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Q&A: NFL execs discuss Player Health & Safety Report with media

Last week, the NFL previewed the "NFL 2013 Health & Safety Report" during a media briefing at the league headquarters in New York. Here is a transcript of the discussions regarding the report:






Wednesday, September 18, 2013

Opening Remarks

Roger Goodell:We are making significant progress on player health and safety matters and that is reflected in the work that is being done.

As you know, a couple of years ago I asked Dr. York to chair our committee on all of our medical efforts. We have close to 15 committees or subcommittees throughout the league that are focusing on various medical initiatives. That needs to be coordinated. It is a difficult and very broad and important job. Dr. York has a committee that is actually meeting shortly, in a few minutes, to continue that work. It has been incredibly effective for us as a league to make sure all of those dots are connected, and we are working cohesively across those different committees. I am thankful for his time, effort and expertise, because he is our only physician in the NFL on the ownership level. He has done a terrific job.

Jeff Miller is our senior vice president of health and safety policy. Health and safety is his sole focus. He reports to me. He is working on all of our various initiatives, whether it is NIH, or the GE initiative. He is focused on that work. He is also focused on working with our partners on youth football. All of that effort is very important to us, and Jeff is doing a terrific job.

Rich [McKay] is the chair of our Competition Committee, dealing with rules and how we are conducting our games. Rich has been instrumental in that, not just through the Competition Committee, but also as president of a club.

This is something that we are happy to take questions on to make sure you all understand everything that is in this annual NFL Health and Safety report. It is another effort for us to be transparent in our work to continually make this game safer. We do believe that this game is better and safer than it has ever been.

Dr. John York:As the chairman of the Owner's Health and Safety Committee, one of our primary things is to look at what is happening on game day, and that starts with the head team physicians. If you look across the board at the 32 clubs and the institutions those physicians represent, you could take that group of doctors, who not only take care of players, but also much of the club itself, including many of the owner's families. Those institutions as well as the outside consultants that we use on the committees -- whether it is Head, Neck and Spine, Cardiovascular, Foot and Ankle, Drugs and Medication -- all of those committee members are from world-class universities, which I have described as the University of the NFL. It is very strong. It represents almost every academic institution in this country.

On the sidelines, those physicians are the key to the teams, with the head trainer, as well as the assistant trainers. Depending on who the head team physician is -- which is either an internist or family practitioner or ER doctor or orthopedic surgeon with a certificate in sports medicine -- all of those other doctors are present, too. In addition, there is an ophthalmologist, radiologist, dentist, chiropractor, there is an airway physician, and now we have the sideline neuro-trauma physician, which is unaffiliated with the clubs. That group of doctors is there solely to take care of the players.

Besides that group, we also have the trainer that is up in the press box. We've given the officials more ability to stop the game if they happen to spot an injury that someone else didn't see. The players have more access to the officials if someone is hurt. If someone is hurt we want anyone and everybody to know so they can get taken care of. Once a player is on the sideline, we do have something new this year that every club is using, which is a sideline app that is on a tablet that gives the team physicians the ability to pull up the history of the player and any problems that have been there in the past, as well as the concussion protocol to go through.

Rich McKay: Competition Committee-wise, let me start with the basics of how the rules get made. They get made by a collaborative effort by a ton of people involved. Whether it is the teams through the survey, whether it is the players' union when we meet in Indianapolis, whether it is the coaches subcommittee and Coach [John] Madden, whether it is the Player Health and Safety panel which Coach Madden also chairs, whether it is the experts that Dr. York talked about, I think we are in a really good place in the way that we not just create rules, but the way we vet the rules. We make sure that everybody understands the intent of the change and then watch the video with the experts to say, "If we make this change, can we also affect the health and safety of the players?"

We feel pretty good about the process. The process has the ultimate vetting of the teams, which is 24 votes required. If you think 24 votes are easy, then you have not tried to get 24 votes before. It is a process that works pretty well. I think it worked again in 2013 for us. We had a number of changes, one of which we have talked about for a couple of years, which is the simple idea of thigh and knee pads. It seemed like a simple idea to go back and make sure those are mandatory. Those have been a part of our game for a long time. They have existed at the lowest level. They exist at the high school level. They exist at the college level. We had gotten away from making them mandatory. We made that change, and we were a little concerned about the player pushback. I am very pleasantly surprised. I think the players have adopted it seamlessly and see the benefit of it. I haven't heard much about it.

Goodell: It has not slowed down offenses either.

McKay: No, it has not. Their great fear of their 4.4 40 time going to 4.5 or 4.6 is not necessarily happening. That was the change that took a long time for us to get through. It was one that I think was a good, solid change that we were glad we made.

The other change was one that involved a defenseless player at the center position on kicks. The interesting thing is where did it come from? It came from the coaches subcommittee, the Madden subcommittee. Some coaches looked at that play and said, "Hey, from the standpoint of success or failure, success happens a lot more than failure. In other words, we make 99 percent of our extra points, and we make 85-plus percent of our field goals, so maybe we need to change that play a little bit." The coaches gave that to us, and then the players union said they 100 percent agree. We made the change that you couldn't load up, six to one side and five to the other, and you had to treat the center as a defenseless player. We thought that was a pretty good change and one that came from the process.

The third one is one you have probably written about the most -- the crown of the helmet change. There is an example of a rule that has probably been talked about for three years, if not four. We have looked at hits, and we looked at plays in open space. We asked players, "What do we need to do to change this?" I think the players' response was, "It is not a good thing to do. It is too dangerous. You should not duck your head. We just have to be better at it." Not sure that answer was good enough as we continued to watch tape and see it happen. We felt like a rule was necessary. I think the rule has been very effective, if for no other reason that coaches have been focused on it and players are focused on it. People do not want to have fouls, so they do not want to violate the rules and get a penalty or get fined. I think it is getting taught. I think players will adjust. Rules like this take time. They literally take years for players that have been doing certain things for a long time to get it where they do not do it. I feel good about that change. It was controversial when we made it, just because the media splash it created. We did not think it would be called very much because it is a fast-action play. We thought it might get fined more often. The biggest thing that we wanted to do was on the conduct, and the way it got taught, and have that go through all of the younger players. We feel pretty good about where that is going to go.

That is really what went on in 2013 from a player-safety standpoint. I have been on the committee since 1994. When I got on the committee we spent about a week on this thing called defenseless players. We have been at player health and safety for a long time. It will always remain our No. 1 priority.

Jeff Miller: What ties together as a theme Dr. York's points about the added specialists on the sideline and the physicians who advise us at NFL University, and Rich's points about how the rules have changed and how the practices have changed, is really the point that is reflected symbolically in the cover of the health and safety report. That the game is always evolving continuously. The changes that we've made over the past few years specifically catalyzed that evolution; it's faster than it was before possibly. Some of the other initiatives that we are engaged in are trying to bring that culture change and evolution to other levels of the sport as quickly as possible. That's when we get into our work with youth football, that's where we get into the scientific research we've invested in that's where we get into spending time before the state legislatures and other bodies to try to mandate the things that we think should be done to make the game safer at every level. It's not just for football, by the way. The investments we make are going to go far beyond football. It's going to cover all sports, it will cover our military, and it will cover our society in general. So as we evolve and we change the culture, part of my job at least, under the direction of the commissioner, is to make that change faster.

Let me go over some of those initiatives. The first is Heads Up Football. This is our work with USA Football, where they started a new program called Heads Up Football to teach the game better and safer. It's really a return to basics. It insists upon teaching tackling correctly and mandates that every coach is certified in the proper tackling techniques, as well as health and safety items. It insists that there is a player safety coach associated with each league. So, one individual not dedicated to coaching his team, but rather, dedicated solely to making sure that the game is being taught appropriately and making sure that the players are protected. It insists that the equipment fits correctly, and it engages the parents. So for the first time, parents aren't just dropping their kid off on the sideline and going about their business. They are actually going down to the field and learning tackling techniques. Some of the best things we've seen as we've gone around and watched Heads Up Football in action, is the moms specifically getting down on the field with tackling dummies. It's remarkable the enthusiasm they bring to it, and it probably brings some amount of hilarity to the kids watching their mothers actually learn how to tackle correctly. It's fabulous that they want to do that. The parents understand the value of the sport, and they want to be more engaged in it in a way that is more knowing, more understanding and, especially given the concerns around the safety of all the youth sports, they want to figure out exactly what it is they need to know.

We anticipated this year that we would be talking about 100 leagues across the country. That was really the design for the pilot -- two in every state. As it turned out, once we started talking about the programming, and as Heads Up Football became a part of USA Football and became part of their discussion as they met with youth leagues around the country, we ended up with these numbers.

As we sit here today 2,800 organizations, or leagues, across the country have adopted it. The 90,000 coaches that are referenced means that 90,000 coaches have gone to USA Football and gotten certified in all of the programs, practices and techniques that I was discussing. That's 90,000 more than existed a year ago. That means, hopefully, next year there will be significantly more than that, and those 90,000 cover 600,000 kids who we know are being taught the game appropriately, and 90,000 coaches who we know can identify issues of dehydration and concussions. We actually cut off the program in terms of sign-ups this year for the purposes of quality control to make sure that it would be done correctly. The last thing we want to do is advertise numbers we can't support. So next year we are going to look to get to all 10,000 leagues across the country, and that's quite a lift. It's a lot of communities that might be hard to reach, but that's the goal. We want youth football unified in a way that it is taught safer and better.

Let me highlight a bit of our scientific work. We invested $30 million with the Foundation for the National Institutes of Health. This fall there will be an announcement, I believe in October or November, about the recipients for our first tranche of money that is being lent that will study chronic traumatic encephalopathy. We will get to that one in a second. And we are working with the NIH on the next tranche of money that we are going to be using to take a look at some of the longitudinal issues that may affect people that may have suffered a concussion at an early age and what effects that may have later in life. We will be spending time on that with NIH. This is reflective of the work we did with GE, the $60 million Head Health initiative that we partnered with GE on, that will both have a significant scientific research aspect to it as well as product development. We are going to learn how to diagnose these injuries better in ways the scientific field doesn't currently, so we teamed with the best diagnostic outfit we could find, and that's GE. So we both put up a significant amount of money to catalyze the science so we can better diagnose concussions in a more objective, scientific way.

The other aspect to that partnership with GE was two innovation challenges. This is a crowdsourcing idea where we put out really difficult problems to the scientific community around the world and say, "please help us solve them, and we will reward you if you come up with a good idea." So the first one that we launched in March just closed, and there was $10 million in prize money associated with it. That was around how to diagnose concussions better, biomarkers, algorithms, things the scientific community understands better than we do, about where the science is and how do we get it moving, and that amount of money certainly brought a number of ideas in. As you can see, people from 27 countries submitted ideas. You can see the key institutions, really the finest in this country, and others have professors, academics and others putting their time and effort into trying to solve these problems, and over the next several months we will award some of that $10 million to some of the best and the brightest of those ideas. We are beginning to go through those now.

The corollary is the second innovation challenge that we launched just two weeks ago with Under Armour as a new partner, and valued partner, in Baltimore. This is also a $10 million challenge, and this time around it's how to protect the brain better. So it could be new materials that absorb force. It could be new designs for protective equipment. It could be new ways to measure the impact. Remarkably, over the first two weeks, we've already had 10,000 people from over 60 countries visit the website. We think that the participation will be overwhelming. We will get a lot of entrepreneurs, small businesses and others to dedicate their resources, ideas and best practices to solving this issue, or addressing it, and we'll reward them significantly sometime next year with a series of prizes that add up to about $10 million.

The last point I want to make around our youth football space is our Lystedt law campaign. Washington State named a law after Zachary Lystedt, who has become a friend of the league, a 13-year-old who suffered a catastrophic injury playing football after he was returned to a game too soon following a concussion. Washington passed a law that became a model, based on international standards, for how to protect youth athletes who have suffered a concussion. The league chose to make this a point of advocacy. We sit here today three years into our work -- and not to claim all of the credit because a lot of our partners around the country certainly helped in this endeavor -- with 49 states that have passed this law. In 49 states, coaches are being educated, kids are being pulled out of sports, not just football, and most importantly not being allowed to return to play until they have seen a qualified health care provider. We are studying that work now to see what impact it had. There is a lot of scientific work being put against it, and we will see what those results are, but we are encouraged that the culture change that we have catalyzed is going to take hold and relatively quickly.

Q&A Session

On Dashon Goldson's suspension being reduced, and if it means a step back for being able to enforce player health and safety initiatives:

Goodell:I don't agree with that. I haven't seen the decision yet, so I would like to see the decision before I make any full comments. But I understand there was still a substantial fine, so it's not that there wasn't a violation of the rule, and it's not as if there weren't consequences for violating that rule. So that, in and of itself, is a shift, and a positive shift that the culture is changing. But the culture doesn't change overnight, and we will probably always have violations of the rules. We had a conference call last night with the Madden coaches committee, which is our player health and safety committee, and the overwhelming reaction is that players are adjusting to the new rules and the new techniques. It is being coached, and it is being played properly, and that is being seen by the people who are watching video. No one watches more video than John Madden, and he really has seen this, and I've heard that consistently from coaches. So I do believe this a very positive shift to the culture, and that we're always going to have things that don't fit into that culture in a period of time. People are recognizing when these hits are not made in the context of the game, and there is an immediate reaction to that.

On whether he feels the players have looked to him to protect their best interests:

Goodell: I'm not sure what that means, other than the fact is what we've done is made the game safer. The rules are better for the players. Players don't like to have their equipment mandated, but ultimately that's in their best interest long-term. What we try to do is what we think is right for the game, and we do that regardless of whether there is an immediate negative reaction or not, because long-term, that's going to be in the best interest of the players and the game.

On the possibility of fining teams for players who are repeat offenders, like the personal conduct:

Goodell: That same policy applies to violations on the field. If you have a number of violations on the field, that can eventually end up being a fine against the club. That does exist. Will we think about, during the season or offseason, making modifications to that so that there is a more direct penalty to a specific violation? That's been discussed before.

On whether there is an update on HGH testing:

Goodell: We've been very open about what we think is best for the players, best for the game and best for the kids who are watching. It shouldn't be in the game. We educate our players on the dangers of it, but we also have to have a testing program ultimately to make it effective. We've compromised as much as we can compromise within reason to still have a program that has credibility. We think it's time.

On differentiating between safe and unsafe helmet hits with the crown of the helmet rule:

McKay: I think as you make rule adjustments, you try to adjust. In other words, you don't just move too far because then the players can't adjust and they can't play the game. In this case, what was happening is that in close-line play, things happen so fast that it really wasn't in our opinion, fair to the players to put them in a position where it is all happening in close-line, and you're not having that acceleration, and you're not having that impact that we were going to put the crown-to-helmet rule in place there. That doesn't mean that it couldn't eventually be there, but we felt like when you got outside the tackle box there were conscious decisions made. It wasn't conscious that, "Hey I want to hurt the other player or hit with the crown of the helmet." It was that they've been playing the game that way for a long time now.

We've got to get in the process of getting the head out of the game, and that was one of the places we felt that we could do it, where you put a rule in, have it taught and watch it go all the way down to the high school level. We have it being taught at the youth level, and now we have to have it taught at the high school level and up. You cannot strike an opponent with the crown of your helmet. We feel like it will take a couple years for that to happen, but to the commissioner's point on culture, we think that culture will actually show up in our game. It will happen because the high school players will begin to practice that way and play that way, same with the college players and our guys. That's how we defined it. We could have started many different ways, but we looked at it as though in space there was much more of a conscious decision and many more teaching points. In close action, there is not the contact and not the problems. We obviously used the medical experts to tell us that.

On the next step:

McKay: You start where there is a pretty stark line. You know where that line is, and that's what you draw. Over time, if you feel like you're missing some plays that you want to capture and want to teach the technique differently, then you adjust. I think this is one where we felt like in dealing with the coaches and talking to the players that they would be able to understand what the rule was and be able to play the game, which is important. We felt like it would help us teach the technique all the way down.

On the players having more on-field access to officials:

York: In the past, the officials had no role in determining whether or not a player was injured. What we've done through the director of officiating, and through what the players association has also asked, is that if there is something going on that the trainers, physicians or coach do not see from the sideline, and it's missed or not detectable from the trainer in the sky that is watching both clubs for any injury, the official can stop the game if a player tells him that he thinks another player is injured or if a player walks into the huddle wobbly. In the past the official did not stop the game. Today, either the player can go to the official, or the official can stop the game without a team timeout.

On whether the official makes the assessment:

York: The official does not make the assessment. The official just becomes part of stopping the game so that [medical personnel] can assess.

On whether an official has stopped a game for that reason this season:

McKay: It happens a lot. It is a pretty typical occurrence. We have told the officials, when in doubt put the player out. When in doubt, let's stop the game; let's call an injury timeout. Let's put the player to the side, which means they have to miss one play, and make sure they get looked at. There were a couple plays last year where people said, "Hey, why wasn't the player taken off the field?" There was a memo sent mid-last year to officials to be on the lookout for this and again in the Competition Committee report this year. We emphasize that all officials, every official on the field, all seven should be on the lookout. If they see a player that they deem could be injured, then get that player to the sideline, and let the medical people deal with it.

On how medical findings could impact rules if there is a preponderance of injuries on certain plays:

York:First, for 35 years we have been doing injury surveillance studies. About three years ago, we completely updated the injury surveillance, and we keep track of those injuries. Those injuries are then looked at by the Competition Committee. Rich happens to sit on the Owner's Health and Safety Committee, primarily because the Competition Committee has started to deal so much with health and safety. I am not on the Competition Committee, but Rich and his committee invite me to those meetings, which I attend primarily in Indianapolis, so there is as much lockstep as possible. There is no point in the Owner's Health and Safety Committee duplicating what they did.

McKay: What Dr. York just said is right. We start with the idea, what does the data tell you? That's really how we got the kickoff change. What the data told us was, we were having too high of an incident of concussions on kickoffs. We looked at a lot of different ways of changing the way the play could be made. And really the one thing we had to do is to reduce the return number. We went back to where the kickoff line had been, 12 years to 15 years before, and we reduced concussions by 40 percent. So that injury surveillance data really spoke to us with respect to change that was necessary.

What you traditionally do is take that data, and you watch the tape. And what the tape does is tell you whether there is a trend. Is there a rule change you make that can affect those numbers? If there is, let's propose, and let's get it out there. With respect to the kickoff rule, what happens was when we watched the tape they came in at all different places. They came at the tackle, they came at the runner, they came at the blocker, they came at a blocker that got trapped blocked from the other side. They came at all different ways, and so we really didn't have a way to modify the play and reduce the numbers. That was why we made the suggested change we did. It starts with data, and the data is then usually tied immediately to the tape, the film. Watch the film and say, "Is there a rule change?" Take that to the players, and then say, "Players if we did this, number one, could you play the game, and how would you modify? Number two, what are the unintended consequences? Number three, how do we officiate?"

What additional data could help?

McKay: It's a good question. I think the biggest change I've seen in the Competition Committee is the expertise that's been brought to the table by the doctors and the medical staff. That is really helpful information. It confirms what we see on video, and it drives you there. So if there's more information they bring to the table that helps us, sure, it can help. But I think doctor, your point is an important thing. The surveillance information we have now is very good. You can tie that surveillance information to these numbers of injuries, on these types of plays and it goes right to video, and that gives you a very good look at what is going on.

On whether there will be rules to protect players from low hits and hits that result in knee injuries:

McKay: Any injury that occurs is going to be looked at. You're going to look at the play and ask, "Is there some rule change that should be in place given what's happened here. Are there more than one? Are there more than five? Are there more than 10? Do we need to do something?"

Let's talk about the low hit to the receiver. When we emphasized this back in 1994, the greatest concern was, "Hey, you've taken out this area, now where are they going to hit?" Well now hold it. You've got from here all the way to here [motions] -- you've got a target zone, and they have played their game that way. Now every year or so, we end up with a low hit that doesn't look good and ends up in a really bad result for the player. So we'll go back and look at it again. But you do have to give the defender a place to hit, so that's why we've left it alone, and we're not really sure we've had that problem. The play this year was very tough. Very tough for the player and very tough for his season and his career, which is a shame, and you have to go back and look at those. But you want to make sure that you've given the defensive player a place to play the game.

With respect to low hits, we brought in this year offensive line coaches, defensive line coaches, defensive linemen and linebacker coaches to the Competition Committee to talk about cut blocking, to talk about that very play and those types of plays, and they really came out recommending no change. Do I think you'll go back and talk about it again? You will because we've talked about it numerous times. We've made a lot of changes in close-line play. Over the years, we've added chop block restrictions from two persons removed, you can't clip. I heard the other night somebody say you shouldn't be allowed to clip. Well, you haven't been allowed to clip for about 10 years now in what is known as a "no-clipping zone." We've made a lot of changes but it doesn't mean that there wouldn't be more.

-- NFL Communications

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