How does NFL protocol work? What does Tua Tagovailoa’s hit mean?

The severity of Tagovailoa’s concussion is unknown but he will have to undergo a five-step procedure before he can return to the field.

WASHINGTON — Tua Tagovailoa stumbled to the ground, his legs were shaky and he was unable to walk to the group after hitting his head on Sunday. And then, Thursday night, he was carried off the field on a stretcher after another hit caused his head to bang violently against the turf and freeze his hands.

The Dolphins said the third-year quarterback is conscious and has movement in all his extremities. He was taken to the University of Cincinnati Medical Center but released and scheduled to return to Miami with the team.

“It was a scary moment. He was evaluated for a concussion and is on the concussion log,” said Dolphins coach Mike McDaniel.

Some who have been watching the scary injury want to know why Tagovailoa was playing just four days after his quick return on Sunday, prompting a joint review by the NFL and the NFL Players Association.

Many former players criticized the decision to allow Tagovailoa to return against Buffalo and the starting XI against Cincinnati.

“Player health and safety is central to the union’s mission,” the NFLPA wrote on Twitter. “Our concern tonight is for Tua and we hope for a full and speedy recovery. Our investigation into the possible breach of protocol is ongoing.”

NFL executive vice president Jeff Miller said the review typically takes a week or two.

“Everything points to it from our point of view,” Miller said of the team and its doctors following Sunday’s concussion transcript. “I know the player, the coach and others have spoken about it. And we are engaged in this review now. So we’re going to come back with a formal answer to that question, something we want to be a part of.”

Before the game, Chris Nowinski, a founder of the Concussion Legacy Foundation who played football at Harvard, said, wrote on Twitter: “If Tua takes the field tonight, it will be a massive step backwards for concussion treatment in the NFL. If he has a second concussion that destroys his season or career, everyone involved will be sued and should lose their jobs, including coaching. We’ve all seen it, even you must know that’s not right.”


Tagovailoa appeared disoriented after the team originally said it was a head injury after suffering a hard punch from Bill’s linebacker Matt Milano late in the first half. He missed just three snaps and returned after halftime. Tagovailoa and the team said a back injury was the reason for his instability after scoring and he was not on the concussion log. It was questionable whether he could play on Thursday, but the game started.


A player who displays or reports symptoms or signs indicative of a concussion or stinger enters the log.

During each game, independent certified athletic trainers (ATC spotters) monitor players on the field. If they see an impact to the head they are called a time-out and the player must be removed from the game, examined and assessed. Team coaches, coaches or physicians, teammates, NFL game officials, unaffiliated neurotrauma counselors (UNC), or stand ATCs may also initiate the protocol.

Any player with a concussion undergoes a six-stage evaluation by a team doctor and UNC to determine the severity of the injury and whether or not they are fit to return to the field. The final step is a neurological exam with examination of the cervical spine, including range of motion/pain, assessment of speech, observation of gait, eye movements, and pupillary examination.

If any items are positive, inconclusive, or suggestive of concussion, the player will be escorted to the locker room.

In the locker room, a team doctor and UNC perform a full neurological exam and complete the NFL Standardized Concussion Assessment Tool.

If there are any abnormalities, the player does not return to the game, is regularly examined by a medical team and undergoes a neurological follow-up examination.

The league introduced the system in 2011 after Cleveland Browns quarterback Colt McCoy suffered a helmet-to-helmet hit in a game and returned without being tested for a concussion. The Browns said the team’s coaches didn’t see the goal because they cared about other players and that no one told them about it. After the game, McCoy was diagnosed with a concussion.


According to, “The arms often go into an unnatural position when a person experiences an impact strong enough to cause a traumatic brain injury, such as a concussion.”

Tagovailoa appeared to assume that position, his fingers crooked awkwardly in front of his face mask for a few seconds as he lay on the grass.

“The fencing reaction is often seen when a player is knocked down or knocked out in full-contact sports competitions such as soccer, martial arts, boxing, rugby and hockey,” according to

It happened to Los Angeles Chargers tight end Donald Parham during a Thursday night game against Kansas City on Dec. 17. Parham was removed on a stretcher and stayed overnight at a hospital for observation after being diagnosed with a concussion.


The severity of Tagovailoa’s concussion is unknown, but it seems encouraging that he was allowed to fly with the team. He must undergo a five-step process before he can re-enter the field. The fifth phase is full training followed by clearance from the team doctor. He must then be examined by an independent neurological specialist.

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