The Impact of Concussions in Football How Refs Can Keep Players Safe

Concussions are one of the most serious issues in football today. Fans see the speed and power on every play, but what we do not always see is how a brain can be shaken inside the skull after a hit. That is the essence of a concussion. The good news is that football has become much more careful about head safety. Rules have changed. Coaches teach better technique. Medical staff are more involved. And one group in the middle of everything is the referee crew. Refs cannot diagnose injuries, but they are the guardians of the game’s safety rules. Their eyes, whistles, and decisions can prevent dangerous hits, stop play when a player is hurt, and make sure the right protocols happen. This article explains concussions in simple terms and shows exactly how referees can keep players safe at every level, from youth leagues to the NFL.

Understanding Concussions

What is a concussion?

A concussion is a mild traumatic brain injury. It happens when a hit or sudden movement makes the brain move quickly inside the skull. You do not have to get knocked out. You do not have to be hit in the head directly. A body blow that whips the head can do it too. The brain is soft, and the skull is hard. When the brain moves and hits the inside of the skull, cells can be stretched and normal brain function can be disturbed for a short time. Most people recover well when they rest and follow medical advice, but a concussion must be taken seriously from the first sign.

Common symptoms and red flags

Concussion symptoms can show up right away or minutes later. A player may feel dizzy, confused, or see stars. Headache is common. Some feel pressure in the head, nausea, or balance problems. They may seem slow to answer questions or forget the play. They can be sensitive to light or noise. Red flags that require immediate medical care include repeated vomiting, worsening headache, trouble walking, extreme confusion, or a loss of consciousness. Referees are not doctors, but they are trained to notice things like a blank stare, stumbling, or a player who is slow to get up and seems off. When in doubt, the player should be removed for evaluation.

Short-term and long-term risks

In the short term, a concussed brain needs rest. Playing again too soon can make symptoms worse and slow recovery. The biggest immediate danger is a second hit before the first concussion has healed. This can lead to second impact syndrome, a rare but catastrophic brain swelling that can be fatal. In the long term, repeated head impacts, even if they do not cause a diagnosed concussion, can add up. Researchers are studying chronic traumatic encephalopathy (CTE), a degenerative condition found in some former athletes. It is linked to repeated head impacts, not just big concussions. That is why reducing all avoidable head contact matters, not only the obvious huge hits.

Myths and facts

Myth: You must pass out for it to be a concussion. Fact: Most concussions do not involve loss of consciousness. Myth: If the player “feels fine,” they can go back in. Fact: Symptoms can be delayed and the decision belongs to a qualified medical professional, not the player or coach. Myth: A helmet prevents concussions. Fact: Helmets prevent skull fractures and cuts. They help, but they cannot stop the brain from moving inside the skull. Myth: Only head-to-head hits cause concussions. Fact: Any hard hit that jolts the head can cause one.

Why Football Has Higher Concussion Risk

The mechanics of hits

Football is a collision sport with short bursts of high speed. Players accelerate, plant, and change direction with strong force. When two bodies meet, the stop can be sudden. The brain moves inside the skull and can twist as well. Rotational force is especially hard on the brain. That is why glancing blows or a fall to the turf can still be dangerous.

Positions at higher risk

Skill positions like wide receivers and defensive backs take hits while running fast. They can be defenseless when catching the ball or jumping. Linemen make contact on almost every play. They may not have many huge hits, but they have many small ones, which still matter. Quarterbacks can take blindside hits. Running backs get tackled in traffic and can hit the ground hard. On special teams, players run long distances and hit at high speed. This combination creates high concussion risk if rules are not enforced and techniques are not safe.

Youth, high school, college, and pro differences

Younger athletes have developing brains and necks that are not as strong, so forces may affect them more. High school football reports more concussions than youth because the athletes are faster and bigger, but not as skilled as college players. College and the NFL have advanced medical teams and video support, but the hits are also faster and harder. The job of the referee crew changes slightly at each level, but the goal is the same: protect the head and neck and remove players who might be concussed.

The Referee’s Role in Player Safety

Referees are not doctors, but they are gatekeepers

Referees do not diagnose concussion. They are not running medical tests or making return-to-play decisions. But they have the whistle and the authority to stop action when safety demands it. They can see a player who is slow to stand, who stumbles, who grabs his helmet, or who looks confused after a hit. They have the power to send that player to the sideline for evaluation. They also control the way the game is played by enforcing safety rules without hesitation.

The authority to stop play and remove a player

Every rule set gives the officiating crew power to stop play for an injured player. When head injury is suspected, the crew should kill the play, signal injury time out, and direct the athlete to the sideline. At some levels, medical spotters in the booth or independent observers can call down to stop play if they see signs that a player might be concussed. In all cases, the principle is the same: if in doubt, sit them out.

Communication with coaches, trainers, and spotters

Good safety depends on fast and clear communication. When a ref suspects a concussion, the nearest official escorts the player to the sideline and informs the head coach. The referee or umpire signals the injury, and if available, the athletic trainer or team physician takes over. In the NFL and many college games, a certified athletic trainer spotter and an independent neurotrauma consultant assist. Officials should use simple language, such as “Number 24 is out for head injury evaluation.” This creates a clear handoff and avoids arguments about motives or game impact.

Rules That Protect the Head

Targeting and defenseless player protection

Most levels of football now have strong rules against targeting. Targeting means making forcible contact to the head or neck area of a defenseless opponent, or using the crown of the helmet to hit any opponent. Defenseless players include receivers during or just after the catch, a quarterback after a change of possession, a kicker in the act of kicking, and others who cannot protect themselves. Indicators that help officials identify targeting include launching upward, leading with the helmet, or hitting above the shoulders. At the college level, targeting can lead to ejection after review. At the high school level, similar acts are illegal and often draw disqualification. The message is simple: do not hit the head or neck, and do not use your head as a weapon.

Using the crown of the helmet and spearing

Spearing is using the top of the helmet to make forcible contact. This is dangerous for both players. For the tackler, it can cause neck injuries. For the ballcarrier, it can concentrate force on the head. Rules punish this behavior with personal fouls and potential disqualification. Officials watch for lowering the head, a crouch followed by an upward thrust, and no attempt to wrap up with arms.

Roughing the passer, kicker, and long snapper

Quarterbacks, kickers, punters, and long snappers are especially vulnerable. They often focus on the ball and cannot defend themselves. Roughing and running-into penalties protect them from late hits, low hits, and hits to the head or neck area. These rules are not about going easy on defense. They are about removing dangerous contact that can lead to concussions and knee injuries. When these fouls are called early, players adjust and the game gets safer.

Blindside blocks and crackback blocks

Blindside blocks involve sudden forceful contact against an opponent who does not see it coming. At many levels, these blocks are illegal if delivered with force, especially to the head or neck area. Legal blocks must use hands or open arms and avoid the head. Officials watch counter-flow plays, reverses, and returns, where blindside contact is common. Enforcing these rules reduces the scariest hits on the field.

Kickoff changes, wedge bans, and fair catches

Kickoffs used to be the most dangerous plays. Many rule changes have made them safer. These include banning wedge blocks, moving the kickoff spot, touchback incentives, and fair catch rules that bring the ball out to reduce returns. Officials enforce these changes and watch for illegal blocks on high-speed returns. By keeping kickoffs cleaner, refs help avoid big collisions that lead to concussions.

Helmet and equipment rules

Helmets must fit correctly and be secured. If a helmet comes off during a play, most rule sets require the player to leave for at least one play. This encourages proper fitting and discourages dangerous habits like loose chin straps. Mouthguards help with dental safety and might help reduce some force transmission, but they do not prevent concussions. Officials should check for required equipment in warmups and address issues early.

On-Field Mechanics to Spot Trouble

What to look for during live play

Officials should track the point of attack and scan the periphery for head contact. Look for a launch, a lowered head, and helmet-to-helmet hits. See if the head snaps back or to the side. Note whether a player remains on the ground, rolls slowly, or is holding the helmet or face mask. Watch special teams closely. These clues tell you who might need attention before the next snap.

After the hit: body language checks

Right after a big collision, look at the players involved. Is anyone glassy-eyed? Do they wobble or stumble? Do they look around in confusion or line up in the wrong spot? Do they complain of light sensitivity or say they “feel weird”? These observations are often enough for the official to stop play and call for evaluation. Small cues save time and prevent a second play that could cause a second hit.

Crew positioning and angles

A well-positioned crew sees head contact clearly. The referee should keep a wide angle on the quarterback, including late contact. The umpire sees interior line play where helmets clash often. The wings have the best angle on receivers and crackback action. The deep officials see defenseless receivers and plays on the ball. Communication among the crew, including quick eye contact and short phrases like “head, head” or “check 14,” helps them respond fast.

Replay and booth support

In the NFL and many college games, medical spotters and independent consultants watch video feeds. They can call a medical timeout if they see a player stumble, appear dazed, or take a dangerous hit. When that happens, the referee stops play, and the player must leave for evaluation. This extra layer helps catch issues the on-field crew might miss in real time.

Managing tempo to prevent the next snap

Offenses often go fast to keep the defense off balance. When safety is in question, tempo must stop. Officials should use the whistle, step in front of the ball, and signal the injury timeout decisively. If a player looks unstable, get between the center and the ball and do not allow a quick snap. Safety comes before pace.

Game Management: Setting the Tone

Pre-game briefings and expectations

Before kickoff, the referee meets with both head coaches and sometimes team captains. This is the time to stress player safety. Officials can say that targeting, spearing, blindside blocks, and hits to defenseless players will be called strictly. They can remind coaches to remove any player suspected of a concussion and that the officials will stop play if needed. Clear expectations help avoid arguments later.

Early flags and clear standards

The first personal foul sets the tone. If a player lowers his head and leads with the crown, flag it. If a receiver is hit high while defenseless, flag it. Do not warn on obvious safety fouls; act. Players learn quickly what will and will not be allowed. Early, firm, and consistent enforcement reduces dangerous plays the rest of the game.

Talking to players about safe technique

Officials can help without coaching. Simple reminders such as “Keep your head up” or “Wrap up, do not launch” can influence behavior. When you see a near miss, a quiet word to the player or position group can prevent the next foul. You are not teaching schemes; you are reminding them how to play within the rules.

De-escalating chippy games

Some games get heated. Emotions rise, and players try to deliver extra shots. This is when concussions happen off the ball. Officials should tighten their coverage, penalize late hits, and separate players quickly. The crew can communicate with coaches to calm their teams. A safe, controlled game helps everyone.

The Concussion Protocol in Practice

When to remove a player

Remove a player if there is any sign of concussion. This includes a hard hit followed by slow movement, confusion, balance problems, or a blank look. If the booth or medical observer calls it, follow through without delay. The standard is not certainty; it is suspicion. Err on the side of caution.

Sideline evaluation basics

Once off the field, a licensed provider evaluates the player. They ask about symptoms and may perform simple tests for memory, balance, and eye movement. On the field, the evaluation is focused and quick. If there is any doubt, the player does not return that day. Officials do not run these tests, but they should make sure the player reaches medical staff and stays out until cleared.

Return-to-play: who decides?

Only medical professionals decide if a player returns. At youth and high school levels, many states require written clearance from a licensed provider trained in concussion management. In college and pro football, independent medical staff often participate. Officials should not allow a player to sneak back in without clear approval from the sideline medical team. If a coach tries to rush a player in, the referee should hold the snap and ask for confirmation.

Documentation and post-game review

Officials should note in their game report if a player was removed for suspected concussion, if a medical timeout was called, and any related fouls. After the game, the crew can review video to improve future decisions and share feedback with assigners or safety committees. The goal is constant improvement.

Special Considerations by Level

Youth and middle school football

Young players need extra protection. Teaching heads-up tackling and correct contact rules is crucial. Officials should be very strict about blows to the head and any use of the crown of the helmet. If a young player looks even slightly off after a hit, stop play and remove them. Many youth leagues require parents to receive information about concussions, and refs should support those policies with clear actions on the field.

High school (NFHS) focus

High school rules emphasize removing a player with possible concussion and not allowing return without medical clearance. Targeting, blindside blocks, and spearing are illegal and may bring ejection. Communication with athletic trainers is key, but in some games the medical staff may be limited. In those cases, the referee must be extra careful and willing to stop play. State laws usually require education for coaches and players, and refs should be familiar with local policies.

College (NCAA) specifics

The NCAA has targeting with replay review and ejection. There may be a medical observer who can stop play. Independent medical personnel often help with evaluations. Officials should use the indicators of targeting and work closely with replay to get it right. Consistency matters across games and conferences, so following the defined indicators and philosophy is important.

NFL and professional leagues

The NFL uses unaffiliated neurotrauma consultants and certified athletic trainer spotters. They can trigger a medical timeout if they see signs of concussion. There are strict rules for roughing the passer and hits to defenseless players. Officials should be decisive in calling fouls that threaten the head or neck. Clear communication with the booth and medical staff keeps the process smooth and protects players at the highest level.

Practical Checklists for Refs

A quick removal script

When you suspect a concussion, be calm and clear. Approach the player and say, “You took a hit. We are stopping play. You need a sideline check.” Turn to the coach and say, “Number 7 is out for head evaluation.” Look for the trainer or physician and point the player their way. Then hold the snap until the player is safely off the field. This simple script avoids arguments and gets the job done.

What to record

Officials should note the quarter and time, jersey number, basic reason for removal (for example, slow to rise after head contact), and whether medical staff took over. If a medical or booth timeout occurred, record that. If a foul was connected to the play, note the penalty and the rule. This helps league administrators, schools, and assigners follow up if needed.

Common mistakes to avoid

Do not let the next play start while a possibly concussed player is still in the huddle. Do not argue medical decisions. Do not try to diagnose. Do not allow a player to re-enter without clear medical clearance. Do not downplay a dangerous hit to “keep the game flowing.” Safety beats speed every time.

Working With Equipment and Technique

Helmets and proper fit

Before the game, officials should look for obvious equipment issues. Helmets should be secure, with chin straps fastened and mouthguards in place when the ball is snapped. If a player repeatedly loses a helmet, the official should send them out to fix the fit. A well-fitted helmet cannot stop all concussions, but it prevents many other injuries and reduces some forces.

Heads-up football and tackling

Coaches teach tackling with eyes up, chest up, and arms wrapping, not spearing. Officials can reinforce this with language during the game. Praise clean hits, especially when a defender turns the shoulder and avoids the head. Penalize dangerous technique. Over time, these consistent signals shape how teams play and practice.

Weather and field conditions

Wet grass, mud, or very hard turf can increase the risk of falls and head contact with the ground. Officials should be aware of field conditions and adjust their vigilance. On slick days, be extra quick to stop play for a player who goes down hard and looks unsteady. Safety checks are even more important in bad conditions.

Frequently Asked Questions

Does every big hit mean a concussion?

No. Many big hits do not cause a concussion, and some concussions come from hits that do not look dramatic. Officials focus on the player’s response, not just the size of the collision. Signs like confusion, slow movement, or loss of balance matter more than crowd reaction.

Can players hide symptoms?

Yes, sometimes players try to tough it out. That is why officials look for objective signs, like wobbling, a blank stare, or lining up in the wrong spot. The rules favor safety. If the crew suspects a concussion, the player must leave for evaluation, even if the player insists they feel fine.

Why are some hits illegal even if the ballcarrier seems okay?

Because the rule targets dangerous actions, not only the outcome. Leading with the crown of the helmet, targeting the head of a defenseless player, and blindside forceful blocks are illegal because they are likely to cause injury. Removing those actions reduces risk for everyone on the field.

Do flags really change behavior?

Yes. Players and coaches adjust quickly when they know what will be enforced. Early, consistent flags for dangerous contact lower the number of risky plays throughout the game. Over a season, this changes habits and reduces injuries.

What if there is no medical staff on site?

At some youth or small-school games, medical support may be limited. The official’s job is still to remove the player and not allow return if concussion is suspected. The league or school should have a plan for parents and medical follow-up. Safety decisions should not depend on the scoreboard or the size of the event.

Case Studies and Scenarios

Big hit on a quarterback

The quarterback throws and is hit high by a defender who launches upward and makes contact to the head. The referee throws a flag for roughing the passer or targeting, depending on the level and indicators. The quarterback gets up slowly, wobbles, and looks confused. The referee stops play for an injury timeout and sends the quarterback to the sideline, notifying the coach. If replay or a medical spotter is available, they may also confirm the removal. The game restarts only when the player is safely off, and another quarterback or replacement is ready.

High-speed collision on a kickoff

On a kickoff return, a trailing blocker delivers a blindside block with shoulder and forearm to the head of an opponent who did not see it coming. A deep wing official flags the foul and the return is brought back with a personal foul penalty. The struck player stays down briefly and then stumbles. The nearest official calls an injury timeout, gestures for medical help, and escorts the player to the sideline. The crew reminds both benches that blindside and head contact will draw flags. The next return is cleaner because the standard is clear.

Player staggering between plays

After a running play, a linebacker gets up and staggers, then leans on a teammate. The umpire sees this and immediately steps in to stop the snap. He calls to the wing, who informs the coach. The player is removed for evaluation. There is no penalty because the hit itself was legal, but the safety steps are the same. The crew writes down the jersey number and the time for their report. This is a textbook example of how to protect a player even when no foul occurs.

Data and Perspective: What the Numbers Suggest

How common are concussions in football?

Rates vary by age and level. High school football reports several concussions per ten thousand athlete-exposures. College and pro rates can be similar or higher, depending on definitions and reporting. The important point is that most athletes never have a concussion in a season, but the risk is meaningful and preventable. Better officiating, safer technique, and strong medical protocols can reduce both the number and severity of injuries.

Do rule changes help?

Yes. Studies in recent years show that stricter rules on targeting, blindside blocks, and kickoff formation reduce dangerous hits. Educational programs and rule enforcement work together. When refs call fouls early and consistently, teams adapt. Over time, the culture shifts toward safer play without removing the excitement of the sport.

How Referees Can Keep Players Safe: Best Practices

Adopt a “safety-first” mindset

Before the game starts, decide that safety is your top priority. This makes split-second choices easier. If you are unsure whether to stop play for a player who looks off, stop play. If you are unsure whether contact rose to the level of targeting, gather information, talk to your crew, and use replay if available. Do not guess lightly, but do not hesitate when safety is at stake.

Use consistent language and signals

Consistency helps coaches accept decisions. Use the same phrases for similar situations. Signal injury timeout clearly. When penalizing a dangerous hit, take a breath and make your explanation calm and factual: “Forcible contact to the head of a defenseless player. 15 yards.” Avoid debating intent. Focus on the action and the rule.

Leverage the whole crew

All seven officials on a typical crew share responsibility. The deep officials watch receivers. The wings watch the edges and blocks in space. The umpire watches line play. The referee watches the quarterback. Share what you see. If one official suspects a concussion, the crew should support that decision. It is better to remove one healthy player than to keep an injured one on the field.

Partner with medical staff

Medical teams are allies. Before the game, locate the athletic trainer or physician. Decide how you will signal them during play. If you have a medical observer or spotter, confirm the communication channel. During the game, trust their decisions. If they say a player is out, the player is out. This partnership is one of the strongest tools for safety.

Coaches, Parents, and Players: Shared Responsibility

Coaches teaching and reinforcing safe play

Coaches set the culture. When they punish players for leading with the crown, when they reward wrap-up tackles and safe blocks, the team follows. Refs see the result on game day. A team that practices safe technique will commit fewer dangerous fouls and will have fewer injuries.

Parents and players speaking up

Players know when they feel off. Parents know their athletes best. If a player reports a headache, dizziness, or confusion, they should be honest with the coach and trainer. Referees cannot hear what happens at home, but they can support honesty on the field by acting quickly when they see signs of trouble. The whole community needs to value brain health.

Training and Preparation for Officials

Safety education

Many leagues require officials to complete concussion awareness training. These short courses explain symptoms, red flags, and removal policies. Officials should refresh this training every season. They should also review the latest points of emphasis from their governing body about targeting, blindside blocks, and defenseless players. Preparation off the field leads to better calls on the field.

Pregame crew meeting

Before kickoff, the crew should discuss who is watching what, how to handle injury timeouts, and how to communicate suspected concussion. Agree on short phrases and eye contact signals. Review the plan for coach interactions and for replay involvement. The more you decide ahead of time, the calmer you will be when a tough moment arrives.

Balancing Safety and the Flow of the Game

Protecting players without over-officiating

Fans sometimes worry that too many flags slow the game down. The best crews strike a balance. They let normal, legal contact happen, but they draw bright lines around the head and neck. They communicate expectations so players can adjust. Once the standard is clear, the number of fouls often drops, and the game flows better than before.

Handling controversy

Not every call will be popular. When a big play is wiped out for a safety foul, coaches and fans may be upset. The referee should be steady and explain the rule briefly. If replay confirms the decision, announce it clearly. Remember that safety calls are about the long-term health of athletes. That is a strong reason to stand by the call.

Conclusion

Putting it all together

Concussions are a real risk in football, but the sport has powerful tools to reduce that risk. Understanding what a concussion is, recognizing symptoms, and removing players quickly are essential steps. Rules against targeting, spearing, blindside blocks, and dangerous hits to defenseless players exist to protect the head and neck. Equipment checks and technique matter too. In the center of all this is the referee crew. Refs cannot diagnose, but they can enforce the rules, stop play, and connect players with medical care. They can set the tone from the first whistle and keep it all game long. When officials, coaches, medical staff, players, and parents work together, football stays fast, physical, and much safer. That is how the game should be played, and that is how we protect the athletes who make it great.