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NFL: Seven Seasons

This weekend will see the end of the 7th year of NFL American Football played at Wembley Stadium. Since their return to London 7 years ago, after an early sortie in the 1980s, they have played a total of 11 games in the iconic stadium. At each of these games, Peter Hamlyn, the consultant Neurosurgeon, and Dr Anil Vikram, the consultant Anaesthetist of The Spine Surgery London have played a crucial role.

Hamlyn, in his role as chief medical officer to the NFL in London, co-ordinates the medical team that provides the safety for these elite athletes.  Anil Visram is in charge of their resuscitation in the event that any of the 106 players that make up the 2 teams are seriously injured.

Many might think that with all their body armour and helmets the game is safe.  Safer perhaps than Rugby.  Big though Rugby players are, the scale of NFL players, on average, is 30% more.  These are true giants of men.  Whilst they can manage only a few minutes of extreme exertion, they are also phenomenal athletes, able to sprint at extraordinary speed in spite of their bulk.  Without the body armour the injury rates would be catastrophic.  Even with the protection, several players are injured on each team at every game.  Dislocated fingers are put back and players go on.  Knee, shoulder, ankle and clavicle injuries have all been seen though concussion has become the leading concern. 

Within the last few years, the NFL have settled a legal case with ex-players for a figure thought to be in excess of $700 million in regard to the long term consequences of concussion in NFL.  Driven by the concern in regard this, they have instigated world leading surveillance systems. 

Having looked after the team throughout the week and conducted the medical briefing in the minutes before the game begins, Hamlyn’s role changes to that of independent neurological assessor for the NFL.  As one of 2 neurosurgeons, the other his long term colleague Ian Sabin, they are each embedded into the teams.  Standing pitch side, their responsibility is to provide an independent assessment of any player who is suspected of having concussion.  In this work, they assist the medic responsible for concussion management that each team will have brought with them.  Often the teams with come with 4 or more doctors, all of varying specialties.  The medics supporting the concussed players have a remarkable tool.  Seated up in one of the observation booths is a ‘spotter’ equipped with a bank of TV screens, every play with every player can be examined at a moment’s notice.  The spotter looks through these plays throughout the 3 hours of the game.  It takes around that time for the 60 minutes of combat to be concluded.  If the spotter sees that a player has been engaged in a collision that looks like it may have caused a concussion he can call down to the medics pitch side and ask them to examine the player.   Likewise, if any of the medics are concerned they are able to review all the plays, on a TV screen pitch side, that the player concerned has been involved in.  Computerised concussion assessments support them in their decision making and in any player where there is a suspicion of concussion they are withdrawn from play. 

Similar systems have been developed in Rugby where in the UK some of the strictest provisions are in place.   Football, as in the English game of soccer, is also now well under way developing a programme for enhanced concussion management.  International groups from across sport have developed guidelines but nowhere is the technology seen in NFL replicated.  Not even Formula One, arguably the sport which set the gold standard for sports medicine and safety back in the 80’s and 90’s, has a system as sophisticated. 

Little wonder is it then that Hamlyn and his team will be joined by senior medical officers from both the RFU and the FA this weekend.  Indeed, with them, Hamlyn is leading the Institute of Sport Exercise and Health in the development of a national programme for concussion management. 

On Wednesday evening of this week, the Chief Medic for the Jacksonville Jaguars, Kevin Kaplin, lectured to Hamlyn’s masters’ students at the Institute of Sport Exercise and Health.  In a breath taking lecture covering just about every organ of the human body, he went through his years of experience of NFL injuries.  An extraordinary doctor for extraordinary players.  His talk was an absolute tour de force of injury management.