Head injuries are the number one safety concern in the National Football League (NFL) and have been for years. According to a report by the Analysis Research and Planning Corporation, an actuarial firm that was commissioned by the players, and reported by Forbes magazine in 2014, about 14% of all former players will be diagnosed with head trauma-related Alzheimer's disease; and another 14% will develop moderate dementia. Former NFL players stand about twice the risk as the general population to suffer from early-onset Alzheimer's, ALS, Parkinson's or dementia.

The number of concussions in 2023 was 219, including those suffered in preseason and regular-season games and practices, according to an NFL report. That is an increase from 213 in 2022, but well below the high of 281 a few years ago.

Adding protection

A new technology that has been tested in NFL practices is the Guardian Cap, a helmet accessory. It is a soft, padded outer shell that goes on top of a player’s helmet. According to the Guardian website, the softer cover provides an additional barrier between the head and the point of contact, making it safer for players.

Teams have been wearing the Guardian in practices since 2020. The NFL mandated the caps for offensive and defensive linemen, tight ends and linebackers during contact practices in pre-season, regular season and playoff games in 2022. In 2023 the NFL expanded this contact practice mandate to include running backs, full backs, receivers and defensive backs. Going into the upcoming season, there are new helmets that provide as much if not more protection than the Guardian, according to a recent Philadelphia Inquirer article. But an extra layer of head protection will not be mandatory for any player during games. And it is widely expected very few players will wear the extra PPE. The attitude of many players was expressed in the Inquirer.

Player attitudes

“I think we look a little goofy,” said a Philadelphia Eagles tight end. He said using it in practice makes sense. “You only get one brain, so I might as well keep it as best you can. When I take it off (during pre-season and regular season games), I’ll be even faster.”

“I hope not (the extra PPE becoming gametime mandatory) because our swag will be ugly,” said another Eagles player.

Just what is swag? It’s slang for a fashionable and comfortable appearance, identity or way of behaving.

“It doesn't look the best,” said one Eagles player. “I feel like I’m a swag type of guy myself, so obviously it doesn’t look very good. My game is part of my swag. If I ain’t looking the part, I don’t feel the part. It has me looking very ugly out there with that big old cap on my head.”

Players quoted in the Inquirer article display a different attitude about using the extra PPE during contact drill practices. One of the Eagles’ players quoted above also said: “At first it was like, oh man, but shoot, whatever keeps us safe and helps us play the next day.”

“They are for our safety, so if they wear them (in contact practices) for safety that’s cool. I’m sure I’ll clown them.”

So far during this NFL pre-season, only a few players have worn the Guardian Cap during a televised game. Televised is a key word, a key factor, here. Wearing extra PPE that may look “goofy” or “ugly” during practices, away from the spotlight, is one thing. Wearing it during prime time, in games in front of 60,000+ fans live and millions more on TV is another. Almost all NFL players, to date, don’t want to be singled out and damage their self-identity and personal “brand” with that huge amount of exposure.

Substitute workplace machismo for swag and many health and safety managers can relate to the reasons why some workers, like NFL players, complain about and resist complying with personal protective equipment requirements. Attitude, behavior, risk-taking and personality are all involved. Almost all football players, almost all athletes in sport in general, are risk-takers.

Long ago, in a world far away…

My father wasn’t a risk-taker. When I was maybe 12 years old, every fall day after school anywhere from 10-20 of us would play sandlot, tackle football. What else was there to do? This was a long-ago world without cell phones, the Internet, social media, video games and a thousand streaming TV channels. Our parents wanted us out of the house after school, didn’t have a worry where we were, just be back by dinnertime. My dad, who played football and was a huge football fan, bought me a Green Bay Packers helmet, his favorite team, and ordered me to wear it during the sandlot games. Of course, I stuck out like an alien. No one wore a helmet or any other protection. Very reluctantly I dragged it to a few games. Maybe wore it once. Never again. Didn’t tell my dad and he didn’t ask.

Peer pressure and self-identity, on a sandlot, in a workplace, among blue collars and multi-million-dollar players, are parts of human nature that always challenge safety.

Postscript: There is more awareness and understanding about concussions today than ever before. Just to remind you, throughout a 12-year study period reported on by PBS’s Frontline and published in the Sports Health journal in 2010, a reportable concussion was defined as a traumatically induced alteration in brain function, which is manifested by:

• alteration of awareness or consciousness, including but not limited to being dinged, dazed, stunned, woozy, foggy, amnesic, or, less commonly, rendered unconsciousness; and
• signs and symptoms commonly associated with post-concussion syndrome, include persistent headaches, vertigo, light-headedness, loss of balance, unsteadiness, syncope, near syncope, cognitive dysfunction, memory disturbance, hearing loss, tinnitus, blurred vision, diplopia, visual loss, personality change, drowsiness, lethargy, fatigue, and inability to perform usual daily activities.