AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
In today’s AMA Update, heading into Super Bowl weekend we chat with the National Football League's Chief Medical Officer, Allen Sills, MD, about how he’s advancing health and safety on and off the football field. Hear more about professional athlete concussion diagnosis and management, plus more details on the NFL emergency action plans that help medical staff provide life-saving care to players like Buffalo Bills Safety Damar Hamlin.
As a neurosurgeon specializing in the treatment of athletes, Dr. Sills also serves as a professor of neurological surgery at Vanderbilt and is the founder and co-director of the Vanderbilt Sports Concussion Center. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Allen Sills, MD, chief medical officer, NFL
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have a special episode leading into the Super Bowl weekend with the NFL's Chief Medical Officer, Dr. Allen Sills, who's going to discuss how he's advancing health and safety in football.
Dr. Sills is a neurosurgeon specializing in the treatment of athletes and, in addition to his full-time position with the NFL, continues to serve as a professor of neurological surgery at Vanderbilt. He's also the founder and co-director of the Vanderbilt Sports Concussion Center. I'm Todd Unger, AMA's chief experience officer from our studio in Chicago. Dr. Sills, how great to have you.
Dr. Sills: Hey, Todd, thanks for having me.
Unger: I know this is probably a very busy time for you, so we appreciate you dropping by today. Well, let's give our viewers a little bit of background on your career, which you began as a neurosurgeon. What motivated and led to you focusing on head trauma in professional athletes?
Dr. Sills: Well, I think there are a couple of things, Todd. One, I found myself getting more and more involved in the care of athletes. Obviously, as you mentioned, as a neurosurgeon, it encompass things like spine injuries but also some brain conditions and brain injuries. And this was around the time in the late 1990s, early 2000s when concussion was really coming to the forefront in sports medicine.
And so I realized, as a neurosurgeon, I didn't really get trained in concussion. So I did had to go back and really learn about that disease and how we could contribute. And so I got very involved from those angles.
But I think also what drove my involvement is I'm a parent. I had kids playing sports and I've coached youth sports for almost 30 years now. So these are issues that were very real to me, not just as a physician, but as a coach and a parent.
Unger: How did that actually lead to the NFL?
Dr. Sills: Well, I started out working really at the community level in high school and college sports and then began to get into some pro sports. I worked in the XFL. Subsequently worked in the NBA and then NHL and got involved on the international level with the International Equestrian Foundation.
And so when the NFL was searching for a chief medical officer, they were looking for someone that had some experience in pro sports and had an interest in concussion care and care of athletes. And that led us to each other.
Unger: Was that something you expected from the get-go? Or is that a big surprise where you've ended up?
Dr. Sills: Not at all. As a neurosurgeon, I really thought I was going to take care of patients with brain tumors. So it's one of those unexpected twists of our careers that we often see. But it's been an incredible journey and something that really combined my passion and interest in neuroscience, neurosurgery concussion with my passion for athletics. And as I said, a lifelong fan, a coach, parent of kids who've been athletes in college. And so it was a natural blend of all of those things.
Unger: And it seems like such a good fit, especially from what you mentioned before when just the issue around concussions and our understanding is increasing. How did your knowledge with all of the research and experience that you have start to change the way that we approach head trauma in professional athletes and in average patients?
Dr. Sills: Well, I think when you think about head trauma, you think about a couple of different domains. First and foremost is prevention. I mean, I think any of us in medicine know the best treatment is to prevent the condition. And so we spend a lot of time, and certainly, we in the NFL are thinking a lot about, how do we reduce the incidence of this disorder by reducing head contact and trying to make the head come out of the game, if you will?
And I think, again, that's an effort not just for football, but for all sports. But I think then you also look at the diagnostic and the treatment piece. How can we better diagnose concussions? How can we then make sure that we effectively get athletes fully healed before we put them back in games?
And so we've tried to look at this problem very comprehensively from all of those different angles because it's not an easy problem to solve and, again, not just inherent to NFL football or football in general. This really applies across all sports.
Unger: Absolutely. You must have a pretty serious national spotlight on your work. And as part of that, you spearheaded the league's Injury Reduction Plan. Can you talk to our viewers out there about what was involved in that plan? And how is that turning out?
Dr. Sills: Well, I started with the NFL in 2017, Todd. And that was the year we had the all-time highest record number of concussions ever recorded in the league. I like to describe it as my housewarming gift. Here you go, new guy. Welcome to the league.
And so we looked at that and said, you know, something has to change. I described it at the time as a call to action. And so we went back to the basics. What's driving these concussions? How are people being injured? What can we do on prevention?
And we came up with this strategy that was based on all of the rich data sources we have available. It was based on our discussions with bioengineers and epidemiologists, injury experts, as well as our sports medicine physicians. And we came up with some specific pillars that we thought would affect the incidence of concussion.
And those were around how we train and practice, the type of equipment that was used, particularly helmets, and then also rules around head contact and some of the rules of the game with special teams plays and then individual tackles. And we did all of those things. And fortunately enough, we saw, in one year, a drop of about 25% in concussions in the league, which is something we've been able to sustain.
So it was a very gratifying effort. But, again, certainly not just me. It was a tremendous collaboration of all these individuals coming together to really look at the problem and approach it from a science and medicine perspective about prevention and epidemiology.
Unger: And like so many things that we talk about in medicine, hearing what you're charting out there, they're system-level issues. There's not just one thing that's going to fix it all. Do you have a goal that you're working toward?
Dr. Sills: Well, one of my colleagues likes to say, there's no finish line for health and safety. I think games can always be made safer. And one of our tenets is that the game can be made safer and more exciting. Those are not mutually exclusive events. And so I think it's on us to continue to challenge ourselves.
Sometimes I think, Todd, there's this idea that, well, players play sports. They're going to get hurt. That's just part of the game. But I don't accept that. I think we can always get better. We can always look at better ways to train, to practice, to play the games, to try to further reduce injury.
We know that there will be some injuries inherent with athletic competitions. But I firmly believe that if we use data and if we take this science and engineering approach to looking at what's driving those injuries, we can actually drive them down substantially.
And so that's something we're trying to do not just for concussion, but across the board with a lot of other injuries because many people don't realize, Todd, our number one time-loss injuries in the NFL are not concussions. They're actually lower extremity injuries—hamstring strains, groin strains, quad strains. So we've got a lot of work to do on a lot of different injury categories.
Unger: You've got all of this work proceeding. You're seeing results and then something happens really unexpected. And, namely, what we're talking about is when Buffalo Bills player Damar Hamlin collapsed on the field following a, what was, looked like a routine tackle. And, thankfully, he's doing fine now.
But I want to talk to you about, when you saw that happen, what is going through your mind? And then as you've looked through the science of what happened, what do you realize?
Dr. Sills: Well, I think the first thing that you realize in that situation is the planning and the preparation for that event started many, many months before. I mean, what you saw in that moment, Todd, was the execution of a plan that was laid out well in advance that involved appropriately trained personnel with designated roles and responsibilities and having the right equipment. And that's really the foundation of emergency preparedness.
For us, it starts with our clubs generating what's called an Emergency Action Plan, an EAP. So they write a detailed playbook that describes exactly what will happen for a variety of emergencies. Just like our players have a playbook for their plays, it's the playbook for our medical staff. And in there, in addition to roles and responsibilities, what equipment has to be on hand, how we'll activate things.
So that happens many months in advance. Then our clubs practice them. Before the season, they come in all together and literally do scenario-based training. We have a third-party company that comes in and supervises that. And they go through all of those steps in real time, with real mannequins, with feedback and videotaping and assessments of how we can do better on that.
And then, lastly, we have a briefing one hour before kickoff. We call it our 60-minute medical meeting. All of the medical personnel get together with the game referee and go through, again, the highlights of that EAP. So, again, in that moment, we're essentially executing something that's been planned and practiced for a long time.
Unger: So you're operating at the pinnacle of preparation and resources with all of those things that you've outlined there that put you in a position to have the outcome that you saw. How do you take that level of preparation and training and translate that into what folks can do when they face medical emergencies in sports at every level?
Dr. Sills: Well, Todd, to me, that's the most important lesson that comes out of an event like what we saw. It's not that on the NFL sidelines, we have 30 different medical professionals or that we've got all of these resources. What are the real basics? And the basics are having a plan, having people train in basic life support, and having some of the equipment.
So for me, again, let's take it down to the youth and community level because as I said, I still coach youth sports. Do we have an AED on hand? The coaches have basic training in CPR, basic life support? Do we know how we'd get a hold of an emergency system if we need to get an ambulance for an emergency?
These aren't things just for the NFL. They're not even things just for football. They should be for all sports. And so I think that, again, the takeaway lesson is not about how many resources we do or don't have. It's what about those basics?
And we often talk about a couple of basic scenarios to be prepared for. Obviously, brain and spine injury, cardiac events, and heat—those are the big three that I think that we have to think about for athletes at all levels.
Unger: So I want to go back to something you talked a little bit about before just in terms of mentality because we continue to hear of athletes across the sports world, who are put back into play or go back into play and have repeated concussions, let's say. And Tom Brady comes to mind in that regard.
I'm just drawing on—when I played football in high school, it was kind of that walk it off or get back in there kind of mentality. How do we shift that mentality about injury and head injuries in particular?
Dr. Sills: Well, to me, Todd, again, it all comes back to education and education of all the stakeholders, of players, of coaches, of parents, agents, fans. Everyone needs to understand that you can't just walk off a brain injury, that brain injuries can't be taped up and put back in the game. It need to be treated differently.
And I do think we're seeing a tremendous culture shift. Again, I've been on the sidelines for games for almost 30 years. And you now see athletes self-reporting at a much higher rate.
I often say our NFL players today have grown up with the concussion protocol. They've had it in high school and college. And they know what it is and they understand their responsibility as part of that to report symptoms.
So the job's never done. But, again, we have to continue to educate everyone. But I think we've made tremendous progress there, again, not just in the NFL, but in sports in general.
But it's a message we have to get out beyond football because, again, these injuries can occur. Whether it's concussion or cardiac emergencies, they can occur in any sport at any level. And we all just need to be aware. And it's really about recognition, suspecting the injury, pulling the athlete out, getting them definitive care.
Unger: Now I know as we head into the biggest football weekend of the year, what's on your mind based on what you've said before, your focus has been on preparation. Is there anything else that you focus on when you're leading up to a game like this?
Dr. Sills: One thing that I would tell you that might surprise you is this game is really no different than any other game for us. And what I mean by that is from a health and safety standpoint, we have all the same resources, all the same planning, all the same equipment in place for every single NFL game. Whether it's preseason, regular season, international playoffs or Super Bowl, they all look the same.
And we've been very intentional about that. And the reason we're intentional about that is because injuries and illnesses and life-threatening injuries and illnesses can occur at any time. So we have to be prepared any time we actually play games or even train. We have emergency action plans for our training facilities. Our clubs practice those as well.
So when I say this game is no different from any other, what I mean is we have to be prepared and have that same level of intensity and preparation for all of the activities we do. And so in that sense, Super Bowl Sunday for me and our medical team doesn't look that different from any of our other game days.
Unger: Well, last question—you've got a big audience of physicians and medical students out there that are watching and listening to this. Do you have any advice for them about how to treat patients who play sports or anything else that they can incorporate into their regular practice?
Dr. Sills: Yeah, my encouragement, Todd, would be get involved and get educated. I mentioned before that I didn't get trained about concussion care as part of my residency. That wasn't something I learned. And so I had to learn it after I got out of training.
But I think there's an incredible need. Physicians can play a great role regardless of their background, especially. This isn't just about orthopedic surgeons or neurosurgeons. Physicians of a variety of disciplines can really contribute to their local communities.
And so I think physicians, if they can become educated about these issues, particularly concussion and talk about emergency preparedness, you can go to local leagues. You can go to local schools, volunteer your services. I think that will be warmly received. And I think it can be incredibly impactful for individual communities.
So to me, sports medicine is not about being given by a small subset of highly trained individuals. We need those folks. And, certainly, at the professional level, that's who does the majority of care. But I think at the community level, it's about getting involved, getting educated, and looking for opportunities to serve because we can make sports safer for athletes at all levels. It just takes education and involvement.
Unger: Well, Dr. Sills, it's so interesting to talk to you, as we lead up to Super Bowl weekend. Thank you for joining us. Big thanks to the NFL, too, for making our discussion happen today. I'm so excited for the game. Even though my Bengals are not going to be part of it, I can't wait to watch the game.
That's it for today's AMA Update. We'll be back soon with another episode. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
