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THE ROLE OF THE UNAFFILIATED NEUROTRAUMA CONSULTANT IN THE NFL

THE ROLE OF THE UNAFFILIATED NEUROTRAUMA CONSULTANT IN THE NFL. John D. Davis IV, MD, MHS NFL Unaffiliated Neurotrauma Consultant NewSouth NeuroSpine Flowood, Mississippi MASI – Biloxi, MS 9/20/18. NFL CMO. Dr. Allen K. Sills Starkville, MS MSU grad in Biological Engineering - 1986

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THE ROLE OF THE UNAFFILIATED NEUROTRAUMA CONSULTANT IN THE NFL

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  1. THE ROLE OF THE UNAFFILIATED NEUROTRAUMA CONSULTANT IN THE NFL John D. Davis IV, MD, MHS NFL Unaffiliated Neurotrauma Consultant NewSouth NeuroSpine Flowood, Mississippi MASI – Biloxi, MS 9/20/18

  2. NFL CMO • Dr. Allen K. Sills • Starkville, MS • MSU grad in Biological Engineering - 1986 • Johns Hopkins for med school and neurosurgery residency • Vanderbilt Professor of Neurosurgery • Named first Chief Medical Officer in NFL history (3/26/17) WWW.NS2.MD

  3. MS CONNECTION WWW.NS2.MD

  4. CONCUSSION • Definition (CDC): a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells WWW.NS2.MD

  5. CONCUSSION • Definition (AANS): a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma; normal brain imaging • NOTE: DOES NOT REQUIRE LOSS OF CONCIOUSNESS WWW.NS2.MD

  6. CONCUSSION • WHY DOES IT MATTER? • SECOND IMPACT SYNDROME: acute, rare, and life threatening brain swelling resulting from a second impact that occurs shortly after and before fully recovering from a concussion. Avoided by recognizing a concussion and removing from play. WWW.NS2.MD

  7. CONCUSSION • WHY DOES IT MATTER? 2) Chronic Traumatic Encephalopathy (CTE) • Can only be definitively diagnosed with path exam of brain (post-mortem) • Future Dx with specialized PET scan? • Assoc w emotional/psych/behavioral disorders and progressive dementia • JAMA 2017 (Mez, et al) showed that 110/111 former NFL players had CTE - SELECTION BIAS WWW.NS2.MD

  8. CONCUSSION 2) CTE (cont.) - Some research indicates that CTE may result from repeated SUB-CONCUSSIVE traumatic brain injury (TBI) - Could focus on concussion be moot? - How much “jarring” is too much? WWW.NS2.MD

  9. CONCUSSION • WHY DOES IT MATTER? 3) LITIGATION -NFL Concussion Class Action Lawsuit in effect 1/7/17: almost $540mil paid out to date; up to $5mil/case • NCAA 2017 Class Action suit settlement for $70mil for future “medical monitoring” and $5mil for concussion research • Ploetz v NCAA re: CTE settled 3 days into the first jury trial (June, 2018) WWW.NS2.MD

  10. LITIGATION WWW.NS2.MD

  11. NFL • 16% increase 2017 vs 2016; Why? Better Dx? • 15% of 2017 concussions were in preseason practice WWW.NS2.MD

  12. NFL RESPONSE • Player safety comes first • Transparency re: concussion in the NFL • www.playsmartplaysafe.com • First CMO in NFL history is neurosurgeon with concussion expertise • 4 pronged approach WWW.NS2.MD

  13. 4 PRONGS • RESEARCH • EQUIPMENT • RULES • RECOGNITION/TREATMENT WWW.NS2.MD

  14. RESEARCH • 9/14/16 – NFL Commissioner, Roger Goodell, announced $100mil in grant money for engineering advancement and medical research in addition to $100mil previously pledged for medical and neuroscience research WWW.NS2.MD

  15. EQUIPMENT Poor performing helmets are being phased out of the NFL WWW.NS2.MD

  16. EQUIPMENT WWW.NS2.MD

  17. EQUIPMENT • Mark Horstemeyer, PhD • Mechanical Eng Prof at MSU/Founder Yobel Technologies • July, 2018 NFL grant recipient • Observations of rams/woodpeckers • Facemask (abt 1/3 of conc in 2015 & 2016) • Simulations; MSU supercomputing WWW.NS2.MD

  18. RULES WWW.NS2.MD

  19. RULES • Playing Rule #11, Article 8—Use of the Helmet—It is a foul if a player lowers his head to initiate and make contact with his helmet against an opponent. It is a penalty that will result in the loss of 15 yards. If the foul is by the defense, it is also an automatic first down. The player may be disqualified. WWW.NS2.MD

  20. RULES • Data from study of film of concussions WWW.NS2.MD

  21. RECOGNIZE/TREAT • WHAT IS AN UNAFFILIATED NEUROTRAUMA CONSULTANT (UNC)? • WHAT IS THE NFL? • NFL - Private corporation with a “board” made up of one rep from each of 32 teams; “CEO” Roger Goodell; HQ in NYC; distributes pooled revenue (equally) and makes rules, etc. • Teams/Owners – City of GB vs Jerry Jones vs multiple; Cowboys franchise worth abt $4B • Players’ Association (NFLPA) – represents interests of players in all discussion/negotiation WWW.NS2.MD

  22. RECOGNIZE/TREAT • HISTORY OF UNC PROGRAM • STARTED IN 2014 • NFLPA ASKED FOR INDEPENDENT PHYSICIAN WITH SPECIAL EXPERTISE IN NEUROTRAUMA ON SIDELINE • TEAM PHYSICIANS ARE EMPLOYED BY THE TEAM • UNC CONTRACTS SOLELY W NFL WWW.NS2.MD

  23. RECOGNIZE/TREAT • ROLE OF UNC: • (3) UNCs per game – one on each sideline and one booth UNC (each city has 5-6 local docs + NFL has a pool of abt 12 subs) • Medical team meeting one hour before KO • Radio contact with all medical personnel and spotters • RED hat • Any player ID’d with possible concussion or stinger gets pulled from play and evaluated WWW.NS2.MD

  24. RECOGNIZE/TREAT • Who can stop play for an evaluation? • Trainer (sideline or booth spotter) • Team doctor • Coach • Ref or NFL official • Teammate • Player (nearly 50%) • UNC (sideline/booth) WWW.NS2.MD

  25. RECOGNIZE/TREAT • Maddock’s Questions: • What’s the venue? • What half is it? • Who scored last in the game? • Who did you play last week? • Who won your last game? *all done inside the tent to prevent “cheating” WWW.NS2.MD

  26. RECOGNIZE/TREAT • ROLE OF UNC: • Team physician performs the evaluation and makes decision re: RTP • UNC oversees the eval, confirms that all proper steps have been followed and records the results (oversee and scribe) • Failure of team to properly evaluate or inappropriate RTP = escalating fines • Fail sideline = locker eval; fail locker room eval = stay in locker/cont concussion protocol WWW.NS2.MD

  27. SUMMARY • CONCUSSION IS A HOT TOPIC DUE TO 1) SECOND IMPACT SYNDROME, 2) POSSIBLE RELATIONSHIP WITH CTE, AND 3) LITIGATION • THE NFL IS TAKING THE LEAD VIA 1) RESEARCH FUNDING, 2) BETTER EQUIPMENT, 3) RULE CHANGES, AND 4) RECOGNITION AND MANAGEMENT OF CONCUSSIONS • ONE OF OUR OWN IS LEADING THE WAY • WOULD I LET MY SONS PLAY FOOTBALL? YES • DO I SEE/TREAT CHRONIC POST-CONCUSSIVE HEADACHES? NO. NEUROLOGISTS DO. WWW.NS2.MD

  28. DISCLAIMERS • THE MATERIAL FOR THIS TALK WAS REVIEWED BY THE NFL FOR FACTUAL ERRORS ONLY • I AM IN NO WAY ACTING ON BEHALF OF OR AS A REPRESENTATIVE OF THE NFL TODAY • ALL MEDICAL OPINIONS EXPRESSED TODAY ARE SOLELY MINE AND NOT THOSE OF THE NFL WWW.NS2.MD

  29. THANK YOU WWW.NS2.MD

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