Explaining the NFL’s new concussion protocol, why it kept Bridgewater out of Dolphins game

The Dolphins became the first case study for the NFL’s updated concussion protocol on Sunday, as the league’s new no-go symptom kept quarterback Teddy Bridgewater out of the team’s 40-17 loss to the New York Jets.

Bridgewater was sidelined after just one offensive play because an independent certified athletic trainer (ATC) situated in an upstairs booth said he stumbled and showed signs of ataxia — abnormality of balance/stability, motor coordination or dysfunctional speech — a symptom that bars a player from returning to the game.

Cornerback Sauce Gardner slammed Bridgewater into the ground at MetLife Stadium and Bridgewater hit his head on the turf, a play that was flagged for intentional grounding and gave New York two points on a safety after the quarterback released the pass from the end zone.

As Bridgewater headed to the sideline, he entered the blue medical tent. The Dolphins announced he had an elbow injury and was being evaluated for a head injury. A person with a red hat — which signals they are an unaffiliated neurotrauma consultant (UNC) assigned by the league and NFL Players Association to assist teams with the diagnosis of head injuries — entered the tent at one point.

Bridgewater then exited the medical tent and headed to the locker room with the consultant. Several minutes later, Bridgewater was ruled out for the remainder of the game due to the ATC Booth Spotter saying they saw Bridgewater stumble. This kept him out even though he passed the concussion evaluation and wasn’t showing signs of a concussion.

According to the league’s protocol, a player is to be removed from a game after a hit to the head if he exhibits or reports signs of concussions, or if a team’s athletic trainer or doctor, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNC spot a sign of a concussion.

A player suspected of a head injury is then administered a sideline survey by the team doctor and consultant. This includes checking for the no-go symptoms — including ataxia, they are loss of consciousness, confusion and amnesia — reviewing video, asking the player to recall the play in which he was hit, giving him a standardized test for concussion assessment and conducting a focused neurological exam.

If the player clears the sideline survey and video doesn’t bring up any red flags, he can return to the game. But if the sideline survey reveals signs of a concussion, is inconclusive or creates suspicion of a head injury, the player is taken to the locker room for further evaluation, which includes a complete NFL Standardized Concussion Assessment Tool (SCAT) and neurological exam.

If the player clears the locker room evaluation, he can return to play, but if not, he can’t return to the game and must stay in the locker room for further medical evaluation and a follow-up neurological exam.

The alteration of the protocol and addition of the ataxia term was announced by the league and NFLPA on Saturday and took into effect Sunday. It came in response to a review of Tua Tagovailoa’s concussion check on Sept. 25. Tagovailoa stumbled after hitting his head on the ground against the Buffalo Bills, but passed the concussion evaluation in the locker room and was able to return to the game. He later said a back injury caused him to wobble.

Four days later, Tagovailoa sustained a concussion and had to be carted off the field on a stretcher against the Cincinnati Bengals, sparking questions about why Tagovailoa returned to the Bills game and was permitted to play on “Thursday Night Football.”

The league and NFLPA said the Dolphins’ team doctor and the neurotrauma consultant followed the league’s step-by-step protocols on Sept. 25 but “the outcome in this case was not what was intended when the Protocol was drafted.”

Ataxia replaced the “gross motor instability” no-go symptom; a player could return to a game if the team physician and consultant concluded that the instability was not the result of a neurological issue. Now, any instability after a hit to the head is deemed to be a neurological issue and sidelines a player for the rest of the game.

Video captured by local South Florida TV cameras at MetLife did not show an obvious stumble from Bridgewater after he was hit, prompting questions about what caused the Booth ATC Spotter to rule him out.

Dolphins coach Mike McDaniel on Monday said he didn’t see Bridgewater stumble but indicated the team wouldn’t press the league for an explanation of what the spotter saw.

Because the spotter ruled Bridgewater out due to the ataxia no-go symptom, he is in the league’s concussion protocol and must clear the league’s five-step process to return to the field. McDaniel said Bridgewater is feeling fine but wouldn’t be able to return to practice in a limited, non-contact capacity until Thursday.

McDaniel said Tagovailoa, who remains in concussion protocol, “is not ready to take the step to do some football stuff yet” but is being reevaluated every 12 to 24 hours.

If neither Tagovailoa nor Bridgewater can play in the team’s Week 6 home game against the Minnesota Vikings, seventh-round pick Skylar Thompson would make his first NFL start.