DrPJax

Interesting debate thread; I just wonder how most people will feel IF Mcd sticks with the same roster ( no duke , Yeldon , Sweeney as Foster, L Smith , and DiMarco stay active ) and we happen to lose 18+ vs our 17 point production that we have even struggled to produce the final month of the season. Yes , imo it is a successful season overall with team , roster improvement etc, but is a one and done playoff appearance acceptable for a Staff with its second playoff appearance in a season where the AFC title is not a forgone Pats certainty ? We all now expect to keep making the playoffs in the future but why let an opportunity go by when just perhaps taking some roster “ risks” could have a huge payoff given our D consistency? Many have advanced the argument about not losing special team efficiency by removing a gunner , Foster, who we might all agree has had little to zero offensive impact. I think his role is being overstated. I have watched every game , play , and Imo our field position battle is mostly dependent on our punters effectiveness. Rarely has the gunner determined the outcome of field position. I would argue if we are so concerned about returns that we have to keep a roster spot just for Foster, why not take the returns out of the equation and punt directionally to eliminate returns? Other teams do this and if there is a chance we can add one more weapon for our anemic pass production ( we are what 24, 25 th in the nfl ?) in a one game win or go home scenario, I would favor that. How about some creative special teams coaching, and do something the Texans don’t expect. Do I think Mcd will “ stay in the foxhole “ as another poster coined an analogy, unfortunately yes. I hope I am wrong and Mcd has the courage to take a small risk for a possible large return. One and done with no attempt to help this offensive lack of production would feel like a let down and would raise some concern about if our staff can adjust to produce a super bowl winner, contender consistently as is their mission statement. So I don’t see adding Duke at the expense of Foster or a safety as scrapping our prior whole season of special team or defensive game plan. What I am suggesting is that this offense, based on the last month, is not capable of winning without a stellar defensive game, and now we face teams who have shown they are capable of easily putting 20 plus up even despite the best defenses. I don’t see us winning in the playoffs with less than 20 points. I would love to see us take a chance to jump start this offense with more creative play calling ( how bout another Smoke td pass), some unexpected personnel moves ( Duke , Yeldon to active squad ) , urgency to score ( only one td on our opening drive in 2019, can’t we script more effectively early to help Josh?), go deep more like the 2 successful plays against the pats, be willing to throw some 50/50 balls if we get in the red zone because fgs aren’t going to cut it, knock off the predictable first down handoffs to Singletary plunging into the line, etc. One person I wouldn’t mess with is Roberts ; he may not have returned any for tds yet but the guy is money on punts and he never lets the ball hit the ground. That alone always helps us win the field position battle and he has been close to breaking it in several punt returns. So, we all saw what Yeldon , Sweeney, Williams did against a good jets D. Williams caught the game winning td against the Titans yet has barely seen the field since. It’s all on the line this Saturday and if Mcd sticks with keeping all those options off the table and we should lose because our O fails to produce again, will you be satisfied that “we showed we could play with them and it came down to that last drive”? Hey , a loss is a loss and you still go home for a long off season. I think this is a winnable game IF we step up to “ championship caliber “ coaching and chance to win , not to just not lose. Willing to be humble, rejoice if the process stays the same and we win a low scoring ( offense scores less than 20) game, but I think a few tweaks and we end up in the AFC championship!

Buffalo ,, sometime you are going to have to take them seriously! Quote of the day ! What a great win. ??

Not trying to be difficult but ; giving a running back who is avg. over 5 yds a carry 8 touches is by definition bad play calling ! 0 targets for your highly paid free agent TE is by definition bad play calling or bad game planning and speaks to a lack of identity for the offense playing foster over Williams and then targeting him once or twice is again bad game planning. Having your kick returner suddenly getting more targets than foster and expecting him to suddenly be comfortable catching the ball under game pressure is bad game planning and bad play calling. never scoring points in the third quarter speaks to bad game planning, again what is this offenses identifying principle? Can you define it ? When your slot receiver is the sole deep target on a critical down, game planning is questionable and again what is the philosophy of the passing game plan? It’s not productive and scoring 14 points is not GOOD or acceptable and the OC is responsible for the game plan. When your offense is confused and huddling as the clock runs down in the game defining drive , that is poor preparation and speaks to poor coaching. Isn’t Daboll responsible for the offense in that situation ? The product speaks for itself. If you think it’s just on Josh , isn’t it the OC s job to design an offense around the capabilities of your given talent ? I agree Josh is a work in progress. Daboll has a history of poor performing offenses and this is just another notch in his belt, by now he is what he is. Josh at least has a chance to develop. There is something wrong with the chemistry between daboll and Josh as the product now doesn’t work. Much easier to try a new OC than draft a new QB. Just like whisenhunt was responsible and dismissed its time for Mcd to salvage this situation imho.

This was a horrible loss and continues the trend of inexplicably poor offensive production. The playcalling is abysmal and we have no identity from game to game. How do you explain not using your very productive young back more than 8-10 carries ? How do you keep having a TE (Smith ) playing who commits more penalties than times he has touched the ball? How do you explain a free agent TE ( Kroft) who is a ghost in the offense? How do you keep an OC where the offense can’t score in the third quarter; keeps going to empty sets on critical downs when the line is not holding up; keeps placing the o in situations where they commit holding penalties that either stop drives or knock you out of or into poor fg position; keeps being so situationally unaware that you waste time on a final drive where you should be trying to win rather than go to OT, and the list could go on. Unfortunately the d also has issues when we start games slowly, still struggle with the run , and they failed to generate any pressure on the game deciding drive allowing mayfield to drive them easily down the field for the winning score. This really has the look of a “ bad” 6-3 team and it’s going to be hard to stop this season from falling apart. Looking at the schedule, the fins look better offensively than when we last played them, , and who has faith in the stretch of games involving the Cowboys, Ravens ,Steelers , and Pats? It hurts to think this but if they don’t make some drastic change with the O, I could easily envision this team only beating the Broncos and Jets on route to a very depressing 8-8 season. For all the good McD did with getting us to the playoffs in season one, he maybe seen as just another Bills coach who blew a good start unless he can get a handle on this offensive debacle. I hope I’m wrong about my outlook but today’s game proved its not only about the W-L record as many only chose to look at , but also how you played en route to that record and what is the true identity of the team as you progress thru the season. This loss identifies us as a pretender with no unified offensive scheme and it will be interesting to see what direction McD chooses. Critical stretch for the franchise is upon us with no easy answers. Just a terrible loss today.imho.

I really liked Allen’s play today. No big issues BUT two things. One was taking an unnecessary sack in red zone that killed a drive. Easily could have thrown it away but just froze and took a bad sack. However , no throws stood out being a bad throw into traffic etc. Two, he has to get this ball security issue behind him, or under control. It cost us dearly against the eagles and almost did today. He did juggle the qb sneak he scored on but made a nice recovery before it squirted out. I only mention it because he did fumble carrying the ball later and while we recovered it, it easily could have turned momentum again in a game that was a one possession game deep into the fourth quarter. He has to be cognizant now that teams will try to hold him up on first contact as they wait for a second guy to come in attempting to strip the ball. It is what it is once you get a rep for fumbling. Tiki Barber struggled with fumbling at one point in his career and Coughlin was close to benching him if my memory serves me. Coughlin really had him work on three point contact security and it turned his fumbling around. This issue is just as important as not making hero throws on plays that are dead. He has shown he is coachable and can change his tendencies so hopefully coaching solves this. I really love the guys competitiveness and his love of his team, leadership qualities while being humble and never throwing teammates under a bus as they continue to drop a Significant rate of passes he rockets into their hands. Get this fumble thing under control, get the o line settled and stable , give him a legit deep threat with an O coordinator who doesn’t keep being cute at wrong times , and Allen will be a consistent winner. I think he is a great fit for Buffalo; he is a good guy you can be proud to be a fan of and I hope he doesn’t let the fumble issue hold him back. Good win today despite run d issues; looks like we have our RB , QB for near future and need a young talented ANDRE REED type guy to grow with, and the Bills will be back in the Super Bowl hunt.

I think this is the most comfortable I can remember feeling about a Bills win in quite some time. I am an Ohio state follower/ fan and watched Haskins every snap the year he played for the bucks. Here are a couple observations ( also it is the worst time to be playing the Bills after that debacle last week, they will be focused on correcting things and they know they need to win these home games if they really believe the playoffs are possible ) ; Haskins is a very accurate passer in a clean pocket. However, with people around him he rushes throws and I think he will continue to get rid of the ball early as he has done previously because he plays very “ soft”. This guy doesn’t like contact at all. He was easily rattled after early pressures in games for the Bucks. He had a good record because his receivers were very good and for the most part the bucks did keep pressure away from him. The Bills should not just let him sit back and only rush 4 playing conservatively because if given time he can make all the throws and that’s the scenario that he might be able to hurt us in. . I hope they take a page from Beli chick and send guys often. They don’t have to sack him but just get close and his contact adverse nature will result in opportunities for 2-3 picks. Haskins is not a really fast guy and he doesn’t have great elusiveness. They did run RPO ‘s at Ohio State with him but he was reticent to carry the ball. Finally close to the end of the year Urban had to emphasize he really needed more production running from Haskins and he had one productive game but quickly reverted back to avoiding running if possible. This is important for our d, as we won’t have to worry about Haskins taking off out of the pocket like Wentz did to us. I think this is even more reason to send blitzes more as even if we break gap integrity Haskins will pull up and throw even with clear space in front of him. I just doesn’t see him hurting us with his legs , so the bills DB’s do need to stick with their coverages if he manages to get outside of the pocket. I think this falls into our defensive scheme strength and is a great matchup for us this week. Haskins has one year at Ohio State and just that limited experience at a college level speaks to how unready I think he is for the pro level. I really liked him at Ohio State but it was obvious he needed to stay at least one more year to help his development. It’s a shame he couldn’t see that and went for the money so soon. He does have a very good arm but he lacks emotional maturity just because he is so young and he was not perceived as a strong leader compared to JT Barret who had preceded him. He was used to playing with the the lead and he did not project the feeling that he would bring the team back from early deficits. I think he had one or two really close games that year and I think there was just one situation where he helped lead the team to a win after they got behind ( I admit this is my overall impression as my memory is a little stale and I didn’t feel like going back to check all the box scores, but I think I have this right ?) Let’s hope the Bills and Daboll can finally jump on a team and make them play from behind. We haven’t done that much this year, so like others have written it would be a huge red flag concerning their playoff hopes if the Bills struggle offensively once more and continue with pre snap penalties and terrible game awareness playcalling. The only way I see the skins staying close is if Josh continues his fumbling and falls into lapses of hanging onto the ball Too long while standing flat footed in the Pocket in the face of unrecognized blitzing lbs or dbs. His pocket awareness needs to be good and if so I think he leads the Bills to an easy 24-7 victory. Let’s go Bills.

I agree with you about how well spoken the players are and it’s great to see this type of chemistry which hasn’t been prevalent in the team since the super bowl run teams of the 90’s. Wanted to point out a you tube interview for you to check out tho. It’s a single guy called Buffalo fanatics. He is ok , just refulsr guy. He did a full 30 min interview with Jordan Phillips on his you tube channel ( Buffalo fanatics ) about 4 days ago now. Check it out because I believe you will see Phillips like you saw the other players. I came away very impressed. He was genuine and had a genuine like of the team, the coaches and culture and he heaped praise on the b lo community and the bills mafia / fans. He was very articulate and well spoken and I have watched many if not all the other shows ( Murphy and tasker etc) and he was even more affable than many of the players they had on. He even had a few chances to go negative about things like the tenn players but he stayed very professional and he was a good representative for the teem. He talked about the process and he also talked some x & o type thug s and he came across very well. He want to do well and he he wants a future with the Bills and comes across very team oriented. It is such a breath of fresh air to see how well this team is actually a “ team” and they stress supporting each other. Phillips even mentioned how the locker room is set up so they are forced to know guys outside their position group and this speaks to McDermott seeing a larger picture too achieve his ultimate football goals. So not trying to argue of undermine you; just thought ihad such a positive feeling about Phillips that I would love to see him succeed on the Bills for a long time maybe it was the venue and he was more withdrawn on the Murphy show ( have to admit I missed that one but will look ). But of you have time check our Buffalo fanatics on YouTube. Phillips took time out from being with his daughter I believe to be with the show and he was very unselfish with his time. I have no affiliation with that web show so just a FYI from one bills fan to another. Sorry I didn’t put a link , IT stuff is not my forte ! Best wishes and go Bills!

With the injury to Mahomes , a dislocated ( subsequently reduced ) right patella , this season has gotten dramatically more interesting from a Bills standpoint. A patellar dislocation will likely cause a 4-6 week minimum ( can be 6-8 weeks with non Surgical management) rehab period followed by the need to split the patella with a brace to prevent more dislocations. Mahomes will be limited with his mobility in a brace and like the nice gentleman who is a PT. Posted on here, he will have the need for surgery in the off-season dictated by mri results as the extent of any associated ligament injuries are determined. Next 24 -48 hours will demonstrate the individual aspects of the dislocation ( like swelling and how he responds to rest , compression, ice etc. ) will affect the short term rehab and how quickly mahomes might Return. Even if he returns he most likely will have limited mobility so he will not be h same pre injury mahomes. Given all that is going on in the AFC , I THINK this now is a season to really push for the super bowl. The injury hursts Kc who has been the 2 Nd seed prospect so far, and leaves only the Texans and Pats as our biggest threats keep in us out of the Super Bowl! With that in mind, I believe Beane needs to take one last look at the roster to give us our best chance In assuring we are deep enough for the run. This is a year ahead of what I would guess most of us thought about our chances of getting to the SB. We really are still in the division race and home field is still in reach as our schedule Is pretty favorable. While I don’t think we need to mortgage any further years , I also think we can’t waste the fact that he AFC is having a down year. The only area I think could derail us is if John Brown ( or Allen of course) is out for any period because thee is no one who has similar talents on the roster right now. I would like to see Beane try to get a 1A type guy like green , Diggs . We have depth everywhere but an experienced backup for brown so while I was not a fan of getting Green before , given the landscape of the afc after tonight , I would really try getting green for a 3 rd and 4 th , or possibly just a second round pick. Would defer to Beane’s judgement on anything more than a third, but I would support him being aggressive more so now than earlier in the season. I think our d line , o line, TEs , RBS, all are ok to make a run and if our lb Thompson is back, we prob have enough depth there as well. The landscape is the most favorable I can ever remember recently for a deep run so Beane let’s make it happen. I know everyone saw mahomes walking and smiling in the locker room post game ( however he was not flexing or bending the knee and it was wrapped ), and while it is a good sign, we won’t know the full rehab prognosis until after the mri. The surrounding ligaments are at a minimum stretched ( which will make recurrence likely ) , and it is possible there could be tears. Based seeing him not on crutches yet in the locker room and still weight bearing, I would guess he has little swelling so far. But I am sure he will leave on crutches with a brace and then it comes down to the mri results. It will take time to strengthen surrounding muscles and allow ligaments to tighten if not torn so he doesn’t dislocate with any flexing of the knee and while he looks as good as you could after a dislocation, this will still take time to prevent recurrent injury on return to play. Hopefully teams will take advantage and give the chiefs a few losses while mahomes is rehabbing ( Denver looks beyond pathetic and I can’t see this coach making it to a second season). If we keep improving and stay injury free, I think we have a legitimate shot a year ahead of expectations to actually be a contender for the SB. HOME FIELD is still possible so let’s go Beane ,,,,be sure you are content with our current depth and let’s go Bills! I think we can do some mild addition to better our depth and experience at our wr position and not hurt us with regards to future development or drafts. I think we should push for home field this year; it is sitting right in front of us and not out of realistic reach. ?

I think the team is looking good. With Singletary coming back , I think gore and Yeldon are great compliments. Now with Duke in and Zay out, foster and McKenzie should be enough for a deep threat esp since we don’t go deep much and josh Has not been accurate deep either. We will get kroft back for depth as well. I would let the year play out on O now. Doubt there is much out there to bring in. One thing i would consider strongly tho is that if the rumors are true about Denver wanting to move people, I would try to get Von Miller. Our D is how we will win most games so why not make it really dominant? We need a premier rusher and zo is getting up there. If you bring miller in somehow , you extend both their careers and can rotate and keep them fresh. Plus you have depth and even cover yourself for zo departing. That’s the only thing I would make a big move for , You are in the cusp of a really special d and just adding a premier rusher to get to Brady could make all the difference. Also would keep looking at punters but that doesn’t have to be a trade. We need a guy who kills it within th 20 more often. Just an idea if Denver really is looking to move on. What do you think ?

I get your point Promo, not arguing that. I just wonder tho if they make those if the momentum stays the same. Also if one of those missed fgs turned out to be a td ( the one where mariotta crossed the line ) we are looking at them scoring 20. He only missed it by a foot and I bet you were holding your breath like I was during the break that the refs were going to give that too the titans. In fact the ref on tc was saying he would have given it tenn so it was a really fortunate win. Glad we got it but I think this team has the talent to be better. Need some coaching things cleaned up. Hey I think it’s ok to still love your team but be critical of stretches of poor play as well. I mean part of the fun of football if Monday morning qbing. How many of us called for duke two weeks ago and they finally , finally pulled the plug on the Zay excuses. Without duke they don’t win today and many on the board were harsh to people who were crtical of Zays play; turns out people should have been critical of his play. But that doesn’t negate loving the bills , at least for me my friend. Always like reading your insights for quite a few years now ! ? e

It’s a good win,,, better than any loss. But you are not going to have many teams miss three fgs like that. We also had our OC call three pass plays when we finally got the lead and we burned zero clock. Luckily Dabol got a chance to redeem himself and saw that had should have called the gore runs sooner. We got some luck there , also titans had a holding , illegal formation , and we still have up a td before it was nullified by Mariotta crossing the line and he did that by literally a foot. I mean it’s great to win and enjoy it but you also have to not accept this as the standard you want to hold your team to. Good news is we somehow won and we hopefully can build on this from a confidence standpoint. Young teams need to learn how to win and we are developing that winning culture. But to be there at the end of the season we need to clean a lot up. We had another bad int that resulted in the game being tied and we should have kicked that fg early when points were hard to come by yet we choose to call a bad qb sneak. Just need to clean this stuff up so Sunday’s keep us all smiling! ??

Yep. He made a clutch adjustment with josh on that td. Josh moved him toward the line and it allowed an inside release. He was on same page with josh and he also caught it in traffic in a clutch play. Zay wa not doing that very often esp the catching part

McKenzie with honorable mention on that jet sweep after misses fg and marriota crossing the line. That was great run.

Saw him run on in the failed 4 th down qb sneak. Never after that

No kidding. But hey they deserved that after gloating about that miracle thing! We got the miracle partially redeemed. Thought they might give one to marriota when he crosses the los but we lucked out!

GTA V rp at its best!

Ok now we are going to have to consider entering you in the TBD concussion protocol ,,,,,let’s see what posters think that protocol should be ! I am thinking one or two dirty martinis prior to reading any further posts about Josh and this dam concussion protocol ! ?

I think you are right , there is really no diff between stage 4 or 5 for a QB , except that stage 5 would imply a second day of full practice , followed by a computer test called the IMPACT test the next day to be sure josh has reached his baseline scores ( prior to the injury) and that his scores remain stable. If his score regressed tomorrow it would probably mean another day in stage 4 of the protocol which really only means he would be retested on computer again on Saturday. I believe if his score is stable tomorrow ( test done after sleeping after having finished a full practice ; the normal sleep part is important as many times patients with lingering symptoms or post concussion syndrome will have difficulty sleeping after exertion ) theoretically he would no longer need to be tested past Friday. The IMPACT test is the only FDA approved protocol for management of concussion and used by the NFL, olympics , FIFA, most high school athletic associations across the country and many colleges as well. Here is a link to the impact test site with a short video explaining its use. https://impactconcussion.com/?utm_source=google&utm_medium=paid_search&utm_campaign=impactproduct&ads_cmpid=6549852907&ads_adid=76904728725&ads_matchtype=b&ads_network=g&ads_creative=385367805553&utm_term=impact concussion&ads_targetid=kwd-314225683657&utm_campaign=&utm_source=adwords&utm_medium=ppc&ttv=2&gclid=Cj0KCQjwuNbsBRC-ARIsAAzITufx6xQwglg6Gk2R2C4wShszuAnxePkx9hEGac068cFN6ezuZRApp5gaAuudEALw_wcB ( hope that works ) . Here is a link for the SCAT5 ( sport concussion assessment tool version 5 ) that has a really nice handout used by clinicians and the last two pages really define the protocol stages for progressive return to exercise , school and studying that is a nice resource and defines what a concussion is and what cardinal signs to look for. This is used for quick ( ten min test Immediately after a witnessed possible concussion or brain injury) on the field ; sideline assessment for initial screening, then formal IMPACT testing occurs later or 24 hours after injury and compared to baseline. https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf The following is the actual consensus statement on concussion in sport that was published from the conference in Berlin in 2016 and shows the multitude of experts brought together to develop the protocol or concussion policy that is in use today by the NFL. Don’t be put off by now formal it looks. It is nicely summed up in italics as you scroll thru the short paper. Pretty ingesting to see the actual report that was the basis for everything. https://bjsm.bmj.com/content/bjsports/51/11/838.full.pdf. Hope that is helpful. I think you are spot on tho that for a qb there is no function diff between stage 4 or 5 , except for just an additional 24 hours to show stability and no regression post exertion. ?

I think you are right on it Kelly, he did take all the snaps and the PROTOCOL by definition means he has to have done or survived a normal practice ( which is everything but contact I would think for a QB, for a non QB contact would be the last step of the protocol ) and then NOT HAVE any recurrent symptoms tomorrow. I think by definition if wed was stage 4 , todays practice would be stage 5 . I believe by definition he has to take the computerized IMPACT testing tomorrow to be sure his reaction times , memory , impulse control , etc all have returned to baseline and remain at his baseline 24 hours after last full practice to fulfill the final step of the protocol. So I think by definition he could really only FULLY clear the protocol by as early as tomorrow so today’s announcement I believe still fits with normal progression and no one can say he definitely out yet. Initially this protocol was set up to be a minimum of 24 hours per stage , however that has been modified for adults allowing faster progression. I think he is following an early course and I bet he will clear it tomorrow only based on the fact that he got all the reps and the focus wasn’t on getting Barkley ready. I don’t believe they have Barkley Standing around like has been reported , without activating the other QB additionally, unless they are almost certain that Josh will be cleared. If for some reason he is not cleared by tomorrow, I don’t see how they could avoid letting Barkley get the lions share of reps. To me tomorrow is the telltale day. if I may, for all those guys ( not you Kelly ) posting that he probably wasn’t concussed or “ was barely “ concussed , you are missing the point. It doesn’t matter how he looks to untrained people on a video. The computerized testing picks up on memory and coordination and reaction times and then compares them to HIS baseline normals. He would not be in the protocol if he had all normal tests to begin with; there is no debate he had a concussion. This as stated is taken control of by outside independent neurologists so there is no way the team puts him in it ( esp since they have no control over the situation once he is in it ) to just protect him or to be cautious etc. By definition the whole process/ protocol is out of team control. To say he was “ never really concussed “, or this was for “ optics “ is laughable and shows how little some people still misunderstand concussions and why independent people are needed to protect the safety of players. How would you like someone with that type of understanding making a decision about the future brain health of your son or fiancé if you are in Allen’s camp ? Thank goodness we are beyond that.

Wow , sorry to hear your kids have had those issues but imo sports are such a vital part of growing up and learning life lessons. I did tons of presports exams / clearance exams and we rarely try to disqualify anyone if there is a sound medical way around it. That one website , the impactconcussion.com, would be really useful for you I think. You can sign your kids up for baseline testing and they also have an app listed on the website for your phone that allows you to keep tract of all the testing related to your kids done on their site ( perhaps more as I haven’t downloaded the app yet.). They also have links to providers in your area tans have been certified by them in concussion protocol testing and interpretation. For someone with family in sports I believe it’s really important knowing the providers your kids are seeing have appropriate credentials. I think the fact that the olympics , NFL, FIFA, Imternational hockey association, etc have all contributed to their research and use the exact testing that is available to you thru the site. Also all the thousands of high school associations and colleges also use that site. BYW, I have NO affiliation financially with the site but thru my clinical research I believe they are currently state of the art for concussion management etc. Thanks for the feedback and wish you and you kids great health. Protect their health because without that nothing else matters much. If I can help with anything like Questions, just let me know, I am not a concussion expert but am a general clinician and have enough credentials that I am used for malpractice cases in family practice and urgent care as an expert to determine the merit of cases. Go bills !

Thanks ! Hope it was useful with all the talk about the concussion protocol. It also points out despite the objective tests it still comes down to individual clinician judgement approval for final clearance. ?

https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf Public service post. Hey guys with all the concern over Josh, I thought it might be a good opportunity to post a couple of links to help us all be in the same page with concussions. The link above is to the SCAT5 ( sport concussion assessment tool 5) and I like it because while it is for a clinician to use on field / immediately post injury, it’s pretty basic and has good info on what symptoms are looked for , what are worrisome or red flag things or observations, and it talks about the things for clearing ( the protocol for increasing activity ) for sports and even for returning to school and studying. It has a good explanation on its last two pages. This information is collected prior to injury and then after for comparison. This is used quickly to determine need for transport to hospital, need for cat scans etc. I am sure Josh was examined by trainers or docs quickly after the injury. Note in red print about player not returning to action on day or injury and this is mandated in all 50 states for high schools. Just wanted you to see the various symptoms and also the protocol for returning defined. Josh is in stage 4 on wed which is good but all that means is he is progressing. So if he is symptom free after practicing Thursday, he MIGHT progress thru stage 5 which means he is ok after full practice (I doubt they allow anyone to have “ contact “ with their qb). That still doesn’t mean he will play. There is a known buffer zone where clinical symptoms ( patient feels better ) improve before physiological complete healing. A big study of around 3000 college athletes with concussion showed the biggest risk for further injury or second impact syndrome was within the first 7-10 days of the initial injury. About 1 in 15 had another concussion within the same year, most within that 7-10 day period. If someone had 3 concussions their risk for more was 3x that of someone with no concussions, so you can see the associate worry surrounding CTE. https://scipol.duke.edu/track/immediate-post-concussion-assessment-and-cognitive-testing-impact The second link is about “ impact”., immediate post-concussion assessment and cognitive testing. This is the computer testing that is the only FDA approve program I know of for managing concussion and returning to participation and one that the NFL , Olympics, FIFA and others use. Also your your high school students do this. It is done prior to injury for baseline and then post injury for management. After a concussion the test would be done 24 hours later by using a computer online portal with a certified trainer present. So I would think Josh is doing this daily. This test has to do with memory, impulse control , reaction time, processing etc. This is important as these things are objectively measured so a competitor athlete can’t underreport symptoms just to be able to play. Also , as some of you have addressed, this is hard to fudge initially by underperforming because if an athlete attempts that, red flags stand out showing statistical things that trained observers catch and make the person perform the test again. This does happen about 10% as self reported on the website, and apparently they have a good success rate catching this. So to be clearer to play the athlete has to return to baseline at a minimum to be cleared. Even doing that tho does not guarantee they will be cleared to play. These tests are all still just clinical “ guides” and it still comes down to the clinical judgment of the independent neurologist to give the full go ahead. That is just a legal way to protect the testing comapny and it does out the onus on a seasoned real life dr and I think that’ s good as these computerized tests are still building data and there is much ongoing research about brain injury. https://impactconcussion.com. BTW, this is the link to the actual company website where the computer testing was developed and marketed. You can actually even purchase a baseline test for your son/ daughter if you wish to have that data. I think the cost was around 20$ or so. Most high schools should be doing this already but I put the link there just for you to see the actual site and place the NFL does use. ( guys I couldn’t test the links prior to posting ,,just a doc and not an IT guy . All the links are public tho so I am sure you can google the info if links don’t work for some reason. ). So , it looks good that Josh is progressing and I expected that for a young healthy guy. He looked good in the video I saw of practice. Will probably know more on Friday if he fully practices Thursday and has no recurrence of symptoms. The one thing I am a little concerned about regarding him playing ( from my fanboy standpoint) is that Mcd is very conservative ( this is obviously a good thing ). He doesn’t even commit to Knox getting more plays when listening to him At the presser almost saying they won’t overload expectations on young guys. Mcd still emphasizes Josh being young and inexperienced. So that makes me LEAN, imho, to a position where I am thinking regardless of protocol, Josh may be sitting until after the bye. I just think Mcd errs on being conservative and just passing a protocol , while that would justify Mcd allowing josh to start, won’t be the only factor in his decision. I know it’s a huge game, yet I am ok with Barkley (sp) with a week of full reps. I would love watching Josh get a chance to “ redeem” himself, but maybe it’s best to believe you have Barkley on the roster just for this purpose and better to give Josh no pressure to recover so quickly. Don’t shoot me, it’s just an opinion and I have no idea what actually will happen. Hope the links provide some basic info so we don’t have to rely on opinion regarding how a concussion is evaluated and followed. ?

Yep it is scary seeing a loved one go thru a head injury. Hope your son is well and never had further episodes. Funny story I grew up in Ohio, trio state area around Pittsburgh pa, wheeling wva, and Steubenville Ohio ( home of Dean Martin of rat pack fame ). So I was a huge skynerd fan growing up. So moved to jacksonville, Florida after getting done with Med training in Toledo, Ohio in 1985. So one night I am in a bar and there is Leon Wilkerson , bass player of skynerd partying at the bar. Introduced myself and ended up driving him to some other places that night. Man , no wonder these guys had short life span. Anytime I ran into him he was “ partying “ and people were always Buying stuff for him at bars. Later on I met Ronnie vanzants wife who opened a bar called free bird here in Jacksonville beach. I was able to have her become a patient and got to know her over several years. Also her daughter became a patient and her daughter was married to the original lead guitar player of shinedown. I was lucky enough to get to know him and his wife and they were all really neat down to earth people. Got to meet some other members of the various incarnations of the band over the years and they were all talented but humble people. Just a neat thing for a small town guy like me who grew up as a fan starting in high school, only to end up being fortunate enough to give back some to them with medical advice as I got older and moved to Jax where I never expected to end up! Life is amazing and good and I will always be a rock fan till the day I am gone. It just boggles my mind that someday I would meet the guys who played on ONE FROM THE ROAD, after I had cranked that album so many times getting psyched for the weekend to arrive in small town rural Ohio ! Love your screen name and thanks for indulging me with my trip down memory road! Go Bills!

I think the only thing you can conclude is that the medical staff examined him and he was alert and able to respond correctly to the brief neurological exam done on the field at the time. For example, he was able to know where he was , situation , had short term recall ( like able to repeat three random objects or names back to the examiner ), and his basic neurological exam field side was normal. This is a very basic exam and is one point in time and has to be interpreted as such. Things can change as time goes on ; doesn’t mean they will but it is possible. So think of it as a Polaroid snapshot of his function right at that moment. That’s all that can be surmised. I was a little surprised he was not accompanied by someone just for legal purposes in today’s litigious environment. On the other hand there are so many people around he was really probably never out of the view of someone on staff. Hard to imagine a scenario where he was confused enough to just run off somewhere randomly without it being caught but you usually do see a trainer at least accompanying a player after that. He is a daredevil and may have taken off before they could keep up with him ! ?

Great question, not dumb at all! Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally. Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?