Boise State Football

BSU star’s hit is a reminder: Concussions are ‘unlike any other injury that we have’

Marc Paul says he would be concerned, too, if all he saw was the snippets on ESPN of his staff’s evaluation of Boise State junior running back Alexander Mattison on Saturday night during the Mountain West championship game.

Mattison stumbled while getting up after a helmet-to-helmet hit late in the fourth quarter at Albertsons Stadium. Cameras spotted him trying to elude the training staff on the sideline and check back into the game before he was told to get back to the sideline.

Mattison then returned to carry the ball on the first four plays of overtime.

What viewers didn’t see, Paul said, was a thorough examination in the team’s medical tent during the lengthy timeout between the end of regulation and the start of overtime. Paul, Boise State’s associate athletic director for sports performance, health and wellness, conducted the exam.

“Everything was clean,” Paul said Sunday in a phone interview with the Idaho Statesman. “I’m looking at him going, ‘There’s nothing here.’

“We know the repercussions. I know what’s going to happen when this kid goes on the field (in terms of viewer reaction). But I had zero to go off of as far as keeping him out of the game.”

Paul spoke to the Idaho Statesman after TV viewers questioned whether Mattison should have been allowed to return to the field. The Statesman asked Boise State football coach Bryan Harsin about the incident Saturday night after the game and during a press conference Sunday, but he hadn’t seen the ESPN clips. He was shown the video after the press conference.

Harsin said he has told the training staff to withhold players if there’s any gray area — that he doesn’t want to be involved in an incident like the much-publicized injury to Michigan quarterback Shane Morris in 2014. Morris nearly collapsed after a hit to the head but returned to the game.

Boise State’s policies and procedures are among the best in the country, Harsin said, and he trusts the trainers to make the right calls.

“It doesn’t matter what the game is,” Harsin said. “... If somebody can’t play, they can’t play. I never got that (Saturday) night, that he couldn’t go. I trust what our process is.”

[Read Boise State’s concussion management plan here]

Alan Shahtaji, the director of the Sports Concussion Clinic at UC San Diego Health in California, said plays like Mattison’s are the most difficult to judge. He works with the U.S. Women’s National Team, where he gets 3 minutes during a soccer game to decide whether a player must be removed for further evaluation — similar to what Paul faced on Saturday night.

Shahtaji said the video he’s seen of Mattison’s response to the helmet-to-helmet hit was “suggestive of a head injury” but that it’s difficult to make a judgment without being on the scene.

“The hardest things are when there’s a big hit and there’s this questionable event right afterward,” Shahtaji said in a phone interview. “They stand up and don’t look exactly right and then by the time they get to you they look perfectly fine and they pass all the tests and exams. What do you do in that situation? ... If you believe they took a few steps dazed and wobbly because they had a brain injury, then they’re done.”

Paul saw Mattison’s uncertain steps live from the sideline but doesn’t have access to replays during the game. Air Force has a replay system on its sideline that Boise State checked out during the October game there, and Paul would like to have one. He thought Mattison’s stumble might have been explained by his attempt to stand while surrounded by others, he said.

The lack of video made Paul’s decision more difficult, Shahtaji said.

“In person, you can miss a ton of stuff,” Shahtaji said. “... We do it for first downs. We should be able to do that for somebody’s brain. Then you see what everybody else is seeing.”

Boise State uses its gymnastics trainer as a medical observer during home football games, serving both teams. It’s a voluntary program that Paul hopes will become a requirement for college football teams. For Saturday’s game, Fresno State brought its own observer, Paul said.

The observer can tell game officials that a player needs to be removed for evaluation. That happened earlier in Saturday’s game with Boise State wide receiver A.J. Richardson, who was cleared to return. The evaluations are done by Boise State’s training and medical staffs while the observer continues to watch the game for other incidents.

“I tell every parent ... there are two injuries I’m never going to screw around with,” Paul said. “I’ll fight with any coach in any sport. That’s head and neck injuries. You only get one brain and one spinal cord.”

The Mattison situation began with a helmet-to-helmet hit and hard landing on the turf with 51 seconds remaining in the Mountain West title game, with the score tied 13-13. Mattison was on his way to 40 carries and 200 yards in the 19-16 loss.

Mattison appeared to wobble as he stood up with the two trainers who ran onto the field. He left the game and was shown by ESPN on the sideline meeting with two staff members. Later in the drive, he headed toward the field to try to return to the game. Two Boise State staff members followed him, and Mattison made a dismissive gesture with his left arm to fend off one of them. He tried to go back on the field for the last play of regulation but was called back.

“He was trying like hell to bypass everybody,” Paul said. “... That’s just a competitive kid trying to get back in the game.”

When regulation ended, Paul was able to get Mattison to the team’s pop-up medical tent in the bench area and calm him down for the exam, which includes neurological checks, memory quizzes and tests for injuries in the head, neck and shoulders area. Questions can include specifics about assignments, what happened on certain plays, who scored last and what happened in last week’s game. Athletes also are asked about symptoms such as headaches or nausea. Some tests are designed to evaluate balance.

The consensus program for concussion evaluation is the SCAT5, Shahtaji said. That full test takes at least 10 minutes.

In-game assessments sometimes are done more quickly, as Shahtaji does with soccer.

“We don’t put a timeline on it,” Paul said. “If there’s symptoms present, it just takes as long as it takes.”

He isn’t sure how long he was in the tent with Mattison, but it was long enough to convince him the Broncos’ running back could return to the game. Paul and his staff notified the coaches that Mattison was cleared.

Paul continued to monitor Mattison after the exam in the tent. He stood with players on the sideline who could tell him Mattison’s assignments so he could look for signs of mental errors, he said. He followed up with Mattison after the game and on Sunday.

That’s important, Shahtaji said, because concussions can reveal themselves later. There also isn’t an objective test for them yet. UC San Diego Health is testing a potential saliva-based test.

“It’s unlike any other injury that we have,” Shahtaji said.

The medical and athletic communities have improved their understanding of concussions and approaches to them, Shahtaji said. But there are some challenging gray areas.

“Yes, you want to protect the athlete and their brain,” he said, “and at the same time, this is a big (game) and you don’t want to hold someone out unnecessarily. They work their whole season — and sometimes their whole lives — to get to that point.”