MEMO
TO: Team Physicians, Team ATCs, Team Neurological Consultants
FROM: Hunt Batjer MD, Richard Ellenbogen MD, Co-Chairs Head, Neck and Spine Committee
RE: NFL Concussion Guidelines

With the NFL 2011 regular season about to begin, the HNS Committee wants to remind you ofsome important points in the game-day care of NFL players diagnosed with a suspectedconcussion:

1. NFL SIDELINE EXAM: We previously sent you the NFL Sideline Concussion Assessment Protocol, which was introduced this year at February?s Combine. It was developed through a collaborative effort of NFL team physicians, ATCs and the Head, Neck and Spine Committee and reviewed by numerous medical experts with decades of experience diagnosing and managing concussions. It is intended to be used as a guide for your medical assessment of NFL players suspected of having a concussion. It includes, in the red box, the 6 obvious signs of disqualification that are a “NO GO” (meaning that the player should not be allowed to return to play). Any player suspected of having a concussion is a ?NO GO? and does not return to play in the same game or practice, and cannot return to play at all until he is cleared by both his team physician and an independent neurologist.

2. THE MADDEN RULE: Named for John Madden, who suggested it, this rules states that, if aplayer is diagnosed with a concussion and removed from a game, he must leave the field and be immediately escorted to the locker/training room, and a member of the medical staff (e.g., an ATC, paramedic, MD, fellow, or resident capable of medical intervention) must remain with the player to observe him if his injury does not require immediate hospitalization. There are no exceptions to this rule and the player is NOT to return to the field under any circumstances. The Madden Rule is intended to protect the players. It provides a quiet environment to permit the player time to recover without distraction. This rule has been endorsed by the NFL Competition Committee and approved by the Commissioner.

3. WHEN IN DOUBT LEAVE THEM OUT: If you have any suspicion about a player being concussed, remove him from the game. Always err on the side of caution.

NFL Health and Safety MEMO (PDF)