The National Football League has come a long way when it comes to providing each and every player with the best health and safety protocols as possible.
The Kansas City Chiefs, along with several officials from the NFL, explained the details of those protocols on Wednesday, where Chiefs' Vice President of Sports Medicine and Performance Rick Burkholder articulated it best.
"We worry about players first and winning second," Burkholder said, stressing the importance of cooperation among everyone involved on game day. "We want to make sure we're all on the same page for the safety of the player. I want to win, but we have to take care of each other."
Here's a look at several of the ways the Chiefs and teams around the NFL are doing just that.
The 60-Minute Meeting
Prior to every single game, medical staff from both teams, including the unaffiliated medical staff in the stadium, get together to discuss how to handle an injury down to the last detail.
"It includes the head referee, the team physicians from both teams, the head athletic trainers from both teams, the unaffiliated neuro consultants, the spotters in the booth, ambulance personnel and the airway management person," Burkholder explained. "We go over all the mechanics of if there's an injury timeout from the booth and how it works with the other team. We're all tied in together."
That cohesion is critical as everyone involved works together to take care of both teams on the field.
"There's a minimum of 30 medical people - that's [unaffiliated neuro consultants], athletic trainers, physicians, X-ray techs, paramedics – and they're taking care of both teams," Burkholder said. "We're obviously taking care of our team, but we're available to take care of the other team, too. At the 60-Minute Meeting, we'll tell the other team's medical staff that we'll see them on the field, where we'll usually meet again and knock out any more details."
In addition to those 30 individuals, NFL Executive Vice President of Health and Safety Policy Jeff Miller explained how the league is trying to provide visiting teams with the resources that they need.
"One element that we added a couple years ago is the Visiting Team Medical Liaison, or VTML," Miller said. "Every team that is traveling across state lines to play another team is met when the plane lands by a licensed physician from that state to cater to every need that they may have in that state. He or she stays with them from the moment the plane touches down until it leaves."
The Emergency Action Plan
The 60-Minute Meeting is an opportunity to discuss the larger plan that is already in place.
"Every NFL franchise is responsible for an Emergency Action Plan at their stadium," Burkholder said. "We turn it in to the NFL before the season for approval. [In fact,] ten days ago, we practiced for eight hours as if a player went down."
When a team travels, they're introduced to that stadium's EAP upon arrival.
"They lay it out on paper for us," Burkholder said. "We also have it on an app on our phones."
Burkholder went on to explain what happened to wide receiver De'Anthony Thomas when he broke his leg last season in Denver and how the plan was carried out.
"He was taken to X-ray on a cart and from there he was taken to the hospital in an ambulance, which was waiting on the ramp," Burkholder said. "There was a trauma surgeon waiting there for him because this was all rehearsed during our 60-Minute Meeting. They called me before we even took off from Denver that the surgery was done and he already had a rod in his leg. That's how this league works medically."
Signage in the Locker Room
The mission of preventing injuries in the first place begins with the equipment on the field.
"There are posters that every team has received with rankings based on the [findings] of biomechanical engineers and laboratory experiments on which helmets and cleats perform the best," Miller explained. "What we did this year, in conjunction with the Player's Association, is to prohibit players from wearing certain helmets on the field."
It's a change that has been largely welcomed across the league.
"This time of year is super important for our equipment managers," Burkholder said. "At the beginning of (Organized Team Activities), every player had to wear a helmet in the 'green' area on the poster to at least try it out. That's a huge cultural change, because some of these guys have played in the same helmet since they were kids. This spring has been monumental for us."
It's not just helmets, either, as proper footwear is being emphasized more than ever before.
"In each practice facility now, there's a 3D scanning device produced by HP for players' feet," Miller said. "Once their feet are scanned, a cleat recommendation will appear for the shoe that fits them best and can best serve them from a health and safety perspective as well as a performance perspective."
Burkholder explained how the Chiefs have been implementing that technology.
"Our Equipment Manager, Allen Wright, probably doesn't get enough credit for how good he is," Burkholder said. "He's been in front of this whole process. Footwear used to be apparel. Now, we look at it as protective equipment. We want it to fit correctly and for it to be the right shoe for the surface that we're on."
The Spotter's Booth
If an injury does occur on the field, that's where coordination between the various medical professionals on hand comes in - such as in the Spotter's Booth high above the action.
"This is where the athletic trainer spotters sit during the course of the game," Miller said. "We have two athletic trainers up here – one for each sideline - and two techs that support them. They can then talk to the team medical staff on the sideline through a communication system and tell them if they need to take a look at something."
And while this process was originally put in place to spot concussions, it exists for all types of injuries.
"This is for every injury," Miller explained. "Let's say a player comes off the field and is limping, Rick can call up to the booth and ask for them to show him what happened to the player on video. They'll cut the play down and send it down to the field, where the medical staff can have a better idea of how to treat the player."
On-Field Video Replay
That brings us down to the field where that replay technology - and the ability to control it - is readily available.
"Here is where you communicate with the spotter in the booth as well as the technician, who can run a replay," NFL Vice President of Football Technology Solutions John Cave said. "One of the things that we're doing this year is that we're providing the ability for the medical staff on the field to control the replay themselves on the field. It saves time and doesn't require that back and forth communication."
There's also a direct phone line in place in case the headset communication isn't working for any reason.
The On-Field Blue Tent
The first step of evaluating a potentially injured player – including those with suspected concussions – occurs in the “blue tent” on the sideline.
"The International Sports Concussion Experts get together and they come up with what their standards are for concussion treatment and evaluation," Miller said. "Between the publication of their paper last May and the beginning of last season, we adopted all of their protocols and mandated them on the sideline."
Deploying those protocols is where the blue tent comes in.
"If a player suffers a blow on the field that's identified up in the booth or by the medical staff on the sideline – or if there's some indication that a player has a symptom of a concussion – that player is brought to the blue tent in the first instance for an evaluation, which was incorporated for privacy," Miller said. "It was our estimation that you can receive a better evaluation in a tent as opposed to being watched by 80,000 people."
That evaluation then determines what happens next.
"If you get red-flagged, you go right inside," Burkholder added.
The Athletic Training Room
If it's determined that a player needs further evaluation – or in any other circumstance where an injured player requires treatment – they'll be brought to the Athletic Training Room.
"In here, we'll have seven certified athletic trainers, usually four to five physicians and a chiropractor, then the [unaffiliated neuro consultants] and airway management people come in too," Burkholder said. It's an active game day place. If they have a concussion and we bring them in, they'll go into [an additional office inside the Athletic Training Room] and close the door."
That's where the technology comes in, whether it be for a concussion or some other injury.
"We have everything on [tablets]," Burkholder said. "Every player, before taking the field for the Kansas City Chiefs in a contact practice, [provides] a [medical] baseline. This is my bloodline to making sure that they're OK on the field. If a player suffers a concussive event and we determine in the blue tent that he needs to come inside, this is what we use."
Every player's medical history is also available through an online database at a moment's notice.
The X-ray Room
If it's determined that a player needs an X-ray performed, that technology is available on hand.
"Every stadium in the National Football League is required to have X-ray equipment," Burkholder said. "If there's a player that gets an X-ray in here, we can download it digitally so that we can either look at it in the X-ray room or in the locker room. It also goes into their permanent electronic record. It's streamlined and good for the player. We also have the ability then to get it back to the player's doctor back home."
It all adds up, from the individuals up in the Spotter's Booth to the medical professionals on standby at nearby hospitals, to a detailed and proactive strategy meant to provide the league's players with the absolute best technology, information and care possible.