What Happened: The Play and Immediate Aftermath
In Week 15 of the 2022 NFL season, the Miami Dolphins faced the Buffalo Bills in a nationally televised game. On a third-and-goal situation, Dolphins safety Justin Hardee delivered a shoulder-level hit to Dolphins quarterback Tua Tagovailoa as he attempted to slide feet first near the Bills’ goal line. The contact struck Tagovailoa’s chin and head, causing him to spin violently and fall to the turf head-first. The severity of the spin and the direct head impact raised immediate concerns about a possible head injury, prompting close evaluation under the league’s concussion protocol.
The Sequence of Events and Response
After the hit, trainers attended to Tagovailoa on the field, and he was briefly evaluated before returning to the game. Later in the drive, he left the game for further assessment, and imaging that night revealed a small subdural hematoma, leading to an emergency relocation for precautionary monitoring. This sequence highlighted the critical nature of in-game concussion evaluation and the importance of removing a player when a head injury is suspected, even when initial sideline checks appear reassuring.
Concussion 101: Basics and Diagnosis
A concussion is a traumatic brain injury that temporarily affects brain function, often triggered by a direct blow to the head or body that causes rapid movement of the head. Common signs and symptoms include headache, dizziness, balance issues, sensitivity to light or noise, confusion, memory problems, nausea, and changes in mood or sleep patterns. Diagnosis is clinical, based on reported symptoms, observed signs, and standardized assessment tools such as the Sports Concussion Assessment Tool (SCAT), with imaging used when red flags suggest more serious injury like bleeding in the brain.
Key Signs and Red Flags
- Loss of consciousness, even briefly
- Severe or worsening headache
- Repeated vomiting
- Slurred speech or weakness
- Seizure or significant confusion
When red flags are present, urgent medical imaging and specialist evaluation are warranted to rule out intracranial hemorrhage or other complications.
NFL Concussion Protocol: Rules and Steps
The NFL’s concussion protocol is a multilayered framework designed to protect players by mandating removal from play when a concussion is suspected and requiring medical clearance before return. The process typically begins with an initial sideline assessment, followed by a in-arena evaluation by an independent neurologist if a concussion is suspected. If a concussion is diagnosed, the player must progress through a symptom-limited and then exertion-based return-to-play protocol, usually spanning at least five days, under the care of an NFL-approved neurologist and other licensed providers.
Protocol Milestones and Decision Points
| Milestone | Details | Why It Matters |
|---|---|---|
| Sideline Screening | Brief assessment for immediate signs of concussion | Determines whether to continue evaluation or remove from play |
| In-Arena Evaluation | Comprehensive exam by an independent neurologist | Confirms diagnosis and need for imaging or clearance |
| Imaging (if indicated) | CT or MRI to rule out bleeding or structural injury | Identifies emergencies such as hematoma |
| Return-to-Play Protocol | Gradual, monitored progression over days | Reduces risk of repeat injury before full recovery |
Medical and Legal Context
Medically, a concussion with a hematoma can require close observation to ensure the clot does not expand and that intracranial pressure remains stable. Treatment may involve observation in a monitored setting, medication for symptom control, and, in rare cases, surgical intervention. Legally, the NFL has faced litigation around concussion-related injuries and protocol adherence. Those cases have driven reforms including expanded on-site neurology consultation, standardized educational materials for players, and clearer documentation requirements to ensure timely diagnosis and safer return decisions.
Tua Tagovailoa’s Recovery Timeline
Tagovailoa’s recovery followed the NFL’s standard medical pathway: initial removal, emergency imaging, hospitalization for monitoring, gradual neurologic assessment, and a stepwise return-to-play program once cleared. Key points in his timeline included the emergency trip for observation, sequential medical clearances, and a cautious ramp-up of activity under team medical staff supervision. The situation underscored how quickly an on-field decision can evolve into a multi-day medical event when a hematoma is present.
Recovery Checkpoints
- Immediate removal from play and sideline evaluation
- Emergency imaging and hospitalization for observation
- Neurologic clearance to advance to the next rehab stage
- Completion of the NFL return-to-play protocol
- Medical clearance to resume full practice and game participation
Implications for Player Safety and Protocols
The Tagovailoa hit reinforced the importance of rigorous sideline assessment, independent neurologic review, and strict adherence to return-to-play timelines. It also spotlighted ongoing refinements in concussion education, rule adjustments to reduce targeting hits to the head, and technology-assisted monitoring to improve detection. For teams, the event served as a case study in executing protocols under pressure and communicating transparently with players, staff, and the public.
Best Practices Emerging from Such Cases
- Consistent use of standardized assessment tools on sideline and in-arena
- Clear escalation pathways when imaging is indicated
- Documentation of every clinical decision point
- Multi-disciplinary oversight including neurology, neuropsychology, and athletic training
- Ongoing player education to encourage self-reporting of symptoms
FAQs
How can you tell if a hit is a concussion on the field?
Concussion signs on the field include loss of consciousness, unsteady balance, confusion about assignment or score, delayed response to questions, visible dazed expression, and any report of headache, dizziness, or vision changes. Immediate removal for evaluation is warranted whenever a concussion is suspected.
What does a subdural hematoma mean in this context?
A subdural hematoma is a collection of blood between the brain’s surface and its outer lining, usually caused by head trauma. When detected after a concussion, it requires close monitoring because it can expand and increase intracranial pressure; emergency care may be needed if it grows.
How long does the NFL concussion protocol typically take?
Minimum timelines often approach at least five days from symptom-limited rest through exertion, but the actual duration varies by individual recovery speed, findings on imaging, and clearance from the team’s neurology team.
How are teams penalized for violating concussion protocols?
Penalties can include fines for personnel, loss of draft picks, or other league-determined disciplinary measures, and they are intended to reinforce compliance with medical and safety rules.
Is Tagovailoa still playing after the hit?
Yes. Following proper diagnosis, treatment, and completion of the NFL return-to-play protocol, Tagovailoa returned to play and continued his career with the Dolphins and later with other teams.