Slowly, sometimes reluctantly, NFL teams are wising up to the dangers of head injuries. A league-mandated concussion protocol has removed much of the guesswork in evaluating players, opting for a more cautious, if imperfect, assessment process that removes players on suspicion of a concussion, only allowing them to return once they pass cognitive testing.

Somehow, that system failed Case Keenum. Against Baltimore on Sunday, the Rams quarterback suffered one of the most evident concussions you'll ever see on the football field -- every armchair doctor watching the game knew exactly what happened.

From the way the back of his head rebounded off the turf -- one of the most common ways in which quarterbacks are concussed -- to his disoriented flailing on the ground, to his inability to stand up, to the slowness and confusion he exhibited once back on his feet, his condition was apparent. No one needed to hear from a sideline assessment: Keenum had a concussion.

Case Keenum

He should have been immediately yanked, replaced by Nick Foles. Instead, Keenum played two more snaps, eventually fumbling the ball away to Baltimore. The Ravens took over possession and won a game-winning field goal, but the events on the field are irrelevant. The Rams and the NFL failed Keenum and put his personal health at risk.

The NFL is first-in-line for blame because its designated ATC spotter -- a certified athletic trainer designated with identifying injuries on the field, and given the power to call medical timeouts in the event of concussions and other injuries -- failed to recognize the concussion.

But the Rams shouldn't have passed the buck, either. The whole stadium knew Keenum was injured -- Foles even got ready to take the field. ATC spotters aren't the only line of defense against concussions, and Rams coach Jeff Fisher -- or a coordinator watching Keenum's behavior -- should have recognized his condition and called for a change. You can't trust someone with an injured brain to make the prudent decision himself.

That's what the Rams did, though, leaving Keenum exposed to much more serious injury. It's fitting that the Rams lost because of that oversight, but it isn't an equitable punishment. Keenum's brain health is worth more than the result of a football game. The NFL is almost certain to bring additional heat against the team, issuing a strong statement Monday:

"Promptly after the conclusion of yesterday's game, we began a review to determine the facts of the injury to St. Louis quarterback Case Keenum and why he was not removed from the game for the necessary evaluation by a team physician or the unaffiliated neuro-trauma consultant as required by our concussion protocols. We are continuing that review today, which includes discussions with the Rams and their medical staff, the ATC spotter, the game officials, our medical advisors and the NFLPA. In the meantime, prior to this week’s games, we will reinforce with all involved the need to ensure that these injuries are properly identified and addressed in a manner consistent with our protocols."

Wes Welker

The Rams could use some extra tutoring on the subject. This isn't the team's first blatant disregard of player health in the past month. On November 9, the team signed free-agent wide receiver Wes Welker to a contract through the rest of the season. Welker's abilities coming out of the slot are well-known, and even with diminished skills, he's clearly capable of contributing on the football field.

Welker's skills were never in question, though. One of the leading reasons he had remained unsigned into November was his lengthy concussion history -- at least six in the NFL, including three within a 10-month span. Welker's health was such a great concern that one of his former teammates, Champ Bailey, openly pleaded for Welker to retire rather than expose himself to greater risks.

"I already played a full season without a concussion, so I'm really not worried about it," said Welker upon signing with the Rams, according to ESPN.

His new coach attempted to wipe his hands of any wrongdoing.

"This is his decision," Fisher said. "He missed football. He loves football. He's fine. He hasn't had any issues. He just wants to play and help us win."[YIELDMO3

Fisher is right about one thing: It's Welker's decision to play, or at least to try and prolong his career. He's an adult, and he received medical clearance. Friends and family can plead otherwise, but Welker is free to do as he chooses.

But if the Rams want to pretend they aren't complicit, they've got another thing coming. The general consensus among NFL teams has been that most were uncomfortable playing Welker given his past concussions and risks that came with tacking on additional traumatic hits. Such blows to the head are an inherent risk of playing football, but the circumstances are much different for someone with half a dozen concussions under his belt.

Jeff Fisher

There's a lot we don't know about concussions and football's affects on the brain, but among our infantile understanding is this: Multiple concussions pit players at an extremely high risk of cognitive injuries later in life. Likewise, we're starting to understand the significant role sub-concussive hits can play on that cognitive health.

Welker already faces very scary, if unknown, circumstances. For an NFL head coach to be so flippant about those risks -- and "He's fine" certainly qualifies -- has the opposite effect of passing the blame.

Fisher and the Rams are implicated by their ignorance to this very serious issue.

The Rams are likely facing a tough decision regarding the future of Fisher as their head coach. In his fourth season, the Rams are a disappointing 4-6, on a three-game losing streak and two games out of the playoffs with six games to play. When the Rams do sit down for an evaluation, they should also consider whether Fisher's Cro-Magnon methods of personnel management fit in this changing era of professional football.

In the meantime, the NFL has a lot of work to do in penalizing the guilty parties and preventing future instances of what happened to Case Keenum. The league had better come down hard.

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CTE in NFL vets


Mike Webster #52

As a player, Mike Webster was an all-time great, earning nine Pro Bowl selections and winning four Super Bowls with the Steelers. In 1997, Webster was inducted into the Pro Football Hall of Fame.


Mike Webster #52

Unfortunately, Webster's post-football life was troubled. He was afflicted by amnesia, depression and dementia in his later years, many of which he spent homeless despite having relatives willing to house him. After his death in 2002, he became the first NFL veteran diagnosed with CTE.


Forrest Blue #75

As an offensive lineman, Forrest Blue was a four-time All-Pro. His eleven-year NFL career was split between the San Francisco 49ers and Baltimore Colts. Blue died in 2011 in an assisted care facility, after which he was diagnosed with CTE.


Lew Carpenter #30

Lew Carpenter made a 47-year career out of football. After playing at the University of Arkansas the running back spent 10 years playing for the Cleveland Browns, Green Bay Packers and Detroit Lions. He retired from coaching in 1996 due to health reasons and died in 2010, agreeing to donate his brain to science.


Lou Creekmur #76

An eight-time Pro Bowl offensive lineman, Lou Creekmur suffered from a 30-year decline in mental health leading up to his death in 2009. He was 82.


Shane Dronett #99

After a 10-year career in the NFL, defensive lineman Shane Dronett experienced significant cognitive troubles in 2006. He suffered from confusion, paranoia, and bouts of rage. In 2009, he picked up a gun and confronted his wife, who fled. In her absence, Dronett fatally shot himself. He was 38.


Dave Duerson #26

In 11 NFL seasons, Duerson was a four-time Pro-Bowler and the 1987 NFL man of the year. In 2011, he shot himself in the chest and died. Duerson had suspected something regarding his mental health: just before shooting himself, he texted his family asking them to donate his brain to science.


Ray Easterling #32

An eight-year veteran who spent his entire career with the Atlanta Falcons, Ray Easterling was one of the veterans to add his name to a federal lawsuit against the NFL regarding concussions. In April 2012, he fatally shot himself, allegedly due to the worsening of his clinical depression and the deterioration of his cognitive functioning.


Cookie Gilchrist #2

Between the CFL and the AFL, Cookie Gilchrist earned nine All-Star bids. The running back was also a two-time AFL rushing champion. After his playing career, Gilchrist displayed erratic and sometimes angry behavior, particularly to those he had worked with in his playing days. He died in 2011 and was diagnosed with advanced CTE.


John Grimsley #59

A 10-year NFL veteran, Grimsley is best known for making the Pro Bowl in 1988. In 2008, he died of an apparent accidental gunshot wound, after which he was diagnosed with CTE.


Chris Henry #15

Henry's CTE diagnosis was a breakthrough that brightened the spotlight on football's dangers. After several run-ins with the law, Henry died in 2009 from a motor vehicle accident. An autopsy revealed that Henry had CTE at just 26 years old. He was the first still-active NFL player to be diagnosed with the condition.T


Terry Long #74

Long was a consistent starter for the Steelers from 1984 until his retirement in 1991. That same year, Long tested positive for steroids and attempted suicide. He eventually killed himself in 2005 by drinking antifreeze.


John Mackey #88

A five-time Pro Bowler and two-time NFL champion, John Mackey was only the second tight end ever admitted to the Pro Football Hall of Fame. After his playing days, Mackey was afflicted with dementia, and his condition worsened until he required full-time care in an assisted living facility. He died in 2011.


John Mackey #88

Since John's death, his wife, Sylvia Mackey, has become a powerful advocate for NFL veterans and continues to push the NFL to change through her activism and legal work.


Ollie Matson #33

In addition to having a 14-year NFL career, Ollie Matson also won two medals at the 1952 Olympics. He died in 2011 from complications from dementia and was later diagnosed with CTE.


Tom McHale #73

A bruising defensive end with an Ivy League education, Tom McHale played in the NFL from 1987 to 1995. He died in 2008 from an accidental drug overdose. His widow now works for the Boston University CTE Center as a family relations liason.


Junior Seau #55

Perhaps the most accomplished player to be diagnosed with CTE, Junior Seau was a 12-time Pro Bowler, the 1994 AFC Player of the Year, and a member of the NFL 1990s All-Decade team.


Junior Seau #55

In May 2012, Seau was found dead from a self-inflicted gunshot wound to the chest. While never diagnosed with a concussion during his playing career, Seau's wife reported that he did admit to experiencing several. The linebacker also experienced insomnia for years leading up to his death.


Justin Strzelczyk #73

As an offensive lineman for the Pittsburgh Steelers, Strzelczyk's career was cut short by his erratic off-field behavior and legal troubles. Upon his death in a high-speed police chase in 2004, alcohol and drugs were initially blamed. An autopsy revealed that the lineman had suffered brain damage.


Andre Waters #20

During his 12-year NFL career, Andre Waters earned a reputation as one of the hardest hitters in the NFL. Unfortunately, Waters wound up shooting himself in the head in 2006. An autopsy discovered brain damage sustained during his playing days.


Jovan Belcher #59

A young, promising NFL linebacker, Jovan Belcher killed himself in a murder-suicide in December 2012. After killing his girlfriend, Belcher drove to the Kansas City Chiefs' practice facility and shot himself with a handgun in the parking lot.


Jovan Belcher #59

After Belcher's death, an autopsy diagnosed CTE in the 25-year-old.

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