Chances are you've seen, either on television or from the stands, that blue tent suddenly pop up on the sidelines of an NFL stadium. Make a fire, get some marshmallows and you could have yourself a cozy, little campsite in the area behind either team's bench.
Of course, the tent -- if it is used -- doesn't stay up for long, maybe about five minutes or so, because it's large enough to obstruct the view of fans sitting in the low seats.
But even in that relatively short time, it serves what the league's medical experts believe is an important role in the diagnosis of concussions.
Credit renowned University of Alabama head athletic trainer Jeff Allen for coming up with the concept of the medical tent in 2015.
Credit Buffalo Bills head athletic trainer Shone Gipson for being a driving force in its arrival this season to the NFL.
"The key for me was the privacy," Gipson said.
In his 13 years on the Bills' training staff, it never quite made sense to Gipson that those critical examinations of a player who sustained head trauma or any other injury needing the attention of a physician or trainer were so out in the open. Once the injured player is sitting on the bench, he becomes a patient, no different than you or I sitting on the examining table in a doctor's office.
The big difference with the office visit is there aren't 70,000-plus people on hand to watch every step of the process, not to mention countless others in front of their televisions. There also aren't teammates sitting on the same bench and more players, coaches, security and other team and game officials standing around us. Nor are there still cameras pointed at us from all directions, sometimes with flashes.
"We actually had a situation once where we had a guy who had a concussion, and we've got all these flashes, everything else going off," Gipson recalled. "And I was like, 'You know what? It would be nice if we had a smaller area.'"
That was what prompted him to get on a plane during the spring of 2015 and fly to Tuscaloosa, Ala., to find out more about the "SidelinER" tent Allen created and manufactured through a company he formed with students and faculty at Alabama's School of Engineering, called Kinematic Sports.
Allen was inspired to find a way to treat players in a more private setting after having an experience similar to Gipson's during the Crimson Tide's 2013 BCS national championship victory against Notre Dame. The player Allen was examining became so nervous from having such an overwhelming number of people and cameras around him that he needed to be taken to the locker room.
After nearly two years of development and seeking approvals from the Southeastern Conference and other non-conference opponents that played in stadiums with narrower space around the field, the "SidelinER" made its way onto Alabama's sideline.
During his two-day visit to Tuscaloosa, Gipson discovered that the tent wasn't used only for football, but also for several other sports, including gymnastics and tennis. Gipson saw for himself how quickly one person could pop it up, about 10 seconds, and the ease with which it expanded and contracted like an accordion. He also couldn't get over how spacious the covering was with a 6-foot ceiling and enough room for an examining table, and three or four people.
Made from a synthetic fabric, it withstands moisture and lets in enough light so medical professionals can see what they're doing after the opening is zipped shut. Including the metal frame that connects to the examining table, it weighs 70 pounds, heavy enough to be sturdy in the elements but light enough for easy transport.
Gipson was sold. The Bills gave him the OK to buy one, which they used in the summer of 2015 at training camp. It came in particularly handy with practice fields at St. John Fisher College so spread out.
That same year, Gipson tried convincing the NFL to grant permission for all teams to use medical tents. It turned him down, saying more research was needed. He tried again in 2016, and again the league said no, citing the need for more study.
Finally, last spring, Dr. Allen Sills, the NFL's chief medical officer, set up a conference call to discuss the merits of using medical tents in games. Two of the call's participants were Gipson and Scott Trulock, head athletic trainer of the Jacksonville Jaguars. The Jaguars had used a "SidelinER" during the 2016 Senior Bowl in Mobile, Ala.
"I just told Dr. Sills I see the benefit of having the player relax and being able to get a good exam with him," Gipson said.
In May, Commissioner Roger Goodell announced that medical tents would be used by all 32 clubs this year, pushing the number of high school, college and pro football teams using them to more than 70. Each NFL team had to purchase three -- one for itself, one for the opponent and a backup. The frame is designed so that extra weight can be added to the base to cope with strong winds like the ones that commonly swirl through New Era Field.
During an examination, only essential medical personnel are permitted inside the tent. Clubs aren't allowed to alter the shape, dimensions or design of the tent, nor are they permitted to heat or cool it. That's for competitive reasons, because the NFL doesn't want players using the enclosure to warm up or cool down. In addition, using the tent for anything other than a medical exam is strictly prohibited and violations are considered "conduct detrimental."
The NFL requires that all sideline concussion evaluations be made in the tent. Other injuries can be triaged in it as well, but the primary use is for physicians, one from the team and an unaffiliated neurotrauma consultant, to handle concussion diagnosis.
"The key thing that we were really worried about initially (with concussion examinations) was the noise," Gipson said. "You try to get them into a small, quiet environment. And it is quieter in that tent, which allows you to give more personal attention, to actually be able to say, 'How are you doing? What did you feel? Talk to the doctor about exactly what you felt? Did you take a knee to the head?'
"It's tougher to do that in front of 70,000 people who are screaming and you have a lot of cameras going off and everything."
In the tent, a player is given a Maddock's test, five standard questions to determine his orientation. If he struggles with any, he is taken into the locker room for a more thorough screening. The questions are:
- Where are we?
- What quarter is it right now?
- Who scored last?
- Who did we play in the last game?
- Did we win the last game?
“The medical tent is not meant to replace the locker room evaluation, but rather to provide a more private and structured place to do examinations of a variety of injuries that are currently done on the sidelines,” Dr. Sills is quoted as saying on the NFL's playsmartplaysafe.com site. “We will ask that all sideline concussion exams be done in the tent, but if the initial screening suggests a concussion, then the more extensive concussion evaluation will be done in the locker room just as we have previously done.”