NFL game official, coach, teammate, sideline Unaffiliated Neurotrauma Consultant (UNC) or booth UNC initiates the protocol.

What is the NFL Concussion Protocol?

Any player in concussion protocol then undergoes a six-step evaluation to determine the severity of the injury and whether or not they’re fit to return to the field. The six steps are:

1. No-go (automatically will not return to play)
   1. Loss of consciousness
   2. Confusion
   3. Amnesia
   4. Gross motor instability as determined by a team physician
2. History of event
3. Concussion Signs/Symptoms
4. Madden’s questions
5. Video review
6. Focused neurological exam
   1. Cervical spine exam (includes range of motion)
   2. Evaluation of speech
   3. Observation of gait
   4. Eye movements and pupillary exam

If any elements of this six-step process prove positive, the player is then ushered to the locker room for further examination. In the locker room, a team physician and unaffiliated neurological consultant conducts a full neurological exam and complete NFL Standardized Concussion Assessment Tool (SCAT.)