On October 10, 2024, NFL Chief Medical Officer Dr. Allen Sills led a discussion, live from London, about how the league, club and local medical personnel work together to prepare and plan for international games.
Over the past several years, the NFL has brought exciting matchups to our fans outside the U.S., with games hosted in London, Munich, Frankfurt, Mexico City, and this season, for our first game in the Southern Hemisphere in São Paulo, Brazil. The league's international presence will further expand in 2025, with the first NFL game in Madrid.
The panel brought together members of the world-class team who deliver best-in-class care to NFL players, for a conversation about the comprehensive undertaking to bring gameday player care, emergency preparedness and field preparation global, and what coordination with local medical personnel looks like in an international setting.
The full webinar is available to view below.
The following experts joined Dr. Sills for the event:
- Dr. Jim Ellis, Medical Director, Emergency Preparedness, NFL
- Nick Pappas, CSFM, Field Director, NFL
- Dr. Mike Patterson, Chief Medical Officer (Events, Venues & Emergency Care), The Football Association (England) and NFL Emergency Response Physician
- Dr. Robb Rehberg, Senior Medical Advisor and Director of Game Day Medical Operations, NFL
- Tyler Williams, Vice President of Player Health and Performance, Minnesota Vikings
Panelists shared the following takeaways during the conversation:
On comprehensive planning leading up to games and providing consistency for players:
Tyler Williams: "It starts four or five months prior to us leaving. Even though we're getting ready for training camps, we start with understanding what we need to bring over there. Our number one goal coming out of those meetings is how can we provide a home away from home for our players, in terms of the least disruptive change – of medical care, of sleeping combinations, of different types of the nutrition concerns that they'll have, and recovery resources."
Nick Pappas: "I'm always keen to talk to the [stadium] groundskeeper, field manager, whoever is managing the playing surface. We've got to make sure we can meet the needs of our field size. From there, we start to understand quality from a performance perspective, and that comes down to what is the existing product, what are the needs they're meeting from an athlete perspective? And then what are our opportunities to leverage either what's in the stadium or local resources to say, 'This is what we may need to put in a field that's NFL specific' or think about how we improve the existing field."
On converting and preparing international stadiums for NFL games:
Dr. Robb Rehberg: "It starts with making sure that we're working with local medical staffs in those countries. But it also involves our planning as well, making sure we have the same equipment on the sidelines that clubs expect on game day – making sure we have the same Injury Video Review Systems, medical tents, all the same things that they would expect so it is seamless. If you didn't know where you were, and you just magically showed up on gameday on the field, you wouldn't know that you were in a foreign country."
Nick Pappas: "We would love to get to a position in a place where, as we repeat in a new location, or visit a location or a market for a second or third or however many times it may be, we're getting to a point where we know exactly how to set the standard. We understand what the capacities are of the region, as far as it may be, weather, resources, personnel, materials, whatever that challenge may be obviously all different locations – and that overarching goal is to recreate the standard that our players are familiar with."
On emergency preparedness and consistency of emergency care at international games:
Dr. Jim Ellis: "In planning, we use the same emergencies that we're concerned about in domestic games, and say, 'How can we get those individuals taken care of?' If they have a cardiac emergency, a head injury emergency, a cervical spine injury emergency, some sort of trauma emergency to the chest or abdomen – taking all of those scenarios and identifying the correct people in those countries that can help us out with any of the issues that may come up."
Dr. Mike Patterson: "Emergency medical care, no matter where you are in the world, is actually pretty universally accepted in its concepts. It's quite simple. And I think that if you get that across, and then, having done that, don't pretend to these guys that they're in the U.S., actually talk about the elephants in the room. The things that feel foreign, different to them, reassure them that things will feel the same and it will be collaborative. If you do those things, and you have set out standard operating procedures that are the same in the U.K., America, Australia and Madrid – wherever you go, those concepts are consistent and universal. Stick to that common language, then people feel reassured."
On bringing the "Team Behind the Team" abroad:
Tyler Williams: "We bring all the same athletic trainers, physical therapists, training coaches… we do bring extra physicians, just because if a person gets sick just traveling overseas or has an orthopedic injury… and you have to leave some people back or send them over to the hospital, it's nice to have some extra sets of hands to problem solve those situations. So we bring a few extra physicians, a few extra specialty medical care providers."
Dr. Jim Ellis: "We always have to take a look at the situation with local rules… in England, the rule is, if you're traveling with your team as a team physician you don't need any [special credentials.] You can't prescribe, and you can't order tests. Munich was different. In Germany – both Frankfurt and Munich – our physicians did have to get temporary license to go in there. Sao Paulo required us to get temporary licenses. We have enough advanced notice where we can do that. It doesn't give them any greater privileges, but you always have to check with those countries to see what the requirement for a traveling team physician is so they're not outside of their scope and staying within the laws of that country."
Dr. Robb Rehberg: "We always have staffing redundancies. We always have people who are ready to go. We always have, in the case of our video review staff, we always have staff that are here from the NFL Football Technology Office that can fill in. We always have somebody who is also qualified as an Athletic Trainer Spotter who can assume that position. We also have backups who are ready, have been pre-identified, and can travel at a moment's notice, should somebody become ill and there's enough time to fly them wherever we need them. The same thing goes for the UNC (unaffiliated neurotrauma consultant). We'll have an extra UNC here and bring more than enough medical personnel to begin with. And even if there was something to happen with the people who are supposed to travel, we always have people who are identified and have cleared their schedule, just in case they're needed to travel in a moment's notice."
On working with local medical staff:
Dr. Mike Patterson: "For my team, and I think for any team that's used to doing their thing on their field of play with emergency care, it starts with deployment. The line of sight that you get in the field of play, the way you divide your team up is very different. The sideline is completely different. And the flow of the game is very different to any other sport... We talk about reading the game, situational awareness and crew resource management speak – that's very different. And so, you have to prepare people for that."
Dr. Robb Rehberg: "Sometime local providers don't understand the football equipment… We talk a little bit about, "Football 101" – this is what a helmet is, this is what shoulder pads are. If we have a catastrophic injury and we're going to remove equipment, this is how the equipment is removed. This is what an athletic trainer is… Getting the local healthcare providers to understand what medical staff that they can expect are coming with the club, understanding the sport, when they can enter the pitch, what they can expect that the club medical staffs are going to do versus our medical staffs and how we package a patient."
