NFL Lessons on Occupational Medicine: Law of Unintended Consequences

New doctors take an oath to “Do no harm.”  In safety and occupational medicine, the challenge is to not implement new rules that wind up creating new and potentially worse problems.  We’ve seen time and time again that the Law of Unintended Consequences can be unforgiving.

Now a new study by professors at Marquette University looks at how a change the NFL made to protect players may have caused a number of unexpected injuries.   The study, titled Safety Regulation in Professional Football: Empirical Evidence of Intended and Unintended Consequences, looks at the NFL’s effort to reduce head and neck injuries.

In 2013, the NFL implemented what is called the “Crown of The Helmet Rule,” penalizing players who hit an opposing player with the top of their helmets.  The obvious purpose was to protect both players from head or neck injuries…an especially important consideration since more than 4,000 former players have signed on to lawsuits over concussions.   Here’s a classic clip of Earl Campbell using his head as a battering ram while playing for the Houston Oilers:

Now a new study indicates that, while the new rule may have had an impact on head and neck injuries, it came with a cost – increases in leg and ankle injuries.   The Marquette U. study found that “concussion reports among defensive players rose by as much as 32 percent (34 percent for all head and neck injuries), but also evidence of an increase in weekly lower extremity injury reports for offensive players by as much as 34%.”

As it turns out, a decrease of 32% in concussions and a 34% increase in lower body injuries is not a simple trade off of a really bad injury for a less serious one.  First, there are more lower body injuries to start with, so the total increase is a net gain.  Second, some would argue that leg and ankle injuries may manifest as disabling conditions, like arthritis, later in life, long after the player has hung up his cleats.  Third, the numbers are hard to compare because every concussion gets treated, so it is hard to tell how they compare year-to-year.

A similar study of college football also found an increase in leg injuries, but no decrease in concussions after the rule change went in at the college level.

The safety field has its own examples of the Law of Unintended Consequences.   About four years ago, OSHA cited oilfield companies if their workers didn’t have on flame resistant clothing (FRCs), regardless of the actual potential for flash fires and explosions to that worker.  It happened during a fierce heat wave and by the end of the summer the industry had many more cases of heat-related illness and even fatalities than it had flash fires.

In another example, the oil pollution rules that came after the EXXON Valdez spill required all barges to have spill rails to keep spilled oil from getting into rivers.   Unfortunately, it turned out that those rails were perfect for trapping water and, when the water froze, barge walkways because as slick as ice rinks, putting deckhands in danger every time they went onto the barge.

This is why a strong management of change process is so important in safety and why a part of that process needs to look at whether reducing hazards in one part of an operation may raise them or create new hazards in other areas.

Of course you could also say that you need to keep you head up, whether you are playing football or managing safety and occupational health.

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