The NFL is taking steps to educate players on concussions and make sure they are reported, implementing a whistle-blower system when training camps start in July.
The league hopes that will ease pressure on players to take the field with a concussion.
"It's an important element of what we're trying to accomplish here," NFL commissioner Roger Goodell said Tuesday after a conference in Rosemont, Ill., with medical personnel from every team in the league. "I have said repeatedly and will continue to say that medical decisions must override any competitive decisions.
"And if anyone feels they are being forced onto the field when they are not ready to play, we want to know about that and look into it."
Dr. Joseph Maroon, the Steelers' neurological surgeon, spoke at the conference along with Dr. Mark Lovell, co-director of the Concussion Center of Sports Medicine at the University of Pittsburgh.
"The main thing is that there's a heightened awareness, not only by the physicians and trainers, but by the players," Maroon told the Tribune-Review last night. "It was an exchange of a very high level. The concept was prevention."
Although details need to be worked out with the players' union, the new system allows anyone to anonymously report when doctors are pressured to clear players or when players are pressured to play.
The deaths of four players in recent years have raised awareness of the issue, and the meeting was held to discuss the latest information on treating the condition.
"I'm not sure if we -- athletes -- know what a concussion is," said Troy Vincent, a veteran NFL defensive back and the president of the NFL Players Association.
Besides implementing the whistle-blower system, the league will require all players to undergo baseline neuropsychological testing starting this season. Rules requiring players to properly buckle their chin strap will be enforced, and a brochure will be distributed to players to help educate them and their families about concussions.
Maroon said the Impact Neuropsychological Test that he and Lovell developed 17 years ago is the accepted standard for concussion care in the U.S. He said 28 of the 32 NFL teams use this test, along with "the NHL, MLB and about 1,500 high school teams."
The baseline test is given to players before each season and after head trauma occurs. Maroon said athletes must return to the "before" standard prior to being allowed to resume play.
At yesterday's conference, Maroon said Goodell mandated a "standard of care" for all 32 NFL teams to adopt.
The heightened awareness comes amid studies indicating that players who suffered multiple concussions might be susceptible to neurological disorders later in life.
It also comes along with reports suggesting brain damage may have been a factor in the deaths of former Philadelphia Eagles safety Andre Waters and former Steelers offensive linemen Mike Webster, Terry Long and Justin Strzelczyk in recent years.
Waters committed suicide in November. Long killed himself in 2005. Webster suffered brain damage and was homeless before he died of heart failure in 2002. Strzelczyk crashed his pickup truck while being chased by police in 2004.
"I don't think we can conclude what exactly caused this," said Dr. Julian Bailes, a neurosurgeon at West Virginia University and a former Steelers physician who's seen Strzelczyk's pathology report. "Although, if you go through the list of potential causes, certainly trauma to me is No. 1.
"Is that football trauma? Is that NFL trauma? Is that high school trauma? Is that falling off a bike as a kid? I don't know."
Bailes also is the medical director at the University of North Carolina's Center for the Study of Retired Athletes, which found in a recent study of more than 2,500 retired NFL players that those who had at least three concussions during their careers had triple the risk of clinical depression as those who had none.
The study also reported that those who recalled having one or two concussions were 1 1/2 times more likely to be diagnosed with depression.
Concussions can be difficult to diagnose, and players who were conditioned when they were children to play hurt are reluctant to reveal injuries.
Former Steelers tight end Mark Bruener, a member of the NFLPA's board who's been diagnosed with four concussions in 12 seasons, knows how players think.
"When you're asking a player on the sideline if he wants to go back in the game, the answer is going to be, 'yes,' " Bruener said.
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