2015 NFL HEALTH AND SAFETY REPORT TABLE OF CONTENTS

Message from Commissioner Roger Goodell...... 4 Message from Dr. John York...... 5 All-Pro Innovators: Leading the Way in Health and Safety Science...... 6 Message from Dr. Betsy Nabel...... 8 Special Teams: Medical Committees Advance Safety Head to Toe...... 9 Head, Neck and Spine Committee...... 10 Engineering Subcommittee...... 12 Cardiovascular Health Subcommittee...... 13 Foot and Ankle Subcommittee...... 14 Head Health: Partnerships, Projects and Progress...... 15 GE-NFL Head Health Initiative...... 18 From the Bench: NIH Researchers Turn Grants Into Answers...... 19 Game Plan: Q&A With Dr. Betsy Nabel, the NFL’s First Chief Health and Medical Advisor...... 20 Rules, Roles and Resources: Making a Difference on the Field...... 22 Measuring Progress...... 24 Taking Action From Above: The Medical Timeout...... 25 Expert Teams and Technology Strengthen Medical Support...... 26 Honoring Our History: A Lifelong Commitment to Former Players...... 28 Screening Events Boost Health and Save Lives...... 30 Programs Go Long for Wellness...... 32 Starting Strong: Teaching Youth the Right Way to Play...... 34 The NFL Foundation: Support With Safety at its Core...... 36 Taking the Lead: About Charlotte Jones Anderson...... 37 Heads Up Football: Expansive Reach, Impressive Results...... 38 Moms Clinics: Putting Parents in Young Players’ Shoes...... 40 Meet the NFL’s Director of Youth and High School Football (Also Known as Dad)...... 41 NFL FLAG Powered by USA Football: Essentials of Healthy Play...... 42

PAGE 2 PAGE Helping Underserved Communities Play it Safe...... 44 New Laws, New Awareness...... 46 Back to Sports: Increasing Participation With Education...... 47 Partnerships to Promote Education...... 47 NFL, Korey Stringer Institute Convene Leaders to Share Strategies...... 48 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH

Cover Photos AP Photo/Ric Tapia AP Photo/Scott Boehm NFL HEALTH AND SAFETY BY THE NUMBERS 27 40 SINCE 2012… 32 Average number of Nearly 40 rule All NFL clubs expert health providers changes in the last Concussions in use electronic at every NFL game to 10 years to make the regular season NFL medical records provide care to players game better and safer games down GE-NFL HEAD HEALTH INITIATIVE 35% 3 1K+ 30 Challenges Concepts for Countries represented Concussions caused innovations submitted by helmet-to-helmet hits in regular season NFL FOUNDATION NFL games down 16 $49M+ NFL clubs have developed Invested in grants over the past programs to increase 43% 17 years, revitalizing nearly 435 access to athletic trainers playing fields in their communities

HEADS UP FOOTBALL SINCE 2013… Youth leagues that participate in HUF saw a decrease in: Hits to defenseless INJURIES BY CONCUSSIONS BY players down 76% 34% PAGE 3 PAGE — 68% 6,300+ 1,000,000+ Youth leagues and 1,000+ Players benefitting, representing

high schools participate 150,000+ coaches NFLHEALTHPLAYBOOK.COM

AP Photo/Perry Knotts MESSAGE FROM COMMISSIONER ROGER GOODELL

Each year, I am proud to introduce the NFL’s Health and Safety Report. We embrace the opportunity to share the important work the NFL is leading to advance safety, from the science lab to the playing field, for current, former and future players, and for athletes in all sports.

We have seen a decline in need medical help, with neither team concussions in our games, and hits to charged for a timeout. defenseless players are down as well. We have made nearly 40 rule changes There must be no confusion: The in the past decade to promote player health of our players will always take safety. Football has never been safer precedence over competitive concerns. than it is right now. And we have no That principle informs all of the work higher priority than to continue this discussed in this report. progress through a core characteristic Our commitment to players is lifelong. of our game: teamwork. In the past seven years, more than We continually bring together the 3,500 former players have benefited foremost authorities in health, safety from a free screening program focused and related technologies, and this year on comprehensive health and wellness. we are especially proud to welcome In communities across America, we the leadership of Dr. Elizabeth “Betsy” are changing the culture around youth Nabel, our new Chief Health and Medical sports for the better through programs Advisor. With peers in other sports such as Heads Up Football that rally leagues and other groups who share strong teams of coaches, players, our goals, we are investing in programs parents, teachers, health professionals like the GE-NFL Head Health Initiative and partner organizations. and our grant to the National Institutes Across the board, we are seeing of Health to bring transformative significant and sustained improvements. developments to sports and beyond. But our work cannot and will not stop. New discoveries inform how we are I look forward to reporting even more PAGE 4 PAGE refining roles and rules on game day successes this time next year. to make the right call for player health Roger Goodell and safety. As just one example, NFL Commissioner this season the NFL is instituting a new medical timeout, which permits independent athletic trainers in the press box to notify an official 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH to stop play if a player appears to MESSAGE FROM DR. JOHN YORK

You will see in this report the details of a deep and growing culture of safety within professional football — a culture that is producing real and important results for athletes of all ages.

Everyone involved with our league safer. We’ve made tremendous gains understands that continued progress and learned much in the past 10 to 15 requires a sustained effort, and that years. We are still learning. we must continue our intense focus on player health and safety. We have As a team executive, I understand the the right people and plans in place to importance of bringing in the best talent build on our momentum. to work toward a common goal. To this end, the NFL uses its unmatched In my role as Chairman of the NFL platform to unite key parties from a Owners’ Committee on Health and cross-section of sports and professions Safety, I have the privilege of working to improve health and safety for a with many prominent medical experts variety of people from all walks of life. I who volunteer their time to advise the especially look forward to working with league on health and safety matters. new Chief Health and Medical Advisor The vast array of institutions and Dr. Betsy Nabel this year. individuals who offer their counsel has given rise to what I call the “NFL Together, we will support major University.” This concept embodies investments in independent research, the thoughtful collaboration, depth innovations in head health and of expertise and actionable insights continuing education for coaches, that are central to our work on these trainers, families and young players. important issues. We will live our mission to have football taught and played safely at Our efforts, in close coordination all ages, and to improve safety in all with the league, have led to rule sports, for athletes at all levels. changes, better equipment, improved medical care and breakthroughs on As a team, we will continue to everything from orthopedic injuries lead the way. to the quality of the surfaces we use. John York, M.D. We are increasingly sophisticated in Co-Chairman, San Francisco 49ers our injury data collection and analysis.

Chairman of the NFL Owners’ 5 PAGE Last year, for the first time, all 32 Committee on Health and Safety clubs collected injury data using electronic medical records. This allows us to track player health and analyze significant amounts of information to drive change and make the game — NFLHEALTHPLAYBOOK.COM ALL-PRO INNOVATORS: LEADING THE WAY IN HEALTH AND SAFETY SCIENCE

Through major investments in independent research, groundbreaking innovations in head health and knowledge sharing across sports, the NFL is leading the way in improving health and safety for all athletes of all ages.

We have an unparalleled platform to create new collaborations across medicine, science and technology. We are committed to engaging experts from diverse disciplines to advance a culture of safety. And as part of that effort, we have added a new senior medical expert to lead our efforts: Dr. Betsy Nabel, who brings leadership experience from the National Institutes of Health (NIH), Harvard University and one of the top hospitals in the world — Brigham and Women’s Hospital. PAGE 6 PAGE 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH

AP Photo/David Rosenblum AP Photo/Paul Spinelli PAGE 7 PAGE NFLHEALTHPLAYBOOK.COM — NFLHEALTHPLAYBOOK.COM MESSAGE FROM DR. BETSY NABEL

It is an honor to join the NFL as its first Chief Health and Medical Advisor.

I believe in the transformative power I welcome the opportunity to work of science. When Commissioner with Commissioner Goodell and Goodell asked me to take on this the medical advisory committees strategic advisory role, he committed to support their progress. The to harnessing the resources of the NFL application of medical research and to improve the safety of all sports. technological advances, combined with the training of players and As a physician, a scientist, a mother coaches, has made the game safer, and a fan of football and sports in but there is more to do. The NFL’s general, I welcome the opportunity medical advisory committees and to advance our understanding of I will keep working to find ways to the factors and conditions that will make professional football — and promote our players’ health and sports for athletes of all ages and at safety. Through support of research, all stages — safer. we will better understand the basic biology of sports injury, including Elizabeth G. Nabel, M.D. concussion and traumatic brain NFL Chief Health and Medical Advisor injury, so we are prepared to prevent, diagnose and treat injuries. The NFL has an opportunity to advance the health and safety of current and former players, as well as players across all sports — men and women, boys and girls. They have the platform to make change happen.

Since joining the NFL in February 2015, I have seen how developments in research, innovation and protocols can improve safety across sports. The NFL has enlisted the best and

PAGE 8 PAGE brightest minds for its medical advisory committees so we can improve our prevention, diagnosis and treatment of injuries. You will read about many of the highlights in this report. 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH SPECIAL TEAMS: MEDICAL COMMITTEES ADVANCE SAFETY HEAD TO TOE

The NFL is advised by some of the finest medical and scientific experts in the country through a number of specialized medical committees. Under the strategic leadership of Drs. York and Nabel, these committees volunteer their time to improve player health and safety by exploring groundbreaking research, updating medical protocols and enlisting medical personnel to address specific needs.

HEAD, NECK AND SPINE COMMITTEE Co-Chairman: Dr. Richard G. Ellenbogen, University of Washington Medicine Professor and Chairman of the Department of Neurological Surgery Co-Chairman: Dr. Hunt Batjer, Lois C.A. and Darwin E. Smith Distinguished Chair in Neurological Surgery UT Southwestern This committee addresses a number of essential issues, including the prevention of head injuries and the improvement of medical protocols, diagnosis and treatment. Additionally, they manage a significant portfolio of advanced neuroscience research designed to deepen understanding and awareness about the brain and the science to protect it.

ENGINEERING SUBCOMMITTEE Chairman: Dr. Jeff Crandall, Professor of Engineering and Applied Sciences at the University of Virginia This subcommittee includes a diverse and experienced group of technical experts — biomechanical engineers, biomedical engineers, material scientists — who study helmets, pads and other protective equipment to improve safety on the field. They engage in significant research designed to advance the development of protective equipment.

INJURY AND SAFETY PANEL Chairman: Dr. Elliott Hershman, Chairman of Orthopedics at Lenox Hill Hospital and Team Orthopedist of the New York Jets The Injury and Safety Panel is the NFL’s oldest active medical committee. The panel’s primary responsibilities include oversight of the various medical committees. In conjunction with the NFL Players Association (NFLPA), the panel also reviews injury data, makes recommendations on research projects and identifies issues for the other committees to address. As an example, the panel’s injury analysis is used by the NFL Competition Committee to consider rule changes and to examine injury consequences of those rule changes.

CARDIOVASCULAR HEALTH SUBCOMMITTEE FOOT AND ANKLE SUBCOMMITTEE Co-Chairman: Dr. Andrew Tucker, Medical Director of Sports Medicine at MedStar Co-Chairman: Dr. Robert Anderson, Chief of Foot and Ankle Surgery Union Memorial Hospital and Head Team Physician of the Baltimore Ravens at Carolinas Medical Center in Charlotte, NC Co-Chairman: Dr. Robert A. Vogel, Clinical Professor of Medicine, University Co-Chairman: Dr. Michael Coughlin, Clinical Professor of Orthopedic Surgery of Colorado Denver; Former Professor of Medicine and Head of Cardiology, at the University of California San Francisco Foot and Ankle Service PAGE 9 PAGE University of Maryland This subcommittee works to prevent lower-limb —

The NFL Subcommittee on Cardiovascular Health explores injuries through fundamental and applied research. issues relevant to the heart health of both active and former A majority of injuries to NFL players affect their players, including significant research projects designed to lower extremities. Orthopedic issues with the foot examine the particular needs of the NFL player population. and ankle may cause significant player time loss. NFLHEALTHPLAYBOOK.COM

AP Photo/Scott Boehm HEAD, NECK AND SPINE COMMITTEE

In the past year, the Head, Neck and Spine “WE ALL HAVE COMMON Committee worked closely with the NFL Players PROBLEMS…WITH RESPECT TO CONCUSSION. IF WE GET TOGETHER Association (NFLPA) to further refine and enhance AND SHARE OUR INFORMATION AND the NFL’s concussion protocol. With feedback KNOWLEDGE AND COOPERATE WITH from physicians, athletic trainers, unaffiliated RESEARCH, THEN WE’RE GOING TO neurotrauma consultants (UNCs) and the players BE MOVING FORWARD.” themselves, the committee looked to improve Martin Raftery, Chairman, International Rugby Board, USA Today, August 24, 2014 ways to identify signs and symptoms of concussions, advance sideline protocols and ensure players receive the best treatment available. Additionally, they played an integral role in developing the mechanism to stop the game to assist a player and worked with the Competition Committee to adopt the medical timeout.

INTERNATIONAL Organizations “need to look at all York, attendees hammered out CONFERENCE ON variations of what is being done priorities, including: CONCUSSIONS: around the world,” Ellenbogen „„ UNITING SPORTS IN A said. “Convening a global Research that enhances COMMON CAUSE conversation on concussion sideline assessment tools Soccer, hockey, rugby — sports research will only further the for concussions „„ around the world share a science and understanding of Improved rehabilitation common concern with American this unique injury and make techniques for enhancing football: the need to effectively sports safer for athletes and the recovery — and how they work „„ prevent, identify and manage general population.” Research programs to improve head injuries. concussion recognition and A FIRST FOR PLAYER SAFETY management In August 2014, the NFL — led The meeting marked the „„ Better understanding of by Dr. Rich Ellenbogen, Co- first time international sports long-term effects of repeated Chairman of the NFL’s Head, federations and several U.S.- head trauma PAGE 10 PAGE Neck and Spine Committee — based professional leagues brought international sports banded together to identify The first of these collaborations leagues together in New promising areas for collaborative is already well underway. The York for the first International research and coordinate these NFL and the Canadian Football Professional Sports Concussion efforts. Over two days at the League (CFL) are jointly examining Research Think Tank. NFL’s headquarters in New how an eye movement test — the King-Devick test — may improve 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH concussion diagnosis on the sideline. Four CFL clubs and several Canadian universities are adding the King-Devick test to their current sideline protocol for concussions. The goal is to see if the test improves the accuracy of diagnosis and therefore identifies players who need to be removed from play — and those who do not.

There is more to come. These leagues will convene for a second international “THIS IS AN think tank meeting in October 2015 in London, where new joint research EXCITING projects will be announced. DEVELOPMENT

HIGHLIGHT REEL A POWERFUL IN THE SCIENCE GLOBAL TEAM International Conference OF SPORTS attendees included representatives from: CONCUSSION.” „„ Australian Football League „„ European Horseracing Paul McCrory, Associate Professor at the Florey Institute of Neuroscience and Mental „„ Fédération Equestre Health, August 24, 2014, The Age (a publication covering Australian Rules Football) Internationale „„ Fédération Internationale de Football Association „„ International Rugby Board „„ National Collegiate Athletic Association „„ National Hockey League „„ National Rugby League „„ Paul G. Allen Family 11 PAGE —

Foundation „„ United States Army „„ United States Olympic Committee NFLHEALTHPLAYBOOK.COM

AP Photo/David Drapkin 2015 ENGINEERING SUBCOMMITTEE

In October 2014, the Head, Neck and Spine Committee added a new subcommittee to its roster: the Engineering Subcommittee. The subcommittee concluded its first project in July 2015.

The NFL and NFL Players Importantly, this study is the the laboratory impacts. The Association (NFLPA) jointly first of its kind to account for top performing helmets were sponsored a laboratory study to rotational velocity and rotational statistically better performers than assess the performance of helmets acceleration in measuring the the helmets in the second group in worn by NFL players. Specifically, performance of the helmets. There terms of reducing the severity of the relative performance of helmets is mounting scientific evidence that the laboratory head impacts. It is was evaluated under laboratory concussions have a component important to remember, however, conditions that simulated open- of their injury caused by rotational that all helmets tested passed field collisions in the NFL. motions of the head impact. National Operating Committee on Standards for Athletic Equipment All testing was performed The helmets have been (NOCSAE) certification and are independently by Biokinetics, a test categorized into two groups therefore permitted to be worn by facility located in Ottawa, Canada. based on their ability to manage NFL players at their discretion. Analysis of the data was performed by the NFL Head, Neck and Spine Engineering Subcommittee, two 2015 HELMET LABORATORY TESTING PERFORMANCE RESULTS NFLPA engineering consultants and

Xenith Epic Varsity THE NFL, IN COLLABORATION an independent biostatistician. WITH THE NFLPA, THROUGH THEIR RESPECTIVE APPOINTED Riddell Revolution Speed BIOMECHANICAL EXPERTS, The laboratory testing involved 17 COORDINATED EXTENSIVE Schutt Vengeance DCT LABORATORY RESEARCH helmet models intended for use ON 17 HELMETS USED BY NFL Xenith X2E PLAYERS TO TEST WHICH in the NFL during the upcoming HELMETS BEST REDUCED Schutt Vengeance VTD HEAD IMPACT SEVERITY. 2015 season. A preliminary survey Helmets are listed in order based on their performance in the Schutt Vengeance VTD II laboratory testing. The bar graph of helmets used by NFL teams illustrates the performance of PERFORMING GROUP

- Riddell SpeedFlex each helmet, with a shorter bar was conducted to assess the representing better performance.

TOP The helmets in the top group Riddell Revolution Speed Classic performed better and were frequency of helmet models used statistically different from the Riddell Revolution helmets in the bottom group. in the NFL and to ensure that Within the top-performing group of helmets, there was no Rawlings NRG Quantum statistically significant difference more than 99 percent of all helmet in performance. The information presented here is based solely Rawlings NRG Tachyon upon the results of this research This poster models used by players were and the expert opinions of the PAGE 12 PAGE scientists involved. presenting the Rawlings Impulse + included in the testing. findings of the Schutt AiR XP Pro (789102) helmet laboratory The helmets were impacted at eight study was shared Riddell VSR-4 ALL HELMETS ARE CERTIFIED AS COMPLIANT WITH THE NATIONAL with all NFL clubs locations, including the facemask, OPERATING COMMITTEE ON SG Varsity STANDARDS FOR ATHLETIC to help equipment EQUIPMENT (NOCSAE) AND ARE front, side and rear of the helmet, THEREFORE PERMITTED FOR USE BY managers and Rawlings Impulse NFL PLAYERS. NO HELMET SYSTEM CAN COMPLETELY PROTECT AGAINST players make to represent the most commonly SERIOUS BRAIN AND/OR NECK Schutt AiR XP (789001) INJURIES A PLAYER MIGHT RECEIVE informed decisions WHILE PARTICIPATING IN FOOTBALL. observed points of contact in with regard to their

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH reviews of NFL game films. helmet choice. CARDIOVASCULAR HEALTH SUBCOMMITTEE

The The NFL Cardiovascular Health Subcommittee explores issues relevant to the heart health of active and former players.

We know that former Members of the NFL players have lower Cardiovascular Health rates of heart disease Subcommittee concluded and lower mortality from in their 2015 research cardiovascular conditions article published in the than the general population. Journal of the American But maintaining those Society of Hypertension good results in the next that, contrary to the generation of retirees suggestion of previous is a key focus. The findings, there were no Cardiovascular Health racial differences in the Subcommittee is examining prevalence of hypertension factors such as strength or prehypertension. training and increased player sizes while developing a longitudinal study that follows former players for up to a decade after they retire, all as part of assessing longer-term risk profiles. PAGE 13 PAGE —

NFLHEALTHPLAYBOOK.COM

AP Photo/Charlie Riedel HIGHLIGHT REEL FOOT AND ANKLE ABOUT THE GE-NFL HEAD HEALTH INITIATIVE SUBCOMMITTEE Aiming to improve the safety of athletes, members of the military and society overall, GE and the Lower-limb issues are responsible for approximately NFL have teamed up to accelerate 60 percent of all NFL injuries and more player concussion research, prevention, time loss than any other injury category. With this diagnosis and treatment. The multi-year collaboration includes statistic in mind, the Foot and Ankle Subcommittee two components: has supported several studies looking at the 1. Open Innovation Program biomechanics of specific foot and ankle injuries. The The program spurs disruptive subcommittee also evaluates shoes — their traction, advancements by awarding grants to scientists, academics, experts their fit, their “flexion” (bending) and more — and and entrepreneurs worldwide their role as safety equipment, not just footwear. across three innovation challenges, The subcommittee is sharing this information with each addressing important and difficult scientific questions: players, equipment managers and shoe companies. „„ Head Health Challenge I (2013): This year, the subcommittee also manufacturers, the ad hoc Diagnosis and Prognosis of produced a video for all equipment committee created “Game Day Mild Traumatic Brain Injuries managers to help educate and Surface Guidelines” to improve „„ Head Health Challenge II (2014): guide them on the proper methods the quality of infill and natural Prevention of Brain Injuries (in for measuring players’ feet and playing surfaces to support player partnership with Under Armour) fitting shoes correctly. In addition, safety. Fields are monitored by „„ Head Health Challenge III (2015): because the sizing of the various independent inspectors to ensure Development of Advanced shoe manufacturers is inconsistent, the guidelines are followed, Materials for Impact Mitigation (in the committee worked to produce and stadium field managers are partnership with Under Armour a unique NFL Brannock Device. required to submit weekly reports and the National Institute for Each team received this sizing tool to confirm the quality of their fields. Standards and Technology) that measures feet in millimeters as opposed to shoe sizes. As a With improved quality of fields, 2. Research and result, players’ shoe fitting will be along with the innovative work by Development Initiative improved, with the expectation of shoe manufacturers, the goal is This four-year research and experts being that they will be less to ultimately diminish the risk of development program will susceptible to foot and ankle injuries. knee, ankle and foot injuries. develop next-generation imaging PAGE 14 PAGE “THE PRIMARY GOAL OF OUR technologies that take a whole-brain The subcommittee’s work doesn’t approach to improving the diagnosis stop there. Three years ago, the COMMITTEE IS TO ENABLE AND MOTIVATE BOTH THE INDUSTRY AND and treatment of patients with leadership of this subcommittee mild traumatic brain injury. Clinical THE PLAYERS TO MORE THINK OF helped to form the Ad Hoc studies at some of the nation’s Committee on NFL Field Surfaces. THE SHOE AS A PIECE OF PERSONAL leading institutions are informing the With membership consisting PROTECTIVE EQUIPMENT.” development of this new technology.

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH of engineers, physicians, turf Dr. Richard Kent, Deputy Director for the Center of scientists and infill surface Applied Bio-Mechanics, University of Virginia HEAD HEALTH: PARTNERSHIPS, PROJECTS AND PROGRESS

Since the program’s start in 2013, grantees of the Head Health Initiative, a joint endeavor between the NFL and GE, have spurred research and development around new brain imaging technologies. The work has achieved promising breakthroughs — from blood tests that speed the diagnosis of brain injury to new solutions for mitigating the force of impact.

CHALLENGE I: Banyan Biomarkers, Inc., Medical College of Wisconsin, NEW TOOLS FOR Alachua, Fla. Milwaukee, Wis. CONCUSSION „„ Implementing a first-of-its-kind „„ Innovating magnetic IDENTIFICATION point-of-care blood test to resonance imaging (MRI) In July 2015, GE and the NFL rapidly detect the presence of scanning technology to announced the six grand prize mild and moderate brain trauma determine the effects of winners of the $10 million Head „„ Working with the University sports-related concussions on Health Challenge I. This challenge of Florida to analyze brain structure and function supports innovations that speed biomarkers, neurocognitive „„ Conducting a study to advance diagnosis for mild traumatic brain testing and neuroimaging on more objective ways of injury (mTBI). These winners were concussed athletes diagnosing concussion and selected from an initial group of judging ability to return to play 16 challenge finalists, narrowed BrainScope Company, Inc., from a pool of more than 400 Bethesda, Md. The University of California, entries from 27 countries. The „„ Developing urgent Santa Barbara (UCSB), Santa 16 challenge finalists proceeded care, handheld Barbara, Calif. to the next round and received electroencephalogram- „„ Creating novel software tools a $300,000 award to continue based traumatic brain injury for determining if connections their efforts. From there, six grand detection technology that transmit information across prize winners were identified. „„ Working with the Purdue different parts of the brain are Each demonstrated substantial Neurotrauma Group to damaged after head injury progress during the past year study collegiate athletes „„ Using state-of-the-art MRI in the and won an additional $500,000 using imaging biomarkers UCSB Brain Imaging Center’s award to advance their work. to potentially enhance laboratory to determine areas BrainScope’s technology of the brain that may become PAGE 15 PAGE and evaluate the potential to disconnected due to information DID YOU KNOW? MORE serve as a surrogate for other transmission loss after injury THAN 1,000 CONCEPTS imaging biomarkers HAVE BEEN SUBMITTED TO HEAD HEALTH CHALLENGES

FROM 30 COUNTRIES. — NFLHEALTHPLAYBOOK.COM The University of Montana, II. This competition attracted more “BY LEVERAGING RESOURCES Missoula, Mont. than 450 ideas from 19 countries AND POOLING EXPERTISE, WE CAN „„ Identifying blood-based — all for better protecting the brain EXPAND OUR UNDERSTANDING OF biomarkers that indicate how from a concussion. The winners BRAIN INJURY AND ACCELERATE the brain reacts following a of the first round each claimed THE DEVELOPMENT OF NEW traumatic brain injury $500,000 and now are competing TECHNOLOGIES THAT WILL HOPEFULLY „„ Exploring levels of proteins for up to five grand prize awards of REDUCE THE PROBABILITY AND and ribonucleic acid (RNA), up to $1 million. These final awards among other potential markers, will be announced in the fall of SEVERITY OF THESE INJURIES FOR as indicators for brain injury 2015 and will be decided based on BOTH SOLDIERS AND ATHLETES.” and recovery progression the progress these seven winners Dr. Eric Wetzel, Technical Manager for Materials for Soldier have shown during the past year. Protection, Army Research Laboratory, Army.mil, November 18, 2014 Quanterix, Lexington, Mass. „„ Developing a simple blood Army Research Laboratory, UCLA and Architected Materials, test to aid in the detection of Baltimore, Md. Inc., Los Angeles, Calif traumatic brain injury „„ Creating helmet tethers that allow „„ Using microlattice material to „„ Using digital immunoassay voluntary head movement during create an under-helmet liner technology to measure sports action while minimizing that absorbs substantially more biomarkers of brain injury sudden accelerations caused energy than current materials in the blood by high-speed collisions often and better protects the brain associated with concussions „„ Collaboration of materials „„ Technology has the potential designers, mechanical impact to mitigate head trauma for experts and neuroscientists members of the military would use a 3-D printing Emory University, Atlanta, Ga. platform to develop real-time responsive helmet technology „„ Developing the handheld CHALLENGE II: iDETECT prototype medical IMPROVING THE The University of Miami Miller School device that can screen and DETECTION AND of Medicine, Coral Gables, Fla. assess concussions from the PREVENTION OF (Collaborating with the University sidelines in near real-time BRAIN INJURY of Pittsburgh School of Medicine „„ Rapidly assesses players’ In November 2014, the NFL and and Neuro Kinetics, Inc.) symptoms, including GE partnered with Under Armour „„ Creating a portable eye goggle cognitive function, balance and announced the first round of that will help identify mild and eye movements winners of Head Health Challenge traumatic brain injury in real-time

“WE HAVE CREATED A DYNAMIC PAGE 16 PAGE FORUM THAT ENERGIZES PEOPLE TO JOIN OUR PURSUIT OF BREAKTHROUGH SOLUTIONS AND EMPOWERS THESE INNOVATORS WITH SUBSTANTIAL FINANCIAL SUPPORT.”

Kevin Plank, Founder and CEO, Under Armour,

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH media announcement, November 13, 2014 by gathering and measuring Viconic, Inc., Detroit, Mich. in 2015 to advance the goal precise eye movements, leading „„ Creating an under-layer for of uncovering new, innovative to more accurate diagnosis synthetic turf systems that materials designed to better „„ Research began in the would make turf fields safer withstand force and protect U.S. military at the Army „„ Would further explore the against concussion. Medical Research and relationship between optimized Materials Command and head-injury protection and In Challenge III, the four partners the Department of Defense the frequency of lower-limb called on the material science Hearing Center of Excellence injuries to provide the turf community to answer the industry with a tool to specify following question: The University of Washington and systems that maximize safety Can your material withstand a force VICIS, Inc., Seattle, Wash. and minimize costs range of up to 12 kilonewtons, „„ Developing a safer, more force-absorbing football withstand 1,200 impacts above 20 helmet to better protect KE (J) and perform in temperatures against head injuries from 0-40 degrees Celsius, with up to 100 percent humidity? „„ Team includes thought- CHALLENGE III: leading engineers and CALL FOR MATERIALS — NIST’s expertise will be put to neurosurgeons, public health THE NEXT FRONTIER the test as they design a new experts and business leaders In May 2014, the White House methodology to examine the committed to elevating athlete convened the Healthy Kids and Safe submissions and create standards performance via science Sports Concussion Summit. There, for the rest of the industry to the National Institute of Standards follow. Head Health Challenge The University of New Hampshire, Technology (NIST) committed to partners and an expert panel Durham, N.H. lending its expertise to making of judges will select up to six „„ Evaluating the HUTT youth sports safer. materials tested by NIST and Technique, a helmetless determined to best absorb force, tackling training system used As a result, the NFL, GE, Under dissipate energy and transfer in many high schools Armour and the Department of momentum. The new materials will „„ Research will examine if Commerce began discussions on transcend sports to benefit the regular implementation of the how to collaboratively advance military and society at large. technique results in player their shared goals of using behavior change and reduces innovative science to make sports injury risk by reinforcing proper safer. NIST officially joined the technique when players go into Head Health Challenge team full-equipment play

“WE WANT TO ENGAGE THE MOST CREATIVE TECHNICAL EXPERTS TO IDENTIFY

ADVANCED MATERIALS THAT IMPROVE 17 PAGE — THE HEALTH AND SAFETY OF ATHLETES, SOLDIERS AND FIRST RESPONDERS.”

Dr. Willie May, Acting Undersecretary of Commerce for Standards and Technology and Acting NIST Director, NIST

media announcement, January 29, 2015 NFLHEALTHPLAYBOOK.COM GE-NFL HEAD HEALTH INITIATIVE INNOVATION • ADVANCEMENT • PROGRESS

As part of the Joint Development Agreement with General Electric’s Magnetic Resonance division, the NFL continues to actively support clinical research into the use of MRI as a tool for improved diagnosis and evaluation of concussions by developing advanced methods of imaging and quantifying brain function.

The NFL’s Head, Neck and Spine could aid in the diagnosis and Committee is actively engaged treatment management of mTBI. in Medical Advisory Boards and Potential imaging biomarkers INNOVATION • ADVANCEMENT • PROGRESS partnering with a number of leading being explored are: changes in healthcare facilities to perform the volumes of the subcortical clinical trials, including University structures (shown in image), of California San Francisco, detection of microbleeds, the Houston Methodist, Hospital for measurement of cerebral blood Special Surgery, Medical College of flow (shown as perfusion in the Wisconsin, University of Pittsburgh image), structural connectivity of Medical Center Sports Medicine the brain (shown as diffusion in Concussion Program, University the image), functional connectivity of Michigan and University of of the brain and changes in key Miami Miller School of Medicine. metabolites for brain function. If the outcomes from the clinical trials are positive, it will potentially result in new methods of medical imaging specific for the evaluation of concussions and management of patients. This exciting work continues to be experimental and is part of a four-year project. PAGE 18 PAGE As part of the GE-NFL Head The images shown were obtained using an investigational device limited by law to Health Initiative, the research investigational use, and not cleared, approved, licensed or authorized by the U.S. FDA or program utilizes state-of-the-art other regulatory authorities for commercial availability. MRI technology to understand how mTBI affects the brain. The studies seek to establish imaging biomarkers that 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH FROM THE BENCH: NIH RESEARCHERS TURN GRANTS INTO ANSWERS

Honing in on a diagnosis. Tracking progress throughout recovery. Linking causes to effect. These milestones are crucial to promoting and improving head health and strengthening a culture of safety. And they are the focus of some of the world’s top research teams, conducting original projects through the Sports and Health Research Program (SHRP).

In 2012, the NFL launched School of Medicine and the U.S. spectroscopy to monitor the SHRP with the Foundation Department of Veterans Affairs, gamma-aminobutyric acid for the National Institutes of is working together to define the (GABA) levels in adolescents Health (FNIH) with a critical criteria for the stages of CTE and who have sports-related imperative: to advance scientific to distinguish CTE from disorders concussions and compare understanding of concussion and such as Alzheimer’s and ALS in levels to those in adolescents head injury in athletes, military post-mortem brain tissue. without injuries service members and veterans, „„ Nationwide Children’s Meanwhile, in the second project, and the general population. Hospital, Columbus, Ohio, and led by Dr. Wayne Gordon at Colorado School of Public Uniting diverse areas of expertise Mount Sinai Hospital in New York, Health, University of Colorado, in necessary areas of inquiry, the a team including researchers Aurora, Colo. Evaluating mobile work of these SHRP researchers from the University of Washington app Spot Light’s effectiveness shows tremendous promise. is identifying and describing the in generating more reports of chronic effects of mild, moderate SHARPENING DIAGNOSIS concussions, more referrals to and severe traumatic brain injury How can a physician more doctors and better adherence and comparing these with the conclusively tell what disorder to return-to-play guidelines features of CTE. caused brain damage? The „„ Indiana University School of answer may become much And that’s just the beginning. Six Optometry, Bloomington, Ind. clearer soon, thanks to teams of new pilot-stage research projects Developing a portable eye- scientists brought together in two recently launched with the tracking instrument to help cooperative agreements with the goals of improving concussion diagnose concussions on the aim of developing standards for diagnosis and identifying ways of sidelines and to monitor injury 19 PAGE chronic traumatic encephalopathy tracking a patient’s recovery: progression in high school and (CTE) diagnosis. college athletes „„ Seattle Children’s Hospital, „„ Baylor College of Medicine, One team, led by Dr. Ann C. Seattle, Wash. Using Houston, Texas. Looking McKee of the Boston University magnetic resonance at concussions’ effects on NFLHEALTHPLAYBOOK.COM — NFLHEALTHPLAYBOOK.COM brain structure and function in adolescents cleared to GAME PLAN: Q&A play and evaluating potential biomarkers for concussions WITH DR. BETSY and recovery „„ Kennedy Krieger Institute, NABEL, THE NFL’S Baltimore, Md. Investigating the potential of somatosensory FIRST CHIEF HEALTH system information processing AND MEDICAL ADVISOR (which processes information such as what an object feels like to touch) as a biomarker President of Brigham and Women’s Hospital in for concussion and recovery in youth aged 13 to 17 Boston since 2010. Professor of medicine at „„ Massachusetts General Harvard Medical School. Former Director of the Hospital, Boston, Mass. National Heart, Lung and Blood Institute at NIH. Studying post-concussion changes in brain molecules Cardiologist. In February 2015, Dr. Betsy Nabel and byproducts to uncover added Chief Health and Medical Advisor to this metabolites (a type of impressive list of credentials — and she is already molecule) that contribute to serious effects of traumatic hard at work transforming how the NFL is working brain injury and identify to improve player health and safety. potential targets for detecting and treating concussions Q: What drew you to this role Q: Traumas like repetitive with the NFL? head injuries are complicated As announced at the 2014 Healthy A: With the NFL’s deep to prevent, detect, diagnose Kids and Safe Sports Concussion commitment to scientific research and treat. What do you see Summit at the White House, the — and the great concern in as essential to tackling the NIH has committed $16 million the sport surrounding health, complexities? from the NFL’s initial $30 million especially concussions — I saw A: We need to start from the grant for a longitudinal study to the potential to make an impact. beginning — understanding research the chronic effects of I am a firm believer in the power the basic biology, the basic repetitive concussions. The study of supporting research in order mechanisms, and gain a will aim to use longitudinal data to to make fundamental discoveries fundamental understanding of the better understand the neurological and translating those discoveries condition. Only then will we have mechanisms of CTE and enable into medical advances. In this a solid foundation for designing the development of an evidence- case, the mission is to improve diagnostic tools and developing based clinical diagnosis. The PAGE 20 PAGE the health and safety of athletes treatment modalities. The science findings of this study could provide in football and really across in this area is moving fast, and direction for clinical trials focused sports — professional and through the NFL’s research and on preventing or slowing long-term amateur, youth and adult. evolving partnerships, they’re effects of the injury. The NIH will doing everything they can to grant the award later this year. expedite progress. 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH Q: Your bio for Boston Magazine’s “50 Most Powerful People” references “breaking boundaries” as one of your strengths. Give an example of how you see yourself doing this in your role with the NFL. A: Partnerships are one key area — nurturing and expanding upon those already forged by the NFL. Scientific research by nature is highly focused, with breakthroughs happening in very discrete areas, yet these incremental breakthroughs are where important advances happen. My goal is to ensure that research discoveries and medical advancements made by NFL- supported research and programs have a ripple effect. That’s why our partnerships are so critical — with the NCAA, with youth sports, across other sports and leagues for women and men. To make sports as safe as they can be, we’ll need to work together.

Q: Talk about how your perspectives as a physician and a parent are shaping your new role. A: Even as a kid, I had an interest in science, health and wellness. As a physician, I know that being physically active is a big part of HIGHLIGHT REEL staying healthy. By helping to DR. NABEL STAT SHEET “THE NFL HAS make sports safer, I can be a part Seventeen patents $3 billion in research THE PLATFORM of improving the health of our and more than projects overseen at BY WHICH IT society as a whole, and that’s very 250 scientific the NIH National Heart, CAN REALLY exciting! As a parent, and hopefully publications Lung and Blood Institute SET SAFETY someday a grandparent, I’m proud STANDARDS FOR 21 PAGE — to play a role in shaping a culture Recipient of the Three children (a son SPORTS AROUND of safety for the next generation. Kober Medal, the and two daughters) THE COUNTRY.” highest honor of who are pursuing Dr. Betsy Nabel, the Association of careers in medicine NFL Chief Health and

American Physicians and science Medical Advisor NFLHEALTHPLAYBOOK.COM RULES, ROLES AND RESOURCES: MAKING A DIFFERENCE ON THE FIELD

A desire to constantly improve our game has transformed football into America’s most popular sport. We are applying this spirit of innovation — along with insights from health and safety leaders — to protect the players who make it possible.

This approach is yielding results. Ongoing rule changes have sparked a progressive reduction in player concussions. And more changes are happening — including new technology on the sidelines and expanded roles for independent experts to strengthen medical support.

As the game continues to transform, our commitment to the health of our players — and a culture of safety — remains stronger than ever. PAGE 22 PAGE 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH

AP Photo/Ric Tapia AP Photo/Gerald Herbert

AP Photo/Julio Cortez PAGE 23 PAGE NFLHEALTHPLAYBOOK.COM — NFLHEALTHPLAYBOOK.COM MEASURING PROGRESS

Changes in rules, enforcement, injury protocols and improved equipment as well as players and coaches embracing a culture change have yielded important advancements on the field — including a decline in concussions. Injury data is regularly analyzed to assess the effectiveness of new rules and inform potential future improvements. Through an ongoing review of rules and protocol, the league continues to make the game better and safer.

CONCUSSIONS IN COMPARED TO 2013, HITS TO REGULAR SEASON GAMES DEFENSELESS PLAYERS DOWN 35% DOWN 68%

173 148 112 CONCUSSIONS CAUSED BY HELMET-TO-HELMET HITS 2012 2013 2014 IN REGULAR SEASON GAMES

22 PLAYERS ON THE FIELD DOWN 43% 156 PLAYS PER GAME 91 PAGE 24 PAGE 256 REGULAR SEASON GAMES 72 52 112 IN THE 2014 SEASON IN CONCUSSIONS = LESS THAN 1/2

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH CONCUSSION PER GAME 2012 2013 2014

AP Photo/Elaine Thompson TAKING ACTION FROM ABOVE: THE MEDICAL TIMEOUT

A completed pass moves the ball to the 40-yard line. “IT IS A BOLD AND IMPORTANT An official signals for a timeout — only this call doesn’t MOVE TO ALLOW [AT] SPOTTERS TO CALL A TIMEOUT TO HAVE AN come from the quarterback or the coach. It comes ATHLETE EVALUATED. I HOPE OTHER from the press box, where a certified athletic trainer PROFESSIONAL AND AMATEUR (AT) has noticed a player in need of medical attention. SPORTS ORGANIZATIONS WILL TAKE NOTICE AND FOLLOW SUIT.” In March, the NFL approved the attention and preventing potential Dr. Javier Cárdenas, NFLevolution.com, March 30, 2015 medical timeout, which will take additional injuries. This year’s effect in the 2015 season. This rule change makes the spotter an significant step for safety allows even more important contributor HIGHLIGHT REEL athletic trainer spotters positioned to a culture of safety. ABOUT THE MEDICAL high above the action to alert a DID YOU KNOW? ANTERIOR TIMEOUT referee to call a timeout if they CRUCIATE LIGAMENT (ACL) „„ If a certified athletic see a player needing assistance. AND MEDIAL CRUCIATE trainer (AT) spotter sees Besides their view of the field, LIGAMENT (MCL) INJURY a player with a potential these athletic trainer spotters RATES ARE AT OR BELOW injury staying in the game FIVE-YEAR AVERAGES. have access to all camera angles after a play, the AT can the replay official can view — as DID YOU KNOW? INJURY signal the side judge to well as significant training and RATES FOR THURSDAY-NIGHT call a time out. experience. Empowering these GAMES WERE BELOW THOSE „„ The side judge will alert “eyes in the sky” just made sense. FOR SUNDAY AND MONDAY the medical staff of the GAMES FOR EACH OF THE player’s team. “We have the [athletic trainer] LAST FOUR YEARS. „„ The game and play clock spotters, they’ve got a really will freeze as the staff good vantage point, they’ve got attends to the player, technology in their booth,” NFL escorting him from the Competition Committee Co- “GAME-DAY MEDICAL CARE OF field for evaluation. Teams Chairman Rich McKay explained NFL PLAYERS CONTINUES TO will not be charged with after the announcement. EVOLVE AT A RAPID RATE. THE NFL injury timeouts. A LOGICAL PROGRESSION TEAM PHYSICIANS AND ATHLETIC „„ Medical personnel will The NFL first added independent TRAINERS UTILIZE A VARIETY evaluate the player and certified athletic trainer spotters OF UNIQUE TECHNOLOGICAL make a return-to-play in 2012 to communicate with INNOVATIONS TO ADVANCE THE decision based on an injury 25 PAGE — team medical personnel about HEALTH AND SAFETY OF THEIR evaluation. In the case of potential injuries — with the PATIENTS — THE NFL PLAYERS.” a possible concussion, twin goals of ensuring that the player will undergo Dr. Matthew J. Matava, immediate past President of the the league’s mandatory players receive prompt medical NFL Physicians Society and St. Louis Rams Team Physician

concussion protocol. NFLHEALTHPLAYBOOK.COM EXPERT TEAMS AND TECHNOLOGY STRENGTHEN MEDICAL SUPPORT

As the game evolves, so do the sidelines. On Control Outreach Network (DICON) to establish a comprehensive average, 27 expert health providers are on hand program to prevent infections for every NFL game to provide care to players. like MRSA in the NFL. DICON With this impressive roster, the NFL continues to inspects all club facilities, develops individual team-by-team infection enhance player care through the integration and control plans and promotes expansion of the roles of several specialists and education and best practices independent experts. for infection prevention league- wide to keep NFL players healthy LOCAL PHYSICIANS FOR screening and diagnosing potential throughout the season. VISITING TEAMS concussions. This season, the LEVERAGING ROBUST This season, the medical staff UNCs will continue to integrate TECHNOLOGY will have a new member: the their expertise into the game-day Players will benefit from all 32 Visiting Team Medical Liaison. medical staff lineup. teams now using electronic Upon arriving in a city for a game, medical records (EMR) on their visiting teams will meet with a local Dr. Javier Cárdenas is one of sidelines. Beta-tested in 2013, the emergency physician certified to these specialists. As the Medical EMR system delivers a player’s practice medicine in that state. Director at the Barrow Concussion health information and history to This liaison will work with the team and Brain Injury Center in Phoenix, physicians in just seconds. to provide for their medical needs, Ariz., and a member of the NFL’s from prescriptions to immediate Head, Neck and Spine Committee, Besides enhancing care to players and guaranteed access to first-rate he worked as a UNC for the 2015 on the sidelines, EMR technology medical facilities. Super Bowl and Pro Bowl games. supports comprehensive injury surveillance and detailed analysis HEAD-INJURY SPECIALISTS “In addition to watching for of injury rates and trends by STAND GUARD suspicious collisions, I look to see epidemiologists at Quintiles, the Since their addition in the 2013 how the athletes are behaving on world’s largest provider of product season, unaffiliated neurotrauma the field,” he said. “Do they look development and integrated consultants (UNCs) have disoriented, sluggish or just off? I’ve healthcare services. assisted the team medical staff clearly seen a culture change at the in identifying and evaluating NFL level in which more players are potential head injuries. UNCs are self-reporting. That’s great. That’s

PAGE 26 PAGE “THE MERGED SYSTEM IS MORE leading concussion specialists what we want to see at all levels.” EFFICIENT AND CAPTURES MORE in their communities, often PARTNERSHIPS DATA EASILY, SO WE CAN LEARN neurosurgeons, selected in FOR PREVENTION EVEN MORE ABOUT THE INJURIES conjunction with the NFL Players Injury prevention and care is Association (NFLPA). These experts WITH OUR PLAYERS.” only one part of athlete health. provide team physicians with an Dr. John York, Co-Chairman, San Francisco 49ers and The league has teamed with additional resource for identifying, Chairman of the NFL Owners’ Committee on Health and Safety, the renowned Duke Infection 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH NFL press conference, May 12, 2015 “Conducting analytics using THE TEAM BEHIND THE TEAM EMRs and other game-related information substantially broadens AN INSIDE LOOK AT IN-STADIUM MEDICAL our understanding of player health STAFF ON NFL GAME DAYS. EACH SIDELINE HAS: and safety,” said Dr. Christina Mack, Quintiles Associate Director of 4 ATHLETIC TRAINERS 2 PRIMARY CARE Assesses and treats player injuries in PHYSICIANS Epidemiology. The collection and conjunction with team doctors Evaluates players for general medical analysis of this injury data may conditions and concussions help inform further advancements 2 ORTHOPEDISTS to improve player safety. Evaluates and treats players for 1 UNAFFILIATED injuries to the bones and joints NEUROTRAUMA Along with quick availability of Consultant assesses possible head 1 CHIROPRACTOR injuries and concussions comprehensive electronic medical Provides back/spinal adjustments for history, team physicians now have players and treats muscular injuries access to sideline video of injuries immediately after they occur to STADIUM MEDICAL TEAM: enhance their ability to diagnosis and treat players. 1 INDEPENDENT 1 DENTIST ATHLETIC TRAINER Treats dental issues The use of electronic tablets as Notifies on-field medical staff of possible injuries from press box 1 AIRWAY MANAGEMENT part of a step-by-step protocol PHYSICIAN also continues to assist physicians 1 OPHTHALMOLOGIST Provides emergency intubation to severely with concussion diagnosis and Treats eye injuries injured, non-breathing players provide consistent care across the 1 RADIOLOGY TECHNICIAN 2 EMT/PARAMEDIC CREW league. As new developments in Takes x-rays of injured players Transports players to hospital in the event technology become available, the at the stadium of serious injuries league will continue to explore ways to integrate these resources. 27 TOTAL GAME-DAY MEDICAL STAFF

Information provided by the National Football League Physicians Society (NFLPS). Numbers reflect the average number of medical staff present and should not be considered official NFL protocol. J. Phillip AP Photo/David

HIGHLIGHT REEL ABOUT THE NATIONAL FOOTBALL LEAGUE PHYSICIANS SOCIETY (NFLPS) The NFLPS is a professional organization founded in 1966 and made up of 170 dedicated, world-class physicians whose mission is to provide superior medical and surgical care to their patients — NFL players. NFLPS members are team doctors focused on the prevention and treatment of injuries in NFL players and are constantly working to improve the care of their patients both on and off the field. Additionally, NFLPS members work closely with athletic trainers,

physical therapists, chiropractors and other medical personnel as a cohesive unit to deliver well-rounded 27 PAGE — care to every NFL player. The NFLPS welcomed a new president in February 2015:

Dr. Robert A. Heyer: Dr. Robert A. Heyer is the President of the NFLPS and Team Internist for the Carolina Panthers. He has been with the team 21 years, since before the team’s first game. Additionally, Dr. Heyer is a member of the NFLHEALTHPLAYBOOK.COM Pulmonary and Critical Care Division at Carolinas Medical Center. HONORING OUR HISTORY: A LIFELONG COMMITMENT TO FORMER PLAYERS

They paved the way. They set the example. They helped to make our game great. While no longer in uniform, former NFL players will always be an integral part of the NFL family.

The league’s commitment to health extends through a player’s lifetime — from his first day on the field until long after he’s left the game. Guided by the experts we convene and initiatives throughout the league, we continue to expand resources and services designed to help our alumni enjoy healthier, more fulfilling lives beyond football. PAGE 28 PAGE 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH

Associated Press Associated Press

AP Photo/Phil Long PAGE 29 PAGE —

NFLHEALTHPLAYBOOK.COM SCREENING EVENTS BOOST HEALTH AND SAVE LIVES

Ten times each year, comprehensive health screenings give all former NFL players insights into their health — including information that could save their lives.

Since 2007, 3,599 former “The NFL Player Care Foundation THE NFL PLAYER CARE players have benefited from the addresses all aspects of life — FOUNDATION (PCF) Healthy Body and Mind Screening medical, emotional, financial, STARTED IN 2007 AS program, a complimentary social and community,” said initiative offered by the NFL Executive Director Belinda Lerner. AN INDEPENDENT Player Care Foundation (PCF) in “We see the Healthy Body and ORGANIZATION TO partnership with the NFL Alumni Mind Screening program as an BETTER SERVE Association and Tulane University important part of our support FORMER PLAYERS. School of Medicine. role. It has saved lives of our DEDICATED TO former players by identifying PCF conducts the Healthy Body life-threatening diseases and will ADDRESSING and Mind Screening events continue to save lives by providing IMPORTANT HEALTH throughout the year, with annual important research data.” AND QUALITY-OF- events scheduled around Super Bowl and Hall of Fame weekends. Services available through the LIFE CONCERNS AND Open to all former NFL players, Healthy Body and Mind Screening IMPROVING OUTREACH the events include a series of program include: TO FORMER PLAYERS, free cardiovascular and prostate „„ Blood pressure and body PCF IMPLEMENTS screenings as well as mental VARIOUS PROGRAMS health resources and education. measurements „„ Cardiovascular medical histories AND PARTNERSHIPS With consent from the „„ Unique cardiovascular TO CONNECT PLAYERS participants, clinical information blood tests WITH CRITICAL gathered from screenings is used „„ Echocardiography (echo) in important research initiatives and electrocardiogram RESOURCES.

PAGE 30 PAGE that could improve the lives of (EKG) screenings NFL retirees and many others. „„ Sleep apnea risk assessments „„ Prostate and sexual health assessments „„ Mental health education and resources 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH PAGE 31 PAGE —

NFLHEALTHPLAYBOOK.COM

AP Photo/Ben Liebenberg PROGRAMS GO LONG FOR WELLNESS

As part of the NFL’s commitment to health and wellness throughout a player’s life, the league supports former players with resources tailored to promote their long-term well-being. In addition to financial assistance, former players may be eligible for a range of programs, several of which are outlined below.

Added to the Former Player The NFL Joint Replacement polices are in place totaling Life Improvement Plan in March Program provides medical and $4,500,797 paid in premiums 2010, the NFL Neurological financial resources to former entirely by NFL clubs. Care Program has neurological players who are uninsured or specialists available at five lack the financing to have joint In 2012, the NFL provided a grant medical centers to evaluate replacement surgery. If a player to establish the NFL Life Line for and treat possible neurological is covered by insurance, the members of the NFL family — conditions among retired players. program provides up to $5,250 current and former NFL players, The program assists players with for health care items or services coaches, team and league staff coordinated care at excellent directly related to the procedure, and their family members — healthcare facilities nationwide, such as co-pays, provided the who may be in crisis. The NFL including Mt. Sinai Medical Center, expense was incurred within one Life Line is a free, confidential Washington University School of year of the surgery. Since the and independently operated Medicine/Barnes-Jewish Hospital, benefit’s October 2007 inception, resource that connects callers University of California-San 532 applications have been with trained counselors who can Francisco School of Medicine, approved, totaling $1,264,132 for help individuals work through Tulane University and University 436 surgeries. any personal or emotional crisis. of California, Los Angeles Health This service is available 24 hours Systems. Each center has a team Players 50 years old or older are a day, seven days a week, 365 of specialists available to retired eligible to receive Long Term Care days a year. To be connected NFL players, led by a neurologist Insurance at no cost to them with a counselor, individuals can who serves as a program director. if they meet the underwriting simply call 1-800-506-0078 or For former players covered by requirements of the insurance chat online. the NFL Player Insurance Plan, provider and are approved. This PAGE 32 PAGE Launched in October 2013, the the cost of evaluation and any coverage provides financial NFL Health Care Information subsequent treatment is covered support for players if they require Hotline connects former NFL at 100 percent. Eligible players who long-term medical assistance at home, in the community, in players with trained specialists cannot afford treatment may apply familiar with both NFL resources to the NFL Player Care Foundation assisted living or in nursing homes. Dating back to its June and the Affordable Care Act. for a grant to cover some or all of Customer Service Advocates the costs of treatment. 2011 inception, 1,648 current

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH work to help players understand insurance options and benefits they may be eligible to receive. As of March 2015, the Hotline received 1,109 calls in the three months of open enrollment, which is in line with last year’s open enrollment period when 2,039 calls were received. Of the 1,109 calls, advocates spoke to 741 unique players and family members. Popular topics discussed included: Health Care Reform (46 percent), Former Player Life Improvement Plan (25 percent), Health Reimbursement Account (15 percent) and Player Insurance Plan and COBRA (12 percent).

DID YOU KNOW? ACCORDING TO A STUDY BY THE NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH (NIOSH), NFL PLAYERS LIVE LONGER THAN THE AVERAGE U.S. MAN, WITH LOWER RATES OF CANCER AND HEART DISEASE.

AP Photo/Aaron M. Sprecher

HIGHLIGHT REEL UNWAVERING COMMITMENT: THE NATIONAL FOOTBALL LEAGUE PLAYERS ASSOCIATION (NFLPA) The NFLPA supports the well-being of former NFL players over the long-term through outreach and research initiatives, including:

The Trust The Trust helps players make a successful transition from professional football by offering counseling across a range of issues: health, education, careers, finances and lifestyle. www.playerstrust.com 33 PAGE —

The Football Players Health Study at Harvard University This vital independent study seeks to learn about the health of the “whole player” over his entire life — before, during and after a football career — and the factors that may affect his health and wellness.

www.footballplayershealth.harvard.edu NFLHEALTHPLAYBOOK.COM STARTING STRONG: TEACHING YOUTH THE RIGHT WAY TO PLAY

True leadership in health and safety requires making a difference far beyond the NFL, professional players and the game of football. It requires applying our resources, expertise and what we’re learning to all sports, at all ages.

Understanding that safety practices must take root at the earliest stages, this year the NFL and its partners aggressively expanded health and safety education to more coaches, players and parents. Award-winning advocacy drew attention to proper playing techniques, safe tackling, fair play and good sportsmanship. Meanwhile, more NFL clubs helped local youth sports leagues in underserved communities benefit from athletic trainers and taught a greater number of parents about sports safety. PAGE 34 PAGE 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH AP Photo/Paul Spinelli PAGE 35 PAGE —

NFLHEALTHPLAYBOOK.COM THE NFL FOUNDATION: SUPPORT WITH SAFETY AT ITS CORE

Keeping children safe and healthy takes teamwork. The NFL Foundation — the league’s MORE THAN non-profit organization dedicated to improving $49 MILLION the health, safety and wellness in athletes, youth IN GRANTS AWARDED IN THE PAST 17 YEARS, football and communities that support our game REVITALIZING 435 — is proud to do its part. PLAYING FIELDS ACROSS THE COUNTRY The NFL Foundation supports a Since 2006, the NFL Foundation significant portfolio of programs has worked with the American to advance this mission. Whether Heart Association and provided promoting new standards in youth more than $8 million to promote $2.5 MILLION and high school football, funding the NFL PLAY 60 Challenge, which FOR 2014 FIELD athletic trainers on more school remains the core, in-school, NFL IMPROVEMENTS IN 15 CITIES sidelines or supporting grassroots club-activated component of the programs that empower parents NFL PLAY 60 initiative. and advance safety for all young $1 MILLION athletes, the NFL Foundation The NFL Foundation also FOR ATHLETIC TRAINERS takes a comprehensive approach continues its grant support of The IN UNDERSERVED Cooper Institute’s FITNESSGRAM to expanding the league’s SCHOOLS LOCATED IN tool, the most widely used commitment to health and safety 16 NFL MARKETS beyond professional football. physical fitness assessment, education and reporting tool in the ACTIVE IN YOUTH FITNESS world. The Foundation has funded To keep kids healthy and help them a longitudinal study in 1,100 $750,000 get moving for at least 60 minutes schools in the 32 NFL markets for FOR 252 FREE YOUTH every day, the NFL Foundation the past six years. FOOTBALL CAMPS HOSTED provides grants to its 32 clubs BY CURRENT AND FORMER through NFL PLAY 60 activities in NFL PLAYERS AND COACHES their local communities. PAGE 36 PAGE

HIGHLIGHT REEL RECOGNITION AS A SAFETY AMBASSADOR In March 2015, the National Athletic Trainers’ Association (NATA) named the NFL Foundation one of its three Youth Sports Safety Ambassadors. NATA recognized the Foundation’s work supporting the Heads

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH Up Football program and the athletic trainer grant program for underserved schools. TAKING THE LEAD: ABOUT CHARLOTTE JONES ANDERSON

CHAIRWOMAN, NFL FOUNDATION EXECUTIVE VICE PRESIDENT, DALLAS COWBOYS As Chairwoman of the NFL Foundation, Charlotte Jones Anderson is an influential leader in youth health and safety.

“The future of our game lies in „„ Supporting the work of “THE NFL FOUNDATION IS PROUD TO the kids in the youth leagues, USA Football and Heads Up SUPPORT THE IMPORTANT WORK ensuring they are playing the Football, to educate coaches, THAT WILL HELP KEEP ATHLETES OF game as safely as possible,” players, parents and programs ALL LEVELS SAFER AS THEY PLAY THE Anderson said. “We have a nationwide about safe SPORTS THEY LOVE. WE ARE PLEASED tremendous opportunity to act as practices in all levels of football TO WORK WITH A DIVERSE GROUP OF a catalyst for raising awareness „„ Funding safety-focused LEADERS IN THEIR RESPECTIVE FIELDS of the importance of safety.” programs in schools, including TO HELP ADVANCE THE IMPORTANT the presence of certified Anderson has played a pivotal role athletic trainers CAUSE OF SPORTS SAFETY.” in the NFL Foundation in: „„ Supporting healthy and active Charlotte Jones Anderson, Dallas Cowboys Executive lifestyles through partnerships Vice President and Chairwoman of the NFL Foundation, NFLcommunications.com, May 29, 2014 with organizations like the American Heart Association PAGE 37 PAGE NFLHEALTHPLAYBOOK.COM — NFLHEALTHPLAYBOOK.COM HEADS UP FOOTBALL: EXPANSIVE REACH, IMPRESSIVE RESULTS

From Seattle to Atlanta and even as far away as “THE SAFETY AND WELL-BEING Camp Humphries in South Korea, health and safety OF OUR ATHLETES IS PRIORITY NUMBER ONE. WE ARE ALWAYS fundamentals are taking center stage for the game’s LOOKING TO IMPROVE SAFETY.” youngest players, thanks to USA Football’s Heads Up Mike McCulloch, President, Ukiah Lions, a new Heads Up Football (HUF) program. A comprehensive way to play program participant in Northern California, NFLEvolution.com, and teach the sport better, Heads Up Football promotes March 18, 2015 proper techniques and positive coaching while bringing clarity to an evolving, often complex landscape.

STANDARDIZING COACH EXPANDING REACH SEEING RESULTS IN ACTION CERTIFICATION AND INFLUENCE Coaching education and Coaches learn approved health Effective programs grow guidelines included in programs protocols for concussion signs quickly. Heads Up Football is like Heads Up Football can have a and symptoms, as well as heat no exception. Currently, more tremendous impact on injury rates, exposure, proper hydration than 6,300 youth leagues and according to a study published July and how to teach tackling and more than 1,000 high schools 2015, in the Orthopaedic Journal of blocking techniques that aim are registered for Heads Up Sports Medicine. to reduce helmet contact. The Football, representing more than program’s certification for coaches 1 million players. The Datalys Center for Sports is becoming a norm nationwide. Injury Research and Prevention In the Northern California Youth High School Heads Up Football conducted a study in 2014 Football and Cheer organization, has earned the endorsement of comparing injury data from leagues for instance, all coaches are the National Federation of State that have adopted Heads Up required to be USA Football- High School Associations, eight Football with those leagues that certified. The same is true of state high school associations have not. Results from this study the Washington Junior Football and leading organizations were released in February 2015. League in Missouri. spanning medicine and sport. The Oregon School Activities Leagues that adopted Heads Up “Heads Up Football gives us the Association (OSAA) became the Football had a 76 percent reduction PAGE 38 PAGE curriculum we need to make sure first state high school activities in injuries and a 34 percent everyone in our community knows association in the United States reduction in concussions compared the safety of their children is to require coaches to complete to non-Heads Up Football leagues. our number one priority,” League Heads Up Football training, This impressive statistic included President Mike Newbanks told effective in 2016. a 34 percent reduction in usafootball.com on March 18, 2015. concussions in practices and a 29 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH percent reduction in concussions EQUIPPED FOR SAFE PLAY “THANKS TO USA FOOTBALL, THE during games. Improved Safer equipment is essential NFL AND THE NFL FOUNDATION, THE techniques, certified coaches and for safer play, and the league EQUIPMENT GRANT PROGRAM AND health awareness all lead to a continues to ensure young MUCH-NEEDED CULTURE CHANGE TO significantly safer youth game. players have the equipment they IMPROVE THE HEALTH AND SAFETY OF need. Building on a collaboration ALWAYS EXPANDING YOUTH FOOTBALL PLAYERS IS WELL THE PLAYBOOK with the Consumer Product UNDER WAY...THE NFL’S SUPPORT Safety Commission (CPSC), the When it comes to youth safety, OF HEADS UP FOOTBALL HAS BEEN A NFL Foundation continues to USA Football isn’t standing still. address the need of youth and KEY TURNING POINT IN THIS EFFORT During the past year, the program high school leagues for new or AND HAS DRAMATICALLY EXPANDED made two new additions to its refurbished equipment. In April THE NUMBER OF YOUTH PROGRAMS curriculum: training on Heads Up 2015, the NFL committed $2 NATIONWIDE THAT ARE TEACHING Blocking and protocols for sudden million to support USA Football’s AND PLAYING THE GAME IN A WAY cardiac arrest, both approved equipment grant program, which THAT PUTS PLAYER SAFETY FIRST AND by USA Football’s medical and helps youth programs obtain new FOREMOST. I APPLAUD THE NFL FOR football advisory committees. or refurbished helmets and other ITS COMMITMENT AND LOOK FORWARD The Heads Up Blocking technique equipment to advance player TO AN EVEN GREATER INVESTMENT BY guides coaches in teaching safety. The grants are distributed THE LEAGUE INTO EFFECTIVE WAYS TO proper engagement with a based on need and merit. ACCELERATE YOUTH SAFETY CULTURE defender, driving with the legs and CHANGE. ULTIMATELY, AS IN FOOTBALL, maintaining correct body position IT WILL TAKE A TRUE TEAM EFFORT BY for safer and more effective play. ALL OF US — INCLUDING PARENTS, USA FOOTBALL FINDS COACHES AND PLAYERS — TO CREATE STRENGTH IN NUMBERS A SAFER AND SMARTER GAME THAT The second annual USA Football INVOLVES FEWER HITS TO THE HEAD National Conference in February AND FAR LESS TRAUMA TO THE BRAIN.” 2015 convened nearly 600 youth Elliot F. Kaye, Chairman, U.S. Consumer and high school football leaders Product Safety Commission in Indianapolis.

The largest event of its kind, the HUF AREAS OF FOCUS: conference focused on youth and Coaching Certification: HUF maintains the sport’s only Player Safety Coach: HUF trains Player high school player safety, education nationally accredited courses with content created from football Safety Coaches to ensure compliance with core and injury prevention. Coaches experts and health professionals. HUF health and safety protocols, including learned from football leaders like coaching certification and conducting safety Concussion Awareness: HUF has partnered with clinics for coaches, parents and players. Tony Dungy and Bill Polian about organizations such as the CDC to develop resources to help how to become better coaches, coaches and parents become educated on what to look for on Heat & Hydration: HUF deploys targeted football administrators and positive the field and to encourage attention to concussion symptoms. education for coaches and parents to increase prevention, recognition and basic treatment influencers on the lives of the Equipment Fitting: HUF teaches coaches, players of athletes for heat-related illnesses. children they coach. They also and parents how to properly fit helmets and shoulder pads for 39 PAGE heard from some of the world’s higher levels of safety. Improperly fitted equipment can place an Sudden Cardiac Arrest: HUF has recently athlete at greater risk of injury. included sudden cardiac arrest protocols as leading sports medicine experts part of the program. Sudden cardiac arrest is in sudden cardiac arrest, injury Heads Up Tackling and Blocking: HUF employs two five-step the leading cause of young athlete fatalities epidemiology and concussion. series that teach the fundamentals to address proper tackling and during exercise across all sports. blocking technique with a focus on reducing helmet contact. NFLHEALTHPLAYBOOK.COM — NFLHEALTHPLAYBOOK.COM MOMS CLINICS: PUTTING PARENTS IN YOUNG PLAYERS’ SHOES

Moms Clinics — with nearly 10,000 enthusiastic attendees since 2013 — are getting moms on the field and into the action.

Hosted by NFL clubs and supported “IT’S IMPORTANT FOR THE NFL by USA Football, these free, TO BE A LEADER AND A TEMPLATE two-hour programs help mothers FOR ALL YOUTH SPORTS.” understand what their children Chris Golic, Moms Clinic leader experience during practices and games. They follow an educational LEADING THE WAY curriculum including: “We want moms to see our „„ On-field demonstrations and commitment is real,” said Chris tackling drills with USA Football Golic, the wife of former NFL Master Trainers defensive lineman and ESPN host „„ Practical advice on diet, Mike Golic, parent of three student- hydration, equipment fitting athletes and a Heads Up Football and concussion recognition Advisory Committee member. and response Golic is a regular at Moms Clinics „„ The opportunity to ask as a leader and a participant. And questions and voice concerns she’s seen positive changes since to current and retired players, the program began in 2012. coaches and health and medical professionals “I think it’s definitely making a difference,” she said. “It gives “YOU’VE GOT TO LOOK THAT PARENT them a chance to ask questions IN THE EYE AND DEMONSTRATE and to experience what their THROUGH ACTIONS, NOT WORDS, kids go through. We want to help THAT YOU ARE DOING THINGS moms make decisions. And they’re starting to trust us as a group that

PAGE 40 PAGE TO CREATE A BETTER, SAFER AP Photo/Kike Calvo ENVIRONMENT FOR THEIR CHILD.” puts safety at the forefront.”

Scott Hallenbeck, CEO and Executive Director, USA Football, Chris Golic, Moms Clinic Leader The New York Times, January 29, 2015 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH MEET THE NFL’S DIRECTOR OF YOUTH AND HIGH SCHOOL FOOTBALL (ALSO KNOWN AS DAD)

With a 12-year career as an offensive tackle under “I BELIEVE IN THE FOOTBALL VALUES. I BELIEVE IN WHAT YOU his belt, a Super Bowl ring and a reputation for player CAN LEARN IN THIS GAME.” advocacy, Roman Oben brings serious credibility to his Roman Oben, NFL Director of Youth Football role as the NFL’s Director of Youth Football, a position he took on in January 2015. He also knows how youth football works. After retiring from the NFL in 2008, he held several leadership positions and launched the Oben Flag Football program, which helps communities bring football skills into their recreation programs.

But what may inform his It’s also about making sure leadership most is his role as a parents know the landscape parent of two school-age sons — as well. “When the language is both of whom play tackle football. standardized and the approach is transparent and everyone knows, AN ADVOCATE FOR then you make better decisions,” SAFETY EDUCATION Oben said. “We have gotten Roman brings a rich perspective smarter to start that discussion and an understanding of what it earlier. And then that creates a means to do “the right things.” safer player, a more educated Since he was drafted by the New parent and a better game overall.” York Giants in 1996 as a third- round pick, Oben has seen the AN AMBASSADOR FOR game evolve — rule changes, FOOTBALL, SAFETY AND practice guidelines, medical PHYSICAL ACTIVITY knowledge and training and Youth participation in almost all education for coaches, as well as sports has dropped for many for the young players themselves. different reasons, Oben said, including the sedentary nature “By the time kids get to high of life today, more options for school, you want them to have the activities and safety concerns. His 41 PAGE proper fundamentals, and you want new role gives his efforts a national the high school coaches to inherit platform to address barriers a generation of kids that have to involvement and encourage the proper base of fundamental parents and youth to experience football knowledge,” he said.

the benefits of the sport. — NFLHEALTHPLAYBOOK.COM NFL FLAG POWERED BY USA FOOTBALL: ESSENTIALS OF HEALTHY PLAY

In April 2015, the NFL announced the expansion of the NFL FLAG Essentials program to reach 2,500 schools, serving 1 million students nationwide.

NFL FLAG Essentials — be physically active and lead a established in 2014 through a healthy lifestyle. partnership between the NFL, USA PUTTING NFL FLAG Football, GENYOUth and Fuel Up AT CENTER STAGE to Play 60 — provides elementary At Super Bowl XLIX in Phoenix, schools with flag football kits. the top 32 NFL FLAG teams from These packages of footballs, flag across the country had the chance belts, posters and educational to show off their skills at the NFL materials for physical education FLAG National Championships. teachers encourage kids to be physically active and learn to enjoy Players and coaches also playing a great team sport. participated in the NFL Pro Bowl pre-game and halftime shows and in Included in the national expansion Super Bowl Media Day. In 2016, the to 2,500 schools, the program has NFL FLAG National Championships focused distribution in 10 cities: will once again be held at Super Atlanta, Boston, Buffalo, Chicago, Bowl 50 in San Francisco. Jacksonville, Miami, Minneapolis, Phoenix, Pittsburgh and San Francisco. For many students, this is their first opportunity to play football. In each of these cities, physical education teachers receive in-person training led by

PAGE 42 PAGE USA Football with a curriculum developed by the Society of Health and Physical Educators.

NFL FLAG, powered by USA Football, builds on the broader goal of the NFL and Fuel Up to Play 60 to encourage kids to 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH HIGHLIGHT REEL NFL FLAG FAST FACTS PAGE 43 PAGE — NFL FLAG Every player Costs are NFL FLAG teaches NFL FLAG Essentials is a great has the chance lower because teamwork, strategy, provides schools entry point to touch the there are no sportsmanship free flag football to the ball and play helmets or and fundamental equipment, curriculum

sport offense pads to buy football skills and training NFLHEALTHPLAYBOOK.COM HELPING UNDERSERVED COMMUNITIES PLAY IT SAFE

Lower injury rates, fewer recurring injuries, improved diagnosis and return-to-play decisions for concussion and other injuries — these are just a few of the significant benefits certified athletic trainers (ATs) contribute to the health of student athletes, according to a study from the American Academy of Pediatrics.

However, financial realities mean Trainers Society (PFATS) to that many high school athletes expand the reach of the program. do not have access to an AT. According to the “AT Benchmark “We are pleased that Gatorade Study” released by the National is joining NATA, PFATS and Athletic Trainers’ Association NFL teams as we continue to (NATA) and the Korey Stringer improve youth athlete safety Institute (KSI), nearly two thirds of across all sports for boys and high schools do not have a full- girls by making athletic trainers time AT and nearly 30 percent do available across the country,” not have any access to an AT. said Dallas Cowboys Executive Vice President and Chairwoman In 2013, the Chicago Bears of the NFL Foundation Charlotte spearheaded a focus on access Jones Anderson. to athletic trainers when they established an initiative to provide “We believe this program is an an AT at every Chicago Public High important step forward toward School football game. In 2014, the ultimate goal of having a 15 other NFL teams joined the full-time athletic trainer in every Bears’ efforts through a new NFL high school in the country, Foundation grant program in their and we couldn’t be more own communities. excited to support the NFL and NATA’s efforts,” said Jeff PAGE 44 PAGE For 2015, not only is the NFL Kearney, Senior Director, Foundation increasing its Gatorade Sports Marketing. commitment to ATs, the program will get a major boost from a new partner: Gatorade is joining the NFL Foundation, NATA and the Professional Football Athletic 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH NEARLY TWO THIRDS OF HIGH SCHOOLS DO NOT HAVE A FULL-TIME ATHLETIC TRAINER

ALMOST THIRTY PERCENT DO NOT HAVE ANY ACCESS TO AN ATHLETIC TRAINER

NFL FOUNDATION ATHLETIC TRAINER GRANT PROGRAM IN 2014 $1M 16 160,000 600+ COMMITTED NFL CLUBS DEVELOPED AIMING TO IMPACT SCHOOLS PROGRAMS NEARLY 160,000 YOUTH

HIGH SCHOOLS WITH CERTIFIED ATHLETIC TRAINERS HAVE LOWER OVERALL INJURY RATES ACCORDING TO A STUDY PRESENTED IN 2012 AT THE AMERICAN ACADEMY OF PEDIATRICS (AAP) NATIONAL CONFERENCE AND EXHIBITION

HIGHLIGHT REEL DID YOU KNOW? IN 2014, SHAPING A CULTURE OF SAFETY IN MINNESOTA AT THE HEALTHY KIDS AND SAFE SPORTS CONCUSSION Vikings head athletic trainer Eric Sugarman and athletic trainers from the SUMMIT AT THE WHITE Twin Cities’ TRIA Orthopedic Center signed up for the AT Grant program, HOUSE, PRESIDENT PAGE 45 PAGE then got to work. The mission was to ensure that every high school OBAMA ANNOUNCED THE — football program in the 13 Minneapolis/St. Paul area public high schools NFL FOUNDATION’S $25 was covered and that injured players would get the treatment they MILLION COMMITMENT TO needed. As a result of this initiative, nearly 600 football players received SUPPORT HEALTH AND SAFETY PROJECTS OVER A attention from certified athletic trainers.

THREE-YEAR PERIOD. NFLHEALTHPLAYBOOK.COM NEW LAWS, NEW AWARENESS

After four years and an intense advocacy campaign, “WE WILL CONTINUE TO FOCUS ON the NFL and its many allies succeeded in their MAKING OUR GAME BETTER AND SAFER AND SETTING THE RIGHT EXAMPLE ON mission of getting a youth concussion law passed HEALTH AND SAFETY IN SPORTS.” in all 50 states. By 2014, all 50 states had enacted Commissioner Roger Goodell, accepting the 2014 BIAWA “return to play” laws modeled after the Lystedt Law, Leadership Award on behalf of the NFL named for the young football player who inspired the original Washington State youth concussion law.

The state laws include the three increase in states without these concussion in the United key components found in the laws, according to the study, which States are both directly and original Lystedt Law: was published in JAMA Pediatrics indirectly related to concussion in December 2014. legislation,” researchers „„ Athletes, parents and coaches concluded in their report. must be educated about “Increased healthcare utilization the dangers of concussions rates among children with each year „„ If a young athlete is suspected of having a concussion, he or she must be removed from a game or practice and not be permitted to return to play — when in doubt, sit them out „„ A licensed healthcare professional must clear the young athlete before he or she can return to play in the subsequent days or weeks

According to researchers at the University of Washington, these regulations — and the heightened local and national media attention leading up to their passage — are PAGE 46 PAGE having an effect:

States with these laws experienced a 92 percent increase Nate Gowdy Photography in concussion-related treatment from 2008–2009 and 2011–2012, NFL Commissioner Roger Goodell, Victor Lystedt, Zackery Lystedt and Richard Adler at the compared with only a 75 percent eighth annual benefit auction for the Brain Injury Alliance of Washington (BIAWA), where

2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH Commissioner Goodell accepted the 2014 BIAWA Leadership Award on behalf of the NFL. BACK TO SPORTS: INCREASING PARTICIPATION WITH EDUCATION

The NFL and the American Heart Association (AHA) are teaming up to help keep kids safe, healthy and having fun while playing the sports they love.

The Back to Sports program specific sports safety issues support from AHA to help new empowers athletic trainers to like concussion, heat, hydration, and experienced athletic trainers provide parents of students who nutrition, cardiac arrest and deliver the program. participate or are considering proper response and preventing participation in sports with pediatric overuse injuries. Along with the NFL and AHA, consistent, clear information strategic alliance experts about sports safety. This year, 100 grant-funded such as the U.S. Centers for athletic trainers will receive all the Disease Control and Prevention, During educational sessions, necessary resources and support Korey Stringer Institute (KSI) families learn about the benefits to host Back to Sports meetings. and National Athletic Trainers’ of sports participation and These include an honorarium Association (NATA) helped develop ways young athletes can stay for the athletic trainer, a CPR in the program content, which safe while being active. Athletic Schools Training Kit, the Back incorporates the most relevant trainers educate parents on to Sports Toolkit and technical evidence-based science to date. PARTNERSHIPS TO PROMOTE EDUCATION

In July 2015, the NFL Foundation announced a new DID YOU KNOW? IN THE 2013–2014 SCHOOL YEAR, educational partnership with the American THE NATIONAL FEDERATION Academy of Family Physicians (AAFP). This initiative OF STATE HIGH SCHOOL ASSOCIATIONS REPORTED will aim to provide informational materials about ITS FIRST RISE IN TACKLE concussions to family physicians, their patients and FOOTBALL PARTICIPATION IN FIVE YEARS. FOOTBALL IS the public. These materials will focus on four key THE NUMBER ONE SPORT OF HIGH SCHOOL BOYS, WITH areas: safety, return-to-play protocols, concussion 47 PAGE recognition and concussion evaluation. MORE THAN 1.2 MILLION PARTICIPANTS. MORE BOYS PLAY HIGH SCHOOL FOOTBALL By ensuring more physicians have the most current information, more THAN THE SECOND- AND youth will receive the best care possible, and more parents will be THIRD-MOST POPULAR BOYS better informed about this injury. SPORTS COMBINED. — NFLHEALTHPLAYBOOK.COM NFL, KOREY STRINGER INSTITUTE CONVENE LEADERS TO SHARE STRATEGIES

In March 2015, the Korey Stringer Institute (KSI) at the University of Connecticut convened leaders at the NFL’s New York headquarters. The first Collaborative Solutions for Safety in Sport meeting was hosted in conjunction with KSI, the National Athletic Trainers’ Association (NATA) and the American Medical Society for Sports Medicine (AMSSM). For the first time, “THESE KINDS OF INITIATIVES HAVE THE POTENTIAL TO BE GAME representatives from the high school athletic CHANGERS IN THE REALM OF associations and the sports medicine advisory ENHANCING HEALTH AND SAFETY OF committees from all 50 states came together to discuss ATHLETES AT ALL LEVELS...”

critical issues for youth athlete safety, including: Dr. Douglas Casa, COO, KSI

„„ Best practices for heat-related forward faster to encourage „„ Only 14 states meet minimum illnesses and cardiac events a more integrated, organized best practices for protecting „„ The necessity of readily approach to improve health and athletes from heat stroke available automated external safety standards that influence „„ Only half have AEDs at school- defibrillators (AEDs) checked our secondary school athletes,” sponsored athletic events monthly for battery life said Dr. Douglas Casa, Chief KSI also organized the first „„ The importance of having Operating Officer of KSI. NATA’s and practicing emergency landmark position statement on Youth Sport Safety Governing action plans preventing sudden death in high Bodies meeting in January 2015 at NFL Headquarters. During this „„ Strengthening medical school athletics, which KSI helped coverage for student-athletes craft, has been endorsed by 16 unprecedented two-day event, leaders from the top youth sport „„ Concussion signs and organizations, including AMSSM symptoms education and the National Federation of national governing bodies came State High School Associations. together to discuss policies and The working group’s activities build considerations for making youth

PAGE 48 PAGE upon an effort by KSI “to move In many cases, sudden death sports safer. Areas of emphasis health and safety policy changes due to cardiac conditions or heat included heat illness, concussion, exhaustion can be prevented cardiac conditions and emergency “ADOPTING THESE MEASURES AND with the right policies and action planning. Representatives PUTTING THEM INTO PRACTICE WILL preparation — yet today: from nine different sports POTENTIALLY HELP SAVE LIVES AND attended, including tennis, soccer, „„ REDUCE INJURY.” Only 12 percent of all states lacrosse, hockey, baseball, require schools to have a wrestling and track and field. 2015 NFL HEALTH AND SAFETY REPORT — REPORT AND SAFETY 2015 NFL HEALTH Jim Thornton, Immediate Past President, NATA, Collaborative detailed emergency plan Solutions for Safety in Sport meeting, March 27, 2015 FOR MORE INFORMATION ABOUT THE NFL’S HEALTH AND SAFETY EFFORTS, PLEASE VISIT NFLHEALTHPLAYBOOK.COM. PAGE 49 PAGE —

NFLHEALTHPLAYBOOK.COM

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AP Photo/Aaron M. Sprecher