September 9, 2025 • 43 mins
In this episode of Cogent Conversations, Dr. Shelly Weinstein sits down with Brian McGuire, who serves as the lead athletic trainer for the NFL Scouting Combine as well as an injury spotter in the league’s Player Health and Safety Program. Brian takes listeners behind the scenes of the combine, explaining the evolving role of athletic trainers in protecting athletes and highlighting the importance of preparation, communication, and emergency action planning at every level of sport.
He offers an inside look at how spotters work behind the scenes to protect players and shares insights on how the role has evolved, the technology and training that support it, and why spotters are a crucial part of game-day safety in the NFL.
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Episode Transcript
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UNKNOWN (00:00):
Music Music
SPEAKER_00 (00:06):
everyone and welcome back to another Cogent
Conversation.
I'm Dr.
Shelley Weinstein, owner ofCogent Steps, and with me today
is our guest, Brian McGuire, aretired United States Marine
Colonel and currently serves asthe head of the United States
Marine Corps Human PerformanceBranch in Quantico, Virginia.
I'd also like to add that Brianwas a member of the CrossFit
Game Safety Advisory Board and amember of the National Strength
(00:28):
and Conditioning Association'sBlue Ribbon Panel on Military
Readiness.
Brian also serves in two keypositions in the National
Football League.
He's the lead athletic trainerfor the NFL Scouting Combine and
has been involved with thatsince 2008.
More recently, since 2017, heserves as one of the Player
Health and Safety ProgramAthletic Trainer Injury
(00:50):
Spotters, but he also justreceived a recent promotion, and
we'll talk a little bit aboutthat.
Welcome, Brian.
SPEAKER_01 (00:55):
Good afternoon, Shelley.
Thanks for having me.
SPEAKER_00 (00:57):
So before we get started, as I do with all of our
guests, I'd like to give you achance to offer any disclosures
that you need to offer to makesure that we stay within the
rules of all of ourorganization.
SPEAKER_01 (01:08):
Thank you, Shelley.
Any opinions or views I expresson my own that are not the
official position of the NFL,the Marine Corps, Department of
Defense, and my participation inthe podcast is not an official
endorsement of Cogent Steps andCogent Conversations.
SPEAKER_00 (01:23):
Thank you very much.
So let's kind of take this backto the beginning, Briar.
You and I have known each otherfor a long time.
First met you many, many yearsago when you were with the
military and doing some workwith the athletic trainers.
But let's start at thebeginning.
Why did you decide to become anathletic trainer?
SPEAKER_01 (01:38):
Well, I was a good, not great athlete in high
school, but I enjoyed all whatsports gave me.
And I had an interest in thehealth sciences and interest in
sports and the health sciencesintersected.
And that led me to pursue theathletic training undergraduate
program.
And here I am.
SPEAKER_00 (01:58):
So what types, growing up as an athletic
trainer, what types and levelsof athletes did you work with?
SPEAKER_01 (02:05):
It's, of course, starting college and I went into
the military.
I received my Marine Corpscommission in 1986, was on
active duty from that time until1990, left the active duty,
continued in the reserves.
And I, you know, from 93 to2001, the first four years of
that, I worked at the EmoryClinic in Atlanta, Georgia, then
(02:27):
moved over to the universitywhere I was the associate
director of athletics for sportsmedicine and the head athletic
trainer and oversaw the deliveryof sports medicine services to
17 different sports and around360 athletes.
So ranging baseball, basketball,tennis, track and field.
(02:49):
I'm going to miss them here.
Swimming, a bunch of others.
But that was it at thecollegiate level.
And we'll talk more about theNFL beginnings here soon, I'm
sure.
SPEAKER_00 (03:00):
Yeah.
So college athletes at variouslevels.
So let's talk a little bit abouthow you broke in to the
professional athletes and whatyou do with the NFL.
And I want to start with yourrole in the Combine, which is
pretty interesting.
And that's become big business,right?
That's televised now.
We see a lot.
But as always with sports, wenever see the backside of
(03:22):
things, right?
What has to go on to get theseathletes ready.
So can you tell us a little bitabout how you got involved with
the Combine and what your roleis in that?
SPEAKER_01 (03:32):
Well, sure.
Well, one of my early mentors atSalisbury University, Hunter
Smith, He later became theIndianapolis Colts head athletic
trainer for 25 years.
And we stayed connected over theyears during my military career.
And as the scouting combinegrew, especially the on-field
events, it outpaced the capacityof the Colts athletic training
staff to cover and support.
(03:55):
They wanted their focus to bemore on the medical aspect of
the combine.
So Colts brought in otherathletic trainers to work with
the athletes, participating inthe on-field skills and drills.
And I was lucky.
to be one of them selected towork at the Combine and I've
been doing it ever since 2008.
SPEAKER_00 (04:12):
What does that week look like or the time?
So can you kind of take usthrough the preparation for the
Combine through the actual,again, kind of what we see on TV
that is now big ratings.
So take us through what thatlooks like with the Combine as
an athletic trainer.
SPEAKER_01 (04:27):
Well, sure.
My focus and that of my team ison the on-field skills and
drills is what you see mainly onTV.
There's There's plenty more tothe Combine.
Really, more of it is related tothe off-field meetings,
interviews, et cetera, andtesting.
And so what it looks like for aparticular one player in a
(04:50):
certain group, he will arriveon, let's say, Monday.
They will do orientation to theCombine.
They'll get exposure from theleague representatives on what
to expect at the Combine, aswell as what to expect as they
lead up to the draft There areinterviews with the teams, the
coaches, the GMs, et cetera,other testing that goes on.
(05:14):
And they also have not justinterviews with the teams, but
interviews with the media.
And that is largely covered aswell.
But that leads up to theon-field skills and drills,
which, again, that's what me andmy team of four athletic
trainers focus on.
SPEAKER_00 (05:33):
So when you talk about that testing that's taking
place before and kind of in thebackground, what kind of testing
are they do?
Are there physicals?
Is it VO2 max?
What is happening behind thescenes?
Is it more physiologic stuff oris it other things?
SPEAKER_01 (05:47):
It's both the physical and mental aspects.
What I'm more involved with orrelated to are the medical
screenings and really think ofpre-participation physicals,
although it's really more thanthat.
It's reviewing the athlete'shistory over their collegiate
career and they get a chance todiscuss their history with the
(06:09):
medical providers from theteams.
SPEAKER_00 (06:12):
Nice.
All right.
So talk to us a little bit aboutthose skills and drills.
That's right, the public-facingside of what we see.
And what is the role of,specifically of you, but of the
medical staff during thoseskills and drills?
SPEAKER_01 (06:26):
Well, to go to the first part of that question,
it's really position-specific.
You will see a lot of, in thecase of the wideouts, a bunch of
different patterns.
They're getting evaluated ontheir ability to change
direction, to run routes, to thevertical jump, et cetera.
Those are the position drills.
(06:48):
The other drills includevertical jump, broad jump,
center reach testing, and ofcourse, the 40-yard dash.
And there are other parts of it,but think that not all the
athletes do the very samedrills.
For example, a lineman wouldn'tdo what the wide outs do.
Let's
SPEAKER_00 (07:06):
hope not.
SPEAKER_01 (07:07):
So, right.
But it changes every year.
Like I like to say, you neverstep in the same combine river
twice.
It's always changing.
It's great to be part of that.
They're always assessing,analyzing, modifying their
procedures as necessary.
But that's the big picture ofit, Shelley.
SPEAKER_00 (07:30):
I imagine that there is a lot of data that comes out
of that, that the teams thendistill down to look for what
they need, to find the best fitsfor what they need for their
teams as well.
And as you said, very positionspecific.
And we're starting to see thateven in pre-participation
physicals at other levels,right?
We're starting to realize thatalignment is not the same as a
(07:52):
running back, is not the same.
Although we need to make suremedically they're all clear,
there are certain things thatpertain more to one particular
position than another position.
So I imagine the data must justbe incredible coming out of a
combine.
SPEAKER_01 (08:05):
Yeah.
It is, Shelley.
And the data that's gathered atthe Combine complements all what
the scouts have been collectingover the college years of the
athletes who were selected to goto the Combine.
So the data collection doesn'tstart and end at the Combine.
It proceeds that by at leastthree years in the case of the
(08:29):
football players who must spendat least that much time in
college.
So there's a lot of data, yes,that is gathered.
And that all leads to draftdecisions that is televised and
the public gets to see some ofthat as well.
And in between the combine andthe draft show, there's also
(08:49):
what's called a pro day.
And that is another chance forthe athletes to show off their
skills to the teams that areinterested in them.
So there's a number ofopportunities for the athlete to
show his skills as the draftdecision years.
SPEAKER_00 (09:09):
Great.
Who else, Brian, is involvedfrom a medicine standpoint?
So you mentioned that some ofthe things they do beforehand,
there's a mental aspect.
So I imagine there's some mentalhealth or psychology people
involved looking and talking tosome of these athletes.
Are there physicians of variouskinds there?
Or is it kind of who else in themedical sphere is involved in
(09:31):
the combine?
SPEAKER_01 (09:32):
Well, just as the complex or the medical
complement of the team'sinterdisciplinary, that is what
you'll see also at the combineas you're doing the evaluation.
So you'll see the orthopedist,primary care, physical
therapists, the athletictrainers are coming along as
well.
(09:52):
And so it's really what you'llsee at the club level, they
bring some portion of thatfootprint to the combine to aid
in the meta evaluations nowagain my focus and that of my my
team of athletic trainers is onthe on field skills and drills
(10:13):
and we you know we do some uhyou know preparation for the
athletes as they request butthey those who are participating
in the skills and drills come ina pretty healthy state so it's
not you know there's not a wholelot of um treatment that we do
like at the stadium they comeready we'll help them out uh get
ready and we're also of coursewe uh we were respond should
(10:36):
there be an injury.
I'm involved in the developmentand implementation of the
Emergency Action Plan, the EAP,and that has evolved over the
years.
So, you know, thankfully, mostof the injuries at the Combine
are strains and strains of, youknow, because there's no, you
know, there's no contact.
It's not environmentalchallenges.
(10:57):
But over the years, we've hadsome emergency situations that
have needed emergency response.
SPEAKER_00 (11:03):
Great.
I love that you said emergency Ithink I've been able to get that
into every podcast I have done.
It is something of mine that Ithink is very important.
It needs to be written.
It needs to be used.
The NATA talks about, you know,has such wonderful papers on how
to put them together.
And it's actually one of theskills that we make our students
do when they take our classes.
We give them a team and alocation and they actually have
(11:27):
to write an emergency actionplan because it is something
that is that important and needsto be used.
So thank you for mentioningthat.
That just makes me happy for mylisteners to hear that.
SPEAKER_01 (11:36):
That's good to hear, Shelly, because there are no
routine emergencies, but thereare routines for emergencies.
And we're lucky to have a verysolid crew of professionals who
support us during the
SPEAKER_00 (11:52):
event.
That's awesome.
Awesome.
So now I'd like to turn to yourrole as an injury spotter with
the NFL and their player healthand safety program.
But as we start that, I'd likeyou to talk, because I believe
you recently just took on apromotion.
I think that might be thecorrect word in the region.
So can you tell us a little bitabout what your new role is in
(12:12):
that position?
SPEAKER_01 (12:14):
Well, I've been an athletic trainer injury spotter
since 2017.
And this year I was named to bethe lead AT spotter for the crew
in DC.
And really that's a, you know,chief among equals sort of
title.
We, you know, we all do the samething.
I'm more involved in schedulingand interviews, but largely
(12:35):
Again, I'm one of four, but I'minvolved more now in the
scheduling and interviews foropen positions.
SPEAKER_00 (12:45):
So you've been a spotter since 2017.
How long has the program existedin the NFL?
It goes back a little bitearlier than that, right?
SPEAKER_01 (12:52):
2012.
SPEAKER_00 (12:54):
And it has evolved a little bit, or quite a bit, I
think, in some ways.
So can you talk about, and Iknow this has gotten more
stringent, what is required tobe a spotter for the NFL?
And again, I think the this goesto having the best fit for the
person that needs to do thisjob?
SPEAKER_01 (13:11):
National Athletic Trainers Association Board of
Certification certified at least10 years working as an athletic
trainer.
And what the league is seekingis sustained and significant
experience working in footballat high levels.
Now, there are some of theparameters that there must be
(13:31):
some distance between anathletic trainer spotter and
working with a club.
And that is important because weare, we're not affiliated with
clubs.
We're, we're league employees.
So we are, that's an importantdistinction that I think, you
know, when I discussed this withfolks who are interested that
some may, may think in my case,you know, we work in DC that
(13:53):
we're employed by thecommanders.
That's not the case.
And that's, that's, we'reemployed by the league.
And that's, that's the true,true as well for the injury
video replay system operator aswell as the neuro trauma,
unaffiliated neuro traumaconsultants.
So we are, again, not employedby the team or we are employed
(14:16):
by the National Football
SPEAKER_00 (14:17):
League.
Thank you.
So can you talk a little bitabout the initial training that
you have to go through as aspotter and then kind of the
ongoing training?
Because I imagine things changeand we've heard about updates
throughout the years, sometimesin the middle of the season,
sometimes at the end of theseason when they've implemented
a new rule or done differentthings.
So can you talk a little bitabout the training pipeline that
(14:38):
you have to go through?
SPEAKER_01 (14:39):
I do.
And I think, you know, it's ablend of self-paced training,
but the, you know, the stock andtrade for what we do, we have
plenary training during the offseason and the leadership from
the player health and safetyprogram.
We do it in a venue similar towhat we're doing now.
(15:00):
We go over the currentprotocols.
We review, you know, data forfrom previous years.
And also we go over changes.
And there have been somechanges.
We won't cover them all here.
But as I mentioned with thecombine, I hope this isn't trite
by this point, but you neverstep in the same NFL season.
(15:21):
It's always changing.
Or you never step in the sameNFL season river.
It keeps changing and for thebetter.
So in the last couple of years,one of the changes was that we
now, we chronicle or catalog thenon-injury head impacts.
And that is curated by a team.
(15:41):
And that helps with largelygetting the head out of the
game.
And that goes intorecommendations for rule changes
and other aspects as well.
So always analyzing, assessing,and modifying if warranted.
SPEAKER_00 (15:58):
And then what about recurrent training?
Do you have to say, do you haveto do so many games a year?
How do you keep your competenceup as an NFL spotter?
SPEAKER_01 (16:07):
Good question.
The AT spotters are required towork at least four games a year.
And that is a standard whichgives a reasonable assurance
that the individual isaccumulating as the time goes on
in their tour, so to speak, as aspotter with different game
(16:28):
situations.
And they remain relevant andcurrent in all of the different
changes that a And also it justgives confidence that the AT
spotters are gaining therequisite experience to continue
on.
So at least four games a year.
And I mentioned the summerplenary training, but there's
(16:49):
also other training that the NFLrequires, ethics training and
other important training relatedto human resources, et cetera.
But also during the season,there are periodic meetings,
which, you know, which serve toclarify, you know, points of
emphasis and, you know, bringfolks attention to areas that
(17:12):
need attention and also toreinforce, you know, the good
things that happen throughoutthe year.
SPEAKER_00 (17:19):
Yeah, so it's very dynamic, it sounds like, very
dynamic.
SPEAKER_01 (17:22):
Just recently, I need to add that the player
health and safety leadershiphave implemented a very
interesting simulation trainingwhere the AT spotters are,
they're given a scenario, theirprovided a video and they're
given you know just about asmuch time as you would get
during a game to make a call onwhat what to do and as as we go
(17:47):
through the questions i'llexplain you know what we are
looking for as an at spotter butyou asked about training shelly
and that really has thesimulation component has really
been a good addition to the
SPEAKER_00 (17:57):
oh i imagine that just has to literally be game
changing if you're reallygetting true experiences and the
timeframe So the, you know, alittle bit of the stress, but
really, you know, it's veryreality based, which I think is
very important for them.
SPEAKER_01 (18:12):
It is.
And it's not a, the simulationscenarios aren't a giveaway
either.
And you have to really, youknow, go in understanding what
triggers a communication andwhat doesn't.
So very, very good enhancementto our training.
SPEAKER_00 (18:28):
Nice.
So can you talk a little bitmore, Brian, about the
technology that you all useduring, so you're, I know
you're, you're upstairs in abooth where you have good view
of the field.
Can you talk a little bit to usabout what's in front of you?
Take us through kind of a gameday scenario when you get there.
I imagine there's some meetingsand some group talk that has to
(18:49):
happen.
Can you kind of take us throughwhat your day is like when you
get ready to start covering agame?
SPEAKER_01 (18:55):
Well, sure.
We're required to arrive threehours before the game, and that
gives us a chance to coordinateand sync with the the injury
video replay system operators toshake out any changes in
communications, just get anassessment that the booth is set
up for game operations.
(19:17):
And it also gives us time toprepare for a very important
part of the gaming operations onthe medical side.
And that's a 60 minute medicalmeeting.
And that is a meeting that is aninterdisciplinary gathering of
the team physicians, teamathletic trainers, the UNCs, the
airway physicians, the EMTsassigned to the games, the
(19:42):
officials primarily, they comeout and ask who the athletic
trainers are.
And we have really justface-to-face interaction.
They hear our voice, we heartheirs.
That's coupled with radio checksthat we do later on.
But the three hours for the gameshow, it gives us a really good
opportunity to settle in, getinto the the mindset that has
(20:06):
been set by the trainingconditions that we've all
benefited from.
So that meeting is very key inhaving everybody understand what
each other is doing and whattheir role is in the EAP.
That really has matured over theyears, and we have great
(20:26):
examples.
You saw it at the conference inAtlanta, how that all came
together in the We make itbetter every year.
So the 60-minute meeting.
In between 60 minutes and gametime, we are doing radio checks,
again, to ensure that the commsare ready without a hitch.
(20:50):
And there's other checks that wedo.
We call down to do radio checkswith the clubs because there's
that communication as well.
So that's what we do before thegame.
Would you like me to proceed onwhat we do during the game?
SPEAKER_00 (21:03):
So I'd like to just add a point.
to that for our listeners.
So, you know, again, NFL game,the big 60 minute meeting, but I
tell our sports providers allthe time, whether it's a high
school volleyball game or ayouth soccer, you know, before
the game starts, you as thesports provider, the AT on the
field should be, you know,reminding your coaches, the
official will usually come overand ask who the medical person
(21:25):
is, remind you who allows you tocome out onto the field, right?
A little bit different.
You're sitting up in the booth,but that medical timeout before
the game is always important.
So everyone's got a visual withan eye to eye.
Who do I look for?
I tell people all the time whenthey start covering sports, I'm
not watching the game to watchthe game.
I'm watching the athletes forinjury.
(21:46):
And so I think that it's, thisjust hits home how serious this
has taken, even at a level whereeveryone's very professional,
but it still needs to be doneand it still needs to be prepped
before every game.
So it's just very important.
It's one of the key things thatGod forbid, should something
happen, everyone is ready.
And I think You know, we all sawthat if you were watching the
(22:07):
game with DeMar Hamlin, how wellthat was carried out.
And I'm sure in part because ofall the training and the
meetings and the rehearsals thatgo over and over again, that
made the difference in someone'slife.
SPEAKER_01 (22:20):
Sure did.
And I don't want to forget therole of NFL operations.
There's a representative thereat the 60-minute meeting, and
they're busy throughout thegame, but they play an important
role during that meeting aswell.
Security is part of it.
You know, the x-ray techs, theway I could go on, it really is
kind of a, you know, a very,very good interdisciplinary
(22:44):
interaction of all thosedifferent providers.
SPEAKER_00 (22:47):
And so whether it's, you know, downsized to a small
high school game or all the wayup to the NFL, I think there's
still a lot of takeaways thatpeople can get from what you're
telling us here today that canbe valuable when they're
providing support to youth or,you know, levels of athletics
that are not professional, thatare just as important to take
care of.
So thank you.
Let's talk about, so now takeus, so we've had the meeting,
(23:09):
you've done your comms check.
So what happens next?
SPEAKER_01 (23:13):
Okay.
Well, my role in that of theother spotters is to observe
play, monitor the broadcast feedand other camera angles that we
have available to identifyathletes who may potentially be
injured on a play with anemphasis on the head and neck
injuries.
What we're looking for with headand neck injuries is a head
(23:34):
impact that causes an injurybehavior that suggests
concussion.
And that's really the twotogether.
It's not just head impacts.
I mentioned earlier, Shelly,that we are cataloging
non-injury head impacts.
But if we call down on everyhead impact without an injury
(23:55):
behavior, you can see where thatgoes.
And certainly the equipment hasgotten better that mitigates the
injury part of it.
SPEAKER_00 (24:03):
So if you You radioed down to the head
athletic trainer because you sawhead impact or concussion
behavior.
What happens then?
SPEAKER_01 (24:10):
Well, the athlete is then put into the blue tent and
evaluated by the unaffiliatedneurotrauma consultant and the
team physician.
They make a determination ofwhether the athlete needs to be
further evaluated in the lockerroom or based on what their
clinical exam shows is eitherruled out of the game or
(24:32):
returned to the game.
You know, the threshold is lowto do that.
As long as there's two, reallythree elements, one, head
impact, concussion behavior, andthe athlete trying to return to
the game, we have the authorityto call down to make that
medical timeout.
SPEAKER_00 (24:49):
So, Brian, how do the videos, you've talked about
all this great technology, buthow do the videos assist the UNC
and the team physicians in theirevaluations?
SPEAKER_01 (25:00):
Thank you, Shelley.
They were able to see near realtime of what the injury
mechanism was along with thetype of concussion behavior that
necessitated our call down tothe sideline.
And after all the times that wecall down, whether it's where we
radio down or whether we callmedical timeout, once the
(25:22):
evaluation is completed, theymake the determination, they
call us and close what's termedclosing the loop.
And that's a very important partof the process because that
gives everybody theunderstanding that the the
evaluation has happened and thatthe determination has been made.
Now, in a very rarecircumstance, if an athlete
(25:42):
returns to the field and theloop has not been closed, we are
required to call down to makeanother medical timeout to
ensure that part of the processhas been taken care of.
SPEAKER_00 (25:58):
Okay.
So that's a lot of moving partsto make sure.
And who all is involved inclosing the loop?
Like what are all the differentparties that are part of that?
Can you just clarify who thatis?
SPEAKER_01 (26:09):
Well, the, the decision-making that leads to
the evaluation is the UNC, theteam physician.
And before the game, I talkedearlier in the meeting here
today, we talked, you know, the60 minute meeting in there is
where we determine who closesthe loop and it differs by team.
It can be the head athletictrainer.
It can be, the team physician orthe UNC.
(26:31):
And it's just a matter of theircomfort level.
That is determined before thegame so we know who that
individual is.
SPEAKER_00 (26:39):
Right.
So again, all these pieceslinked together from what you
talked about earlier, themeeting beforehand, the
practicing, the discussion.
So everything at the end of theday is closed and there's good
understanding on everyone'spart.
SPEAKER_01 (26:54):
Yes.
And I mean, the differentscenarios, I've covered a couple
of them where when we radiodown, it's where we see the
injury and the mechanism andbehavior.
We will call down if the athleteis walking off the field and as
a change of possession or asubstitution, we see it, we call
it down.
Or if an athlete is beingevaluated on the field after a
(27:17):
head impact and concussionbehavior, even though it would
be obvious to everybody in thestadium and watching on TV what
has happened, a helmet impact orhead impact with a concussion
behavior, we still call thatdown.
Now, we don't do that while theathlete is being walked off the
field by the athletic trainingstaff.
We wait.
(27:37):
A reasonable interval hashappened when things when the
athlete has been moved to thesideline again to direct the
evaluation to occur.
And again, I may have coveredthis earlier, but if the athlete
is trying to return to thehuddle or return to play after
having the helmet, the headimpact and the concussion
(27:57):
behavior, that is what triggersthe medical timeout to the
referee.
And in that case, even after wemake the medical timeout to the
referee and he stops, theofficial stops the game and
ushers the player off the field,we still call down to the
sideline via the radio to ensurethat evaluation is conducted.
SPEAKER_00 (28:17):
Great.
Thank you.
That's a very good explanationof how that all works.
So Brian, you've talked aboutall this video and the behaviors
you're looking for and thehead-to-head contact.
Do you, as an observer up inthat, are you recording every
time there's head contact?
Because that seems like that's alot of activity that could
happen.
Could you just explain that alittle bit more?
SPEAKER_01 (28:38):
Sure, sure.
Even though we may not call downto the sideline or referee for
every head impact that doesn'thave a concussion behavior, we
do document the, or what we calltag the videos of the non-injury
head impacts.
And that is fed into a team atthe NFL league office who is
(29:03):
curating that information tosupport the overall effort to,
you know, to reduce head impactsof any type, and that is useful
to them.
So we, again, we don't call downto the field for every head
impact, but we do those headimpacts that we see on different
(29:24):
plays, we do tag those videos soanother team can review them.
And Shelly, we also, althoughour emphasis is on head and neck
injuries, we do document the,the occasions where an athlete
has sustained an orthopedicinjury of any type, where a
response is needed on the field,and also in the rare
(29:48):
circumstance where an athletehas to be removed from the field
via cart, et cetera, asignificant injury.
And we don't call down for thoseinjuries, for those non-head and
neck injuries, but what happensoften is because of the quality
of the injury video reviewsystem, the teams will call up
to us us to see the mechanism ofa non-traumatic knee injury, for
(30:14):
example, and that aids in theirdiagnosis just as it aids the
UNC's and the team physician intheir evaluation of concussions.
SPEAKER_00 (30:23):
And that makes perfect sense because we talk
all the time about when you'reon the field, you're not a
spectator, you're watching, butthat view has got to really
provide some additionalsubstance for the staff who's
evaluating that injury.
That's wonderful.
You really can't be not payingattention.
I mean, you can't even blink upthere, Brian, during that game.
You're constantly, with yourhead on a swivel, looking at all
(30:47):
of those monitors and what'sgoing on.
I mean, your focus really mustbe intense.
I would imagine you've got to bea little tired after covering a
game?
SPEAKER_01 (30:56):
Well, there's a very good team up there that we were
assigned.
The AT Spotters are assigned todifferent teams, so it certainly
is intense.
But the more, you know, the moregames that we do, the more
comfortable you are with thepace of the game.
And, you know, there's there'snever, never a dull moment.
(31:17):
But you just you're able to tolook forward a bit to prepare,
prepare yourself when the gamemight might become a little bit
more intense, but vigilance isthere all the time.
what we've seen also in recentyears, that medical timeouts
have decreased.
And that is because, in part,that the officials are
(31:38):
recognizing that something iswrong with the athlete after
sustaining a head impact andhaving them be evaluated.
So that helps everybody, thatthey're available to see that
and do that.
So they do as well.
Also, we see that the individualathletes themselves are giving
(31:59):
the tap out sign and takingthemselves out of the game, as
well as teammates saying that afellow teammate needs to be
evaluated.
So there are a number of waysthat an athlete will get before
a team of providers to beevaluated for a concussion.
So that's the immediate responsepart of that.
(32:20):
Then the evaluation piece comesin.
And that's where you see theathlete go in the blue tent and
the evaluation happens with theunaffiliated a neurotrauma
consultant and the teamphysician.
And after the decision is made,whether the athlete can return
or not, they call up to us toclose that loop.
And that is very important.
(32:40):
It sounds pretty elementary, andit is, but we're very, very
focused on that to ensure thatin the heat of the moment, that
all who are involved in theprocess of ensuring that the
athlete has been evaluated withthe correct disposition, either
not clear to play or clear tothat is known to all.
So closing the loop happensafter that, after the evaluation
(33:05):
piece.
SPEAKER_00 (33:06):
That's great to hear because I was thinking, you
know, once you guys have madeyour call, you're kind of done.
But now I'm thinking when youtalked about the simulation
earlier, these are greatexamples, right, to help train
for nuances.
Because I imagine there's somenuances and I imagine the more
you do this, the more you'reable to pick up on some things
that you might not have noticedor the different angles and the
(33:27):
different people It's just allfeeding in to making a better
decision for that athlete.
SPEAKER_01 (33:34):
Well, and that's from the spotter's perspective.
This will be my ninth yearcoming up.
And I think I've worked 48 gamesso far in the previous years.
And just every game just sort ofadds to the game slowing down
for us, if you're familiar withthe term.
It's just you get a sense of theflow of the game and what's what
(33:59):
actions need to be taken andwhat actions don't need to be
taken in the event of a injurythat could be a concussion.
So, yeah.
SPEAKER_00 (34:08):
Brian, this is great information.
So can you take us, you're inthe booth, and what is that
timeframe?
So you talk about all thistechnology, you're hearing the
broadcast, you're watching it ondifferent videos, you have to
make a decision.
I would imagine pretty quickly,what is happening from the time
you suspect something and seethe behavior and injury to the
call down the review.
(34:29):
What is it?
Can you explain that timelineand how fast you need to do that
or what the right answer is forthat?
SPEAKER_01 (34:37):
Thank you, Shelly.
The longest that we would haveis 40 seconds, and that is the
play clock.
And that's the amount of timethe offense has to snap the ball
before a penalty is given to theoffense.
But many times, it's muchquicker than that.
And this is where knowledge ofthe game and the preseason
(34:57):
scenario training comes in thatif there's a an offense that has
a or team that runs a hurry upoffense that 40 seconds can get
compressed very very quickly anddepending upon the closest of
the game and you know within thetwo minute period before the
halves are over the game's overthat can be a single digit
second so the longest amount oftime we have is 40 but most
(35:21):
times it's much less than thatso again that's where the
training comes in and thescenarios that were provided to
review
SPEAKER_00 (35:28):
And again, I imagine that's where that value of that
simulation training that you getis very helpful to make it real
life.
SPEAKER_01 (35:35):
Absolutely, yes.
And again, as I mentioned at theoutset of the podcast, there are
some pretty stringentprerequisites to become an AT
spotter centered around mainlythe length of time that an
individual has with working at ahigh level in football.
SPEAKER_00 (35:52):
Great.
The next question I have, soyou're independent, right?
So we know that you're hired bythe NFL.
So how How do playoffs and theSuper Bowl work as far as the
spotters go?
Are there the same number ofspotters?
How do you get picked or anopportunity to participate in
playoffs?
SPEAKER_01 (36:09):
Generally speaking, the home team, wherever that
game is played, the home team ATspotters cover that game as
well.
So that's the general aspect.
There are certainly some nuancesto that.
As the playoffs go on, there aremore plus-ups in different
areas, not just the spotters butyou know plus ups but not you
(36:32):
know not excessively so butgenerally speaking Shelly that
the whatever home stadium ishosting whatever the playoff
game is the home AT spotterscover them.
SPEAKER_00 (36:44):
And that makes sense because when you talked about
this whole interprofessionalteam with security and
operations it would make sensethat that person who knows that
field right is familiar with allthe the goings on so that seems
to to make a lot of sense.
What's your favorite part aboutbeing a spotter?
I'm curious.
You're going into your ninthyear, so you must absolutely
(37:04):
still love this.
What about it is your favoritepart?
SPEAKER_01 (37:09):
Well, my favorite part is as it was working in the
large sporting events that I'veworked before.
I was the chief athletic trainerfor rowing and canoe kayak
during the 1996 CentennialOlympic Games.
Again, I've worked at Combinefor many years.
For me, it's kind of the thecoming together of all of the
(37:30):
interdisciplinary members of theteam and working through
scenarios and problems, but witha way, as I said earlier, there
are no routine emergencies, butthere are routines for
emergencies.
And just kind of understandingwhat your part is in the whole
system, but being part of thatwhole system is very
(37:51):
professionally satisfying to me.
And I'm glad to be part of it.
So hopefully I've explain thatwell enough, that this is big
enough than just one person, bigenough than me, bigger than me,
but I'm glad and professionallygratified that I am part
SPEAKER_00 (38:08):
of it.
It's systems thinking.
We can only see the part that wecan see.
And so when you put the wholepart together, it gives us all a
much better picture.
One of the things that we'restarting to see in the
professional leagues is spottersin other sports.
So we're starting to see them insoccer and rugby.
And I think I know what youranswer to this will be, but
obviously that's a good thing.
Do you think, and again, Iunderstand this is just your
(38:31):
personal feeling.
Do you think that we need to addspotters in college football?
SPEAKER_01 (38:37):
Well, they are Shelly.
Uh, I can't give you a, youknow, a precise, you know, uh,
number of, of the leagues thathave them, but I think the
bigger the league, the morelikelihood is that they have a
spotter capability.
And you mentioned MLS, you know,NHL has them as well.
And, um, uh, Aussie rulesfootball, I believe, has them as
(39:00):
well.
I'll stop there because I knowthat there are others that have
them, but some don't.
And some, you know, they do it abit differently than the NFL.
MLS has it done centrallylocated.
I believe it's in Texas.
And they do it that way.
NHL, I believe it's in New York.
So rather than having on fieldor at the venue, AT spotters are
(39:22):
doing it all electronically.
So our system works for the NFLand and other sports leagues, et
cetera, have their own.
So, I mean, what the beauty ofthe spotter system or the genius
of it is, is that, you know,putting us above at the press
box level really makes a lot ofsense because you've been on the
(39:44):
sideline as have your listeners.
Football players in the NationalFootball League are pretty big
people.
And there's a lot that happenson the NFL sideline that the
athletic training staff is, thatthey have to, to be concerned
about.
And, you know, having that extraset of eyes above the field
makes a lot of sense.
And it would for other leaguesas well, other sports too.
SPEAKER_00 (40:08):
It was the one time I felt small in my life when I
was in charge of the offensivelinemen at UNC.
And I, you know, they were thefat kids and I was their mama.
It was my nickname.
And, you know, I, you know, theytowered over me both width and
height wise.
But yeah, I just think it'sgreat that we're starting to see
other sports really bring thisyou know, you, the NFL has been
(40:29):
doing it since 2012.
We're seeing more and more ofit.
I think personally, I would loveto see, you know, college
football kind of mandated.
I understand there's money anddifferent things that go, are
involved in it.
But I think as we continue totry to improve safety for our
athletes, I think it would besomething that would be
beneficial.
(40:49):
And, you know, it's, you guyshave done it now for, you know,
several, several years and beingable to take the good from each
thing.
And like you said, each sporthas a different way of doing it
that works for that sport.
So again, I just think it'swe're taking care of the
athletes, which is what our goalis.
I think from the time we becameathletic trainers or physical
therapists, right, is we want tomake sure those athletes are
(41:10):
safe and can continue to play.
What would you say?
So we have a lot of listeners onhere.
We do have a lot of students wholisten, both physical therapy,
athletic training.
We get some young physicians onhere as well.
What would you say to anaspiring athletic trainer who
wants to work at a higher level?
So, you know, whether it's theOlympics or whether it's, you
(41:31):
know, pro sports or collegesports, what do you think are
some things that they need tothink about as they move through
their career that would do themwell in being able to achieve
their goals?
SPEAKER_01 (41:41):
Well, I would recommend mastering both, you
know, traditional sportsmedicine and modern technology.
Hands-on skills are necessary,but plus the knowledge of the
modern day technological toolslike load management and data
aggregation platforms isnecessary.
in terms of how to make thatturn into opportunities on a
(42:04):
bigger stage.
Build a network throughinternships, volunteering, and
conference attendance.
There's certainly professionalsocial media platforms out there
that help enable that.
And also develop strongcommunication skills, because
you're constantly coordinatingthrough coaches, physicians, and
front office staff.
(42:24):
Pro sports, as many of yourlisteners know is a demanding
environment where you're goingto need to effectively
communicate up and out and downand in.
As good as we get withtechnology, the face-to-face
communication across manydifferent aspects of an
organization verbally and inwriting still is at a premium
(42:46):
and developing those skills isnecessary to get on that stage.
SPEAKER_00 (42:53):
Awesome.
The human factor still matters.
We aren't replaced in yet withAI.
So, great.
Brian, anything else to add aswe bring this conversation to a
close?
SPEAKER_01 (43:04):
No, Shelley, it's been a pleasure.
SPEAKER_00 (43:07):
Thank you.
This has been a very informativeconversation, Brian.
You have so much to offer andsuch keen insight and thoughts
that are very pertinent to ourlisteners, and I'm deeply
appreciative of you being heretoday and sharing your knowledge
and expertise.
And with that, to our listeners,another Cogent Conversation
comes to an end, and we hopeyou'll join us next month for
another Cogent Conversation.
(43:27):
session.
Music Music
SPEAKER_00 (00:06):
everyone and welcome back to another Cogent
Conversation.
I'm Dr.
Shelley Weinstein, owner ofCogent Steps, and with me today
is our guest, Brian McGuire, aretired United States Marine
Colonel and currently serves asthe head of the United States
Marine Corps Human PerformanceBranch in Quantico, Virginia.
I'd also like to add that Brianwas a member of the CrossFit
Game Safety Advisory Board and amember of the National Strength
(00:28):
and Conditioning Association'sBlue Ribbon Panel on Military
Readiness.
Brian also serves in two keypositions in the National
Football League.
He's the lead athletic trainerfor the NFL Scouting Combine and
has been involved with thatsince 2008.
More recently, since 2017, heserves as one of the Player
Health and Safety ProgramAthletic Trainer Injury
(00:50):
Spotters, but he also justreceived a recent promotion, and
we'll talk a little bit aboutthat.
Welcome, Brian.
SPEAKER_01 (00:55):
Good afternoon, Shelley.
Thanks for having me.
SPEAKER_00 (00:57):
So before we get started, as I do with all of our
guests, I'd like to give you achance to offer any disclosures
that you need to offer to makesure that we stay within the
rules of all of ourorganization.
SPEAKER_01 (01:08):
Thank you, Shelley.
Any opinions or views I expresson my own that are not the
official position of the NFL,the Marine Corps, Department of
Defense, and my participation inthe podcast is not an official
endorsement of Cogent Steps andCogent Conversations.
SPEAKER_00 (01:23):
Thank you very much.
So let's kind of take this backto the beginning, Briar.
You and I have known each otherfor a long time.
First met you many, many yearsago when you were with the
military and doing some workwith the athletic trainers.
But let's start at thebeginning.
Why did you decide to become anathletic trainer?
SPEAKER_01 (01:38):
Well, I was a good, not great athlete in high
school, but I enjoyed all whatsports gave me.
And I had an interest in thehealth sciences and interest in
sports and the health sciencesintersected.
And that led me to pursue theathletic training undergraduate
program.
And here I am.
SPEAKER_00 (01:58):
So what types, growing up as an athletic
trainer, what types and levelsof athletes did you work with?
SPEAKER_01 (02:05):
It's, of course, starting college and I went into
the military.
I received my Marine Corpscommission in 1986, was on
active duty from that time until1990, left the active duty,
continued in the reserves.
And I, you know, from 93 to2001, the first four years of
that, I worked at the EmoryClinic in Atlanta, Georgia, then
(02:27):
moved over to the universitywhere I was the associate
director of athletics for sportsmedicine and the head athletic
trainer and oversaw the deliveryof sports medicine services to
17 different sports and around360 athletes.
So ranging baseball, basketball,tennis, track and field.
(02:49):
I'm going to miss them here.
Swimming, a bunch of others.
But that was it at thecollegiate level.
And we'll talk more about theNFL beginnings here soon, I'm
sure.
SPEAKER_00 (03:00):
Yeah.
So college athletes at variouslevels.
So let's talk a little bit abouthow you broke in to the
professional athletes and whatyou do with the NFL.
And I want to start with yourrole in the Combine, which is
pretty interesting.
And that's become big business,right?
That's televised now.
We see a lot.
But as always with sports, wenever see the backside of
(03:22):
things, right?
What has to go on to get theseathletes ready.
So can you tell us a little bitabout how you got involved with
the Combine and what your roleis in that?
SPEAKER_01 (03:32):
Well, sure.
Well, one of my early mentors atSalisbury University, Hunter
Smith, He later became theIndianapolis Colts head athletic
trainer for 25 years.
And we stayed connected over theyears during my military career.
And as the scouting combinegrew, especially the on-field
events, it outpaced the capacityof the Colts athletic training
staff to cover and support.
(03:55):
They wanted their focus to bemore on the medical aspect of
the combine.
So Colts brought in otherathletic trainers to work with
the athletes, participating inthe on-field skills and drills.
And I was lucky.
to be one of them selected towork at the Combine and I've
been doing it ever since 2008.
SPEAKER_00 (04:12):
What does that week look like or the time?
So can you kind of take usthrough the preparation for the
Combine through the actual,again, kind of what we see on TV
that is now big ratings.
So take us through what thatlooks like with the Combine as
an athletic trainer.
SPEAKER_01 (04:27):
Well, sure.
My focus and that of my team ison the on-field skills and
drills is what you see mainly onTV.
There's There's plenty more tothe Combine.
Really, more of it is related tothe off-field meetings,
interviews, et cetera, andtesting.
And so what it looks like for aparticular one player in a
(04:50):
certain group, he will arriveon, let's say, Monday.
They will do orientation to theCombine.
They'll get exposure from theleague representatives on what
to expect at the Combine, aswell as what to expect as they
lead up to the draft There areinterviews with the teams, the
coaches, the GMs, et cetera,other testing that goes on.
(05:14):
And they also have not justinterviews with the teams, but
interviews with the media.
And that is largely covered aswell.
But that leads up to theon-field skills and drills,
which, again, that's what me andmy team of four athletic
trainers focus on.
SPEAKER_00 (05:33):
So when you talk about that testing that's taking
place before and kind of in thebackground, what kind of testing
are they do?
Are there physicals?
Is it VO2 max?
What is happening behind thescenes?
Is it more physiologic stuff oris it other things?
SPEAKER_01 (05:47):
It's both the physical and mental aspects.
What I'm more involved with orrelated to are the medical
screenings and really think ofpre-participation physicals,
although it's really more thanthat.
It's reviewing the athlete'shistory over their collegiate
career and they get a chance todiscuss their history with the
(06:09):
medical providers from theteams.
SPEAKER_00 (06:12):
Nice.
All right.
So talk to us a little bit aboutthose skills and drills.
That's right, the public-facingside of what we see.
And what is the role of,specifically of you, but of the
medical staff during thoseskills and drills?
SPEAKER_01 (06:26):
Well, to go to the first part of that question,
it's really position-specific.
You will see a lot of, in thecase of the wideouts, a bunch of
different patterns.
They're getting evaluated ontheir ability to change
direction, to run routes, to thevertical jump, et cetera.
Those are the position drills.
(06:48):
The other drills includevertical jump, broad jump,
center reach testing, and ofcourse, the 40-yard dash.
And there are other parts of it,but think that not all the
athletes do the very samedrills.
For example, a lineman wouldn'tdo what the wide outs do.
Let's
SPEAKER_00 (07:06):
hope not.
SPEAKER_01 (07:07):
So, right.
But it changes every year.
Like I like to say, you neverstep in the same combine river
twice.
It's always changing.
It's great to be part of that.
They're always assessing,analyzing, modifying their
procedures as necessary.
But that's the big picture ofit, Shelley.
SPEAKER_00 (07:30):
I imagine that there is a lot of data that comes out
of that, that the teams thendistill down to look for what
they need, to find the best fitsfor what they need for their
teams as well.
And as you said, very positionspecific.
And we're starting to see thateven in pre-participation
physicals at other levels,right?
We're starting to realize thatalignment is not the same as a
(07:52):
running back, is not the same.
Although we need to make suremedically they're all clear,
there are certain things thatpertain more to one particular
position than another position.
So I imagine the data must justbe incredible coming out of a
combine.
SPEAKER_01 (08:05):
Yeah.
It is, Shelley.
And the data that's gathered atthe Combine complements all what
the scouts have been collectingover the college years of the
athletes who were selected to goto the Combine.
So the data collection doesn'tstart and end at the Combine.
It proceeds that by at leastthree years in the case of the
(08:29):
football players who must spendat least that much time in
college.
So there's a lot of data, yes,that is gathered.
And that all leads to draftdecisions that is televised and
the public gets to see some ofthat as well.
And in between the combine andthe draft show, there's also
(08:49):
what's called a pro day.
And that is another chance forthe athletes to show off their
skills to the teams that areinterested in them.
So there's a number ofopportunities for the athlete to
show his skills as the draftdecision years.
SPEAKER_00 (09:09):
Great.
Who else, Brian, is involvedfrom a medicine standpoint?
So you mentioned that some ofthe things they do beforehand,
there's a mental aspect.
So I imagine there's some mentalhealth or psychology people
involved looking and talking tosome of these athletes.
Are there physicians of variouskinds there?
Or is it kind of who else in themedical sphere is involved in
(09:31):
the combine?
SPEAKER_01 (09:32):
Well, just as the complex or the medical
complement of the team'sinterdisciplinary, that is what
you'll see also at the combineas you're doing the evaluation.
So you'll see the orthopedist,primary care, physical
therapists, the athletictrainers are coming along as
well.
(09:52):
And so it's really what you'llsee at the club level, they
bring some portion of thatfootprint to the combine to aid
in the meta evaluations nowagain my focus and that of my my
team of athletic trainers is onthe on field skills and drills
(10:13):
and we you know we do some uhyou know preparation for the
athletes as they request butthey those who are participating
in the skills and drills come ina pretty healthy state so it's
not you know there's not a wholelot of um treatment that we do
like at the stadium they comeready we'll help them out uh get
ready and we're also of coursewe uh we were respond should
(10:36):
there be an injury.
I'm involved in the developmentand implementation of the
Emergency Action Plan, the EAP,and that has evolved over the
years.
So, you know, thankfully, mostof the injuries at the Combine
are strains and strains of, youknow, because there's no, you
know, there's no contact.
It's not environmentalchallenges.
(10:57):
But over the years, we've hadsome emergency situations that
have needed emergency response.
SPEAKER_00 (11:03):
Great.
I love that you said emergency Ithink I've been able to get that
into every podcast I have done.
It is something of mine that Ithink is very important.
It needs to be written.
It needs to be used.
The NATA talks about, you know,has such wonderful papers on how
to put them together.
And it's actually one of theskills that we make our students
do when they take our classes.
We give them a team and alocation and they actually have
(11:27):
to write an emergency actionplan because it is something
that is that important and needsto be used.
So thank you for mentioningthat.
That just makes me happy for mylisteners to hear that.
SPEAKER_01 (11:36):
That's good to hear, Shelly, because there are no
routine emergencies, but thereare routines for emergencies.
And we're lucky to have a verysolid crew of professionals who
support us during the
SPEAKER_00 (11:52):
event.
That's awesome.
Awesome.
So now I'd like to turn to yourrole as an injury spotter with
the NFL and their player healthand safety program.
But as we start that, I'd likeyou to talk, because I believe
you recently just took on apromotion.
I think that might be thecorrect word in the region.
So can you tell us a little bitabout what your new role is in
(12:12):
that position?
SPEAKER_01 (12:14):
Well, I've been an athletic trainer injury spotter
since 2017.
And this year I was named to bethe lead AT spotter for the crew
in DC.
And really that's a, you know,chief among equals sort of
title.
We, you know, we all do the samething.
I'm more involved in schedulingand interviews, but largely
(12:35):
Again, I'm one of four, but I'minvolved more now in the
scheduling and interviews foropen positions.
SPEAKER_00 (12:45):
So you've been a spotter since 2017.
How long has the program existedin the NFL?
It goes back a little bitearlier than that, right?
SPEAKER_01 (12:52):
2012.
SPEAKER_00 (12:54):
And it has evolved a little bit, or quite a bit, I
think, in some ways.
So can you talk about, and Iknow this has gotten more
stringent, what is required tobe a spotter for the NFL?
And again, I think the this goesto having the best fit for the
person that needs to do thisjob?
SPEAKER_01 (13:11):
National Athletic Trainers Association Board of
Certification certified at least10 years working as an athletic
trainer.
And what the league is seekingis sustained and significant
experience working in footballat high levels.
Now, there are some of theparameters that there must be
(13:31):
some distance between anathletic trainer spotter and
working with a club.
And that is important because weare, we're not affiliated with
clubs.
We're, we're league employees.
So we are, that's an importantdistinction that I think, you
know, when I discussed this withfolks who are interested that
some may, may think in my case,you know, we work in DC that
(13:53):
we're employed by thecommanders.
That's not the case.
And that's, that's, we'reemployed by the league.
And that's, that's the true,true as well for the injury
video replay system operator aswell as the neuro trauma,
unaffiliated neuro traumaconsultants.
So we are, again, not employedby the team or we are employed
(14:16):
by the National Football
SPEAKER_00 (14:17):
League.
Thank you.
So can you talk a little bitabout the initial training that
you have to go through as aspotter and then kind of the
ongoing training?
Because I imagine things changeand we've heard about updates
throughout the years, sometimesin the middle of the season,
sometimes at the end of theseason when they've implemented
a new rule or done differentthings.
So can you talk a little bitabout the training pipeline that
(14:38):
you have to go through?
SPEAKER_01 (14:39):
I do.
And I think, you know, it's ablend of self-paced training,
but the, you know, the stock andtrade for what we do, we have
plenary training during the offseason and the leadership from
the player health and safetyprogram.
We do it in a venue similar towhat we're doing now.
(15:00):
We go over the currentprotocols.
We review, you know, data forfrom previous years.
And also we go over changes.
And there have been somechanges.
We won't cover them all here.
But as I mentioned with thecombine, I hope this isn't trite
by this point, but you neverstep in the same NFL season.
(15:21):
It's always changing.
Or you never step in the sameNFL season river.
It keeps changing and for thebetter.
So in the last couple of years,one of the changes was that we
now, we chronicle or catalog thenon-injury head impacts.
And that is curated by a team.
(15:41):
And that helps with largelygetting the head out of the
game.
And that goes intorecommendations for rule changes
and other aspects as well.
So always analyzing, assessing,and modifying if warranted.
SPEAKER_00 (15:58):
And then what about recurrent training?
Do you have to say, do you haveto do so many games a year?
How do you keep your competenceup as an NFL spotter?
SPEAKER_01 (16:07):
Good question.
The AT spotters are required towork at least four games a year.
And that is a standard whichgives a reasonable assurance
that the individual isaccumulating as the time goes on
in their tour, so to speak, as aspotter with different game
(16:28):
situations.
And they remain relevant andcurrent in all of the different
changes that a And also it justgives confidence that the AT
spotters are gaining therequisite experience to continue
on.
So at least four games a year.
And I mentioned the summerplenary training, but there's
(16:49):
also other training that the NFLrequires, ethics training and
other important training relatedto human resources, et cetera.
But also during the season,there are periodic meetings,
which, you know, which serve toclarify, you know, points of
emphasis and, you know, bringfolks attention to areas that
(17:12):
need attention and also toreinforce, you know, the good
things that happen throughoutthe year.
SPEAKER_00 (17:19):
Yeah, so it's very dynamic, it sounds like, very
dynamic.
SPEAKER_01 (17:22):
Just recently, I need to add that the player
health and safety leadershiphave implemented a very
interesting simulation trainingwhere the AT spotters are,
they're given a scenario, theirprovided a video and they're
given you know just about asmuch time as you would get
during a game to make a call onwhat what to do and as as we go
(17:47):
through the questions i'llexplain you know what we are
looking for as an at spotter butyou asked about training shelly
and that really has thesimulation component has really
been a good addition to the
SPEAKER_00 (17:57):
oh i imagine that just has to literally be game
changing if you're reallygetting true experiences and the
timeframe So the, you know, alittle bit of the stress, but
really, you know, it's veryreality based, which I think is
very important for them.
SPEAKER_01 (18:12):
It is.
And it's not a, the simulationscenarios aren't a giveaway
either.
And you have to really, youknow, go in understanding what
triggers a communication andwhat doesn't.
So very, very good enhancementto our training.
SPEAKER_00 (18:28):
Nice.
So can you talk a little bitmore, Brian, about the
technology that you all useduring, so you're, I know
you're, you're upstairs in abooth where you have good view
of the field.
Can you talk a little bit to usabout what's in front of you?
Take us through kind of a gameday scenario when you get there.
I imagine there's some meetingsand some group talk that has to
(18:49):
happen.
Can you kind of take us throughwhat your day is like when you
get ready to start covering agame?
SPEAKER_01 (18:55):
Well, sure.
We're required to arrive threehours before the game, and that
gives us a chance to coordinateand sync with the the injury
video replay system operators toshake out any changes in
communications, just get anassessment that the booth is set
up for game operations.
(19:17):
And it also gives us time toprepare for a very important
part of the gaming operations onthe medical side.
And that's a 60 minute medicalmeeting.
And that is a meeting that is aninterdisciplinary gathering of
the team physicians, teamathletic trainers, the UNCs, the
airway physicians, the EMTsassigned to the games, the
(19:42):
officials primarily, they comeout and ask who the athletic
trainers are.
And we have really justface-to-face interaction.
They hear our voice, we heartheirs.
That's coupled with radio checksthat we do later on.
But the three hours for the gameshow, it gives us a really good
opportunity to settle in, getinto the the mindset that has
(20:06):
been set by the trainingconditions that we've all
benefited from.
So that meeting is very key inhaving everybody understand what
each other is doing and whattheir role is in the EAP.
That really has matured over theyears, and we have great
(20:26):
examples.
You saw it at the conference inAtlanta, how that all came
together in the We make itbetter every year.
So the 60-minute meeting.
In between 60 minutes and gametime, we are doing radio checks,
again, to ensure that the commsare ready without a hitch.
(20:50):
And there's other checks that wedo.
We call down to do radio checkswith the clubs because there's
that communication as well.
So that's what we do before thegame.
Would you like me to proceed onwhat we do during the game?
SPEAKER_00 (21:03):
So I'd like to just add a point.
to that for our listeners.
So, you know, again, NFL game,the big 60 minute meeting, but I
tell our sports providers allthe time, whether it's a high
school volleyball game or ayouth soccer, you know, before
the game starts, you as thesports provider, the AT on the
field should be, you know,reminding your coaches, the
official will usually come overand ask who the medical person
(21:25):
is, remind you who allows you tocome out onto the field, right?
A little bit different.
You're sitting up in the booth,but that medical timeout before
the game is always important.
So everyone's got a visual withan eye to eye.
Who do I look for?
I tell people all the time whenthey start covering sports, I'm
not watching the game to watchthe game.
I'm watching the athletes forinjury.
(21:46):
And so I think that it's, thisjust hits home how serious this
has taken, even at a level whereeveryone's very professional,
but it still needs to be doneand it still needs to be prepped
before every game.
So it's just very important.
It's one of the key things thatGod forbid, should something
happen, everyone is ready.
And I think You know, we all sawthat if you were watching the
(22:07):
game with DeMar Hamlin, how wellthat was carried out.
And I'm sure in part because ofall the training and the
meetings and the rehearsals thatgo over and over again, that
made the difference in someone'slife.
SPEAKER_01 (22:20):
Sure did.
And I don't want to forget therole of NFL operations.
There's a representative thereat the 60-minute meeting, and
they're busy throughout thegame, but they play an important
role during that meeting aswell.
Security is part of it.
You know, the x-ray techs, theway I could go on, it really is
kind of a, you know, a very,very good interdisciplinary
(22:44):
interaction of all thosedifferent providers.
SPEAKER_00 (22:47):
And so whether it's, you know, downsized to a small
high school game or all the wayup to the NFL, I think there's
still a lot of takeaways thatpeople can get from what you're
telling us here today that canbe valuable when they're
providing support to youth or,you know, levels of athletics
that are not professional, thatare just as important to take
care of.
So thank you.
Let's talk about, so now takeus, so we've had the meeting,
(23:09):
you've done your comms check.
So what happens next?
SPEAKER_01 (23:13):
Okay.
Well, my role in that of theother spotters is to observe
play, monitor the broadcast feedand other camera angles that we
have available to identifyathletes who may potentially be
injured on a play with anemphasis on the head and neck
injuries.
What we're looking for with headand neck injuries is a head
(23:34):
impact that causes an injurybehavior that suggests
concussion.
And that's really the twotogether.
It's not just head impacts.
I mentioned earlier, Shelly,that we are cataloging
non-injury head impacts.
But if we call down on everyhead impact without an injury
(23:55):
behavior, you can see where thatgoes.
And certainly the equipment hasgotten better that mitigates the
injury part of it.
SPEAKER_00 (24:03):
So if you You radioed down to the head
athletic trainer because you sawhead impact or concussion
behavior.
What happens then?
SPEAKER_01 (24:10):
Well, the athlete is then put into the blue tent and
evaluated by the unaffiliatedneurotrauma consultant and the
team physician.
They make a determination ofwhether the athlete needs to be
further evaluated in the lockerroom or based on what their
clinical exam shows is eitherruled out of the game or
(24:32):
returned to the game.
You know, the threshold is lowto do that.
As long as there's two, reallythree elements, one, head
impact, concussion behavior, andthe athlete trying to return to
the game, we have the authorityto call down to make that
medical timeout.
SPEAKER_00 (24:49):
So, Brian, how do the videos, you've talked about
all this great technology, buthow do the videos assist the UNC
and the team physicians in theirevaluations?
SPEAKER_01 (25:00):
Thank you, Shelley.
They were able to see near realtime of what the injury
mechanism was along with thetype of concussion behavior that
necessitated our call down tothe sideline.
And after all the times that wecall down, whether it's where we
radio down or whether we callmedical timeout, once the
(25:22):
evaluation is completed, theymake the determination, they
call us and close what's termedclosing the loop.
And that's a very important partof the process because that
gives everybody theunderstanding that the the
evaluation has happened and thatthe determination has been made.
Now, in a very rarecircumstance, if an athlete
(25:42):
returns to the field and theloop has not been closed, we are
required to call down to makeanother medical timeout to
ensure that part of the processhas been taken care of.
SPEAKER_00 (25:58):
Okay.
So that's a lot of moving partsto make sure.
And who all is involved inclosing the loop?
Like what are all the differentparties that are part of that?
Can you just clarify who thatis?
SPEAKER_01 (26:09):
Well, the, the decision-making that leads to
the evaluation is the UNC, theteam physician.
And before the game, I talkedearlier in the meeting here
today, we talked, you know, the60 minute meeting in there is
where we determine who closesthe loop and it differs by team.
It can be the head athletictrainer.
It can be, the team physician orthe UNC.
(26:31):
And it's just a matter of theircomfort level.
That is determined before thegame so we know who that
individual is.
SPEAKER_00 (26:39):
Right.
So again, all these pieceslinked together from what you
talked about earlier, themeeting beforehand, the
practicing, the discussion.
So everything at the end of theday is closed and there's good
understanding on everyone'spart.
SPEAKER_01 (26:54):
Yes.
And I mean, the differentscenarios, I've covered a couple
of them where when we radiodown, it's where we see the
injury and the mechanism andbehavior.
We will call down if the athleteis walking off the field and as
a change of possession or asubstitution, we see it, we call
it down.
Or if an athlete is beingevaluated on the field after a
(27:17):
head impact and concussionbehavior, even though it would
be obvious to everybody in thestadium and watching on TV what
has happened, a helmet impact orhead impact with a concussion
behavior, we still call thatdown.
Now, we don't do that while theathlete is being walked off the
field by the athletic trainingstaff.
We wait.
(27:37):
A reasonable interval hashappened when things when the
athlete has been moved to thesideline again to direct the
evaluation to occur.
And again, I may have coveredthis earlier, but if the athlete
is trying to return to thehuddle or return to play after
having the helmet, the headimpact and the concussion
(27:57):
behavior, that is what triggersthe medical timeout to the
referee.
And in that case, even after wemake the medical timeout to the
referee and he stops, theofficial stops the game and
ushers the player off the field,we still call down to the
sideline via the radio to ensurethat evaluation is conducted.
SPEAKER_00 (28:17):
Great.
Thank you.
That's a very good explanationof how that all works.
So Brian, you've talked aboutall this video and the behaviors
you're looking for and thehead-to-head contact.
Do you, as an observer up inthat, are you recording every
time there's head contact?
Because that seems like that's alot of activity that could
happen.
Could you just explain that alittle bit more?
SPEAKER_01 (28:38):
Sure, sure.
Even though we may not call downto the sideline or referee for
every head impact that doesn'thave a concussion behavior, we
do document the, or what we calltag the videos of the non-injury
head impacts.
And that is fed into a team atthe NFL league office who is
(29:03):
curating that information tosupport the overall effort to,
you know, to reduce head impactsof any type, and that is useful
to them.
So we, again, we don't call downto the field for every head
impact, but we do those headimpacts that we see on different
(29:24):
plays, we do tag those videos soanother team can review them.
And Shelly, we also, althoughour emphasis is on head and neck
injuries, we do document the,the occasions where an athlete
has sustained an orthopedicinjury of any type, where a
response is needed on the field,and also in the rare
(29:48):
circumstance where an athletehas to be removed from the field
via cart, et cetera, asignificant injury.
And we don't call down for thoseinjuries, for those non-head and
neck injuries, but what happensoften is because of the quality
of the injury video reviewsystem, the teams will call up
to us us to see the mechanism ofa non-traumatic knee injury, for
(30:14):
example, and that aids in theirdiagnosis just as it aids the
UNC's and the team physician intheir evaluation of concussions.
SPEAKER_00 (30:23):
And that makes perfect sense because we talk
all the time about when you'reon the field, you're not a
spectator, you're watching, butthat view has got to really
provide some additionalsubstance for the staff who's
evaluating that injury.
That's wonderful.
You really can't be not payingattention.
I mean, you can't even blink upthere, Brian, during that game.
You're constantly, with yourhead on a swivel, looking at all
(30:47):
of those monitors and what'sgoing on.
I mean, your focus really mustbe intense.
I would imagine you've got to bea little tired after covering a
game?
SPEAKER_01 (30:56):
Well, there's a very good team up there that we were
assigned.
The AT Spotters are assigned todifferent teams, so it certainly
is intense.
But the more, you know, the moregames that we do, the more
comfortable you are with thepace of the game.
And, you know, there's there'snever, never a dull moment.
(31:17):
But you just you're able to tolook forward a bit to prepare,
prepare yourself when the gamemight might become a little bit
more intense, but vigilance isthere all the time.
what we've seen also in recentyears, that medical timeouts
have decreased.
And that is because, in part,that the officials are
(31:38):
recognizing that something iswrong with the athlete after
sustaining a head impact andhaving them be evaluated.
So that helps everybody, thatthey're available to see that
and do that.
So they do as well.
Also, we see that the individualathletes themselves are giving
(31:59):
the tap out sign and takingthemselves out of the game, as
well as teammates saying that afellow teammate needs to be
evaluated.
So there are a number of waysthat an athlete will get before
a team of providers to beevaluated for a concussion.
So that's the immediate responsepart of that.
(32:20):
Then the evaluation piece comesin.
And that's where you see theathlete go in the blue tent and
the evaluation happens with theunaffiliated a neurotrauma
consultant and the teamphysician.
And after the decision is made,whether the athlete can return
or not, they call up to us toclose that loop.
And that is very important.
(32:40):
It sounds pretty elementary, andit is, but we're very, very
focused on that to ensure thatin the heat of the moment, that
all who are involved in theprocess of ensuring that the
athlete has been evaluated withthe correct disposition, either
not clear to play or clear tothat is known to all.
So closing the loop happensafter that, after the evaluation
(33:05):
piece.
SPEAKER_00 (33:06):
That's great to hear because I was thinking, you
know, once you guys have madeyour call, you're kind of done.
But now I'm thinking when youtalked about the simulation
earlier, these are greatexamples, right, to help train
for nuances.
Because I imagine there's somenuances and I imagine the more
you do this, the more you'reable to pick up on some things
that you might not have noticedor the different angles and the
(33:27):
different people It's just allfeeding in to making a better
decision for that athlete.
SPEAKER_01 (33:34):
Well, and that's from the spotter's perspective.
This will be my ninth yearcoming up.
And I think I've worked 48 gamesso far in the previous years.
And just every game just sort ofadds to the game slowing down
for us, if you're familiar withthe term.
It's just you get a sense of theflow of the game and what's what
(33:59):
actions need to be taken andwhat actions don't need to be
taken in the event of a injurythat could be a concussion.
So, yeah.
SPEAKER_00 (34:08):
Brian, this is great information.
So can you take us, you're inthe booth, and what is that
timeframe?
So you talk about all thistechnology, you're hearing the
broadcast, you're watching it ondifferent videos, you have to
make a decision.
I would imagine pretty quickly,what is happening from the time
you suspect something and seethe behavior and injury to the
call down the review.
(34:29):
What is it?
Can you explain that timelineand how fast you need to do that
or what the right answer is forthat?
SPEAKER_01 (34:37):
Thank you, Shelly.
The longest that we would haveis 40 seconds, and that is the
play clock.
And that's the amount of timethe offense has to snap the ball
before a penalty is given to theoffense.
But many times, it's muchquicker than that.
And this is where knowledge ofthe game and the preseason
(34:57):
scenario training comes in thatif there's a an offense that has
a or team that runs a hurry upoffense that 40 seconds can get
compressed very very quickly anddepending upon the closest of
the game and you know within thetwo minute period before the
halves are over the game's overthat can be a single digit
second so the longest amount oftime we have is 40 but most
(35:21):
times it's much less than thatso again that's where the
training comes in and thescenarios that were provided to
review
SPEAKER_00 (35:28):
And again, I imagine that's where that value of that
simulation training that you getis very helpful to make it real
life.
SPEAKER_01 (35:35):
Absolutely, yes.
And again, as I mentioned at theoutset of the podcast, there are
some pretty stringentprerequisites to become an AT
spotter centered around mainlythe length of time that an
individual has with working at ahigh level in football.
SPEAKER_00 (35:52):
Great.
The next question I have, soyou're independent, right?
So we know that you're hired bythe NFL.
So how How do playoffs and theSuper Bowl work as far as the
spotters go?
Are there the same number ofspotters?
How do you get picked or anopportunity to participate in
playoffs?
SPEAKER_01 (36:09):
Generally speaking, the home team, wherever that
game is played, the home team ATspotters cover that game as
well.
So that's the general aspect.
There are certainly some nuancesto that.
As the playoffs go on, there aremore plus-ups in different
areas, not just the spotters butyou know plus ups but not you
(36:32):
know not excessively so butgenerally speaking Shelly that
the whatever home stadium ishosting whatever the playoff
game is the home AT spotterscover them.
SPEAKER_00 (36:44):
And that makes sense because when you talked about
this whole interprofessionalteam with security and
operations it would make sensethat that person who knows that
field right is familiar with allthe the goings on so that seems
to to make a lot of sense.
What's your favorite part aboutbeing a spotter?
I'm curious.
You're going into your ninthyear, so you must absolutely
(37:04):
still love this.
What about it is your favoritepart?
SPEAKER_01 (37:09):
Well, my favorite part is as it was working in the
large sporting events that I'veworked before.
I was the chief athletic trainerfor rowing and canoe kayak
during the 1996 CentennialOlympic Games.
Again, I've worked at Combinefor many years.
For me, it's kind of the thecoming together of all of the
(37:30):
interdisciplinary members of theteam and working through
scenarios and problems, but witha way, as I said earlier, there
are no routine emergencies, butthere are routines for
emergencies.
And just kind of understandingwhat your part is in the whole
system, but being part of thatwhole system is very
(37:51):
professionally satisfying to me.
And I'm glad to be part of it.
So hopefully I've explain thatwell enough, that this is big
enough than just one person, bigenough than me, bigger than me,
but I'm glad and professionallygratified that I am part
SPEAKER_00 (38:08):
of it.
It's systems thinking.
We can only see the part that wecan see.
And so when you put the wholepart together, it gives us all a
much better picture.
One of the things that we'restarting to see in the
professional leagues is spottersin other sports.
So we're starting to see them insoccer and rugby.
And I think I know what youranswer to this will be, but
obviously that's a good thing.
Do you think, and again, Iunderstand this is just your
(38:31):
personal feeling.
Do you think that we need to addspotters in college football?
SPEAKER_01 (38:37):
Well, they are Shelly.
Uh, I can't give you a, youknow, a precise, you know, uh,
number of, of the leagues thathave them, but I think the
bigger the league, the morelikelihood is that they have a
spotter capability.
And you mentioned MLS, you know,NHL has them as well.
And, um, uh, Aussie rulesfootball, I believe, has them as
(39:00):
well.
I'll stop there because I knowthat there are others that have
them, but some don't.
And some, you know, they do it abit differently than the NFL.
MLS has it done centrallylocated.
I believe it's in Texas.
And they do it that way.
NHL, I believe it's in New York.
So rather than having on fieldor at the venue, AT spotters are
(39:22):
doing it all electronically.
So our system works for the NFLand and other sports leagues, et
cetera, have their own.
So, I mean, what the beauty ofthe spotter system or the genius
of it is, is that, you know,putting us above at the press
box level really makes a lot ofsense because you've been on the
(39:44):
sideline as have your listeners.
Football players in the NationalFootball League are pretty big
people.
And there's a lot that happenson the NFL sideline that the
athletic training staff is, thatthey have to, to be concerned
about.
And, you know, having that extraset of eyes above the field
makes a lot of sense.
And it would for other leaguesas well, other sports too.
SPEAKER_00 (40:08):
It was the one time I felt small in my life when I
was in charge of the offensivelinemen at UNC.
And I, you know, they were thefat kids and I was their mama.
It was my nickname.
And, you know, I, you know, theytowered over me both width and
height wise.
But yeah, I just think it'sgreat that we're starting to see
other sports really bring thisyou know, you, the NFL has been
(40:29):
doing it since 2012.
We're seeing more and more ofit.
I think personally, I would loveto see, you know, college
football kind of mandated.
I understand there's money anddifferent things that go, are
involved in it.
But I think as we continue totry to improve safety for our
athletes, I think it would besomething that would be
beneficial.
(40:49):
And, you know, it's, you guyshave done it now for, you know,
several, several years and beingable to take the good from each
thing.
And like you said, each sporthas a different way of doing it
that works for that sport.
So again, I just think it'swe're taking care of the
athletes, which is what our goalis.
I think from the time we becameathletic trainers or physical
therapists, right, is we want tomake sure those athletes are
(41:10):
safe and can continue to play.
What would you say?
So we have a lot of listeners onhere.
We do have a lot of students wholisten, both physical therapy,
athletic training.
We get some young physicians onhere as well.
What would you say to anaspiring athletic trainer who
wants to work at a higher level?
So, you know, whether it's theOlympics or whether it's, you
(41:31):
know, pro sports or collegesports, what do you think are
some things that they need tothink about as they move through
their career that would do themwell in being able to achieve
their goals?
SPEAKER_01 (41:41):
Well, I would recommend mastering both, you
know, traditional sportsmedicine and modern technology.
Hands-on skills are necessary,but plus the knowledge of the
modern day technological toolslike load management and data
aggregation platforms isnecessary.
in terms of how to make thatturn into opportunities on a
(42:04):
bigger stage.
Build a network throughinternships, volunteering, and
conference attendance.
There's certainly professionalsocial media platforms out there
that help enable that.
And also develop strongcommunication skills, because
you're constantly coordinatingthrough coaches, physicians, and
front office staff.
(42:24):
Pro sports, as many of yourlisteners know is a demanding
environment where you're goingto need to effectively
communicate up and out and downand in.
As good as we get withtechnology, the face-to-face
communication across manydifferent aspects of an
organization verbally and inwriting still is at a premium
(42:46):
and developing those skills isnecessary to get on that stage.
SPEAKER_00 (42:53):
Awesome.
The human factor still matters.
We aren't replaced in yet withAI.
So, great.
Brian, anything else to add aswe bring this conversation to a
close?
SPEAKER_01 (43:04):
No, Shelley, it's been a pleasure.
SPEAKER_00 (43:07):
Thank you.
This has been a very informativeconversation, Brian.
You have so much to offer andsuch keen insight and thoughts
that are very pertinent to ourlisteners, and I'm deeply
appreciative of you being heretoday and sharing your knowledge
and expertise.
And with that, to our listeners,another Cogent Conversation
comes to an end, and we hopeyou'll join us next month for
another Cogent Conversation.
(43:27):
session.
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