‘Eye in the Sky' trainers monitor NFL players from high above action

Four Sundays a year, Kent Biggerstaff arrives at his booth in the south end of the Heinz Field press box and anonymously does a job that could change lives.

As a certified athletic trainer for more than 40 years, 17 of which were spent as the Pirates head trainer, he is used to being on the field with the players, but here, as the NFL's "Eye in the Sky," the league counts on him to provide a greater perspective.

Because down there on that field, even with two teams' physicians and game referees working, injuries can go undetected. Down there, a player may take a hit to the head and know something isn't right but keep on going because that's his instinct. Down there, a head coach may be too distracted calling the next play in pursuit of victory to know when one of his 11 needs medical attention.

Biggerstaff has served in this role since 2011, when the league started using certified athletic trainers _ paid by the NFL and not the teams _ to work via headset with team physicians to identify injuries and quickly send video clips of how they occur. He and the athletic trainers in this role around the league were a key part of the NFL's effort to promote better safety, but there were limits to what he could do to actually save a player from himself _ a player like, say, Patriots wide receiver Julian Edelman.

In the fourth quarter of last year's Super Bowl, Edelman absorbed a vicious helmet-to-helmet hit from Seahawks safety Kam Chancellor. He seemed wobbly, but no penalty was called, and Edelman stayed in the game with the Patriots trailing by 10 and trying to execute a two-minute drill. Later in the drive, Edelman caught another pass and, after being tackled, crawled for several seconds. The Patriots won, with Edelman one of their heroes, but the scenario amounted to the NFL's worst nightmare.

"There were a handful of times last year where we identified players who we thought could or should have been evaluated by the team medical staff," said Jeff Miller, the NFL's senior vice president of health and safety policy, "but because of the nature of the game, no timeouts or no time for the huddle, etc., that player stayed in the game. The Edelman situation was one of those. There was no mechanism to stop the game."

So, this season, if there is a chance a player has a head injury and it is missed by team physicians, referees and others, Biggerstaff can call for a "medical timeout" from the booth and remove the player for at least a play.

"We're the fail-safe," said Biggerstaff, who splits the Steelers home games with University of Pittsburgh assistant athletic trainer Tim Dunlavey. "It's not trying to disrupt any momentum or rhythm of the game."

For decades, head injuries went largely unreported or unnoticed. A player's ability to persevere through the violence of football was considered a matter of toughness. But scientific research slowly began to catch up to the myth making, and with better understanding came the awareness that players' brains were being exposed to repeated trauma. More than 5,000 former players came together for a class-action suit against the league for not warning them of the dangers of brain injury, and a settlement was reached in April.

The last five years have seen the NFL scramble to fight the perception that it does not properly care for its work force, and this year's addition of the medical timeout is the latest move in that direction.

The Eye in the Sky's ability to call a medical timeout is getting attention because it's new, but the eyes on the sidelines still have the most control over player safety. Steelers physicians Tony Yates (internal medicine), Joe Maroon (neurosurgery) and Jim Bradley (orthopedic surgery) are the ones who decide the severity of an injury and whether a player can return to the game, often in the span of a few minutes.

In the fourth quarter of last year's playoff loss to the Ravens, both quarterback Ben Roethlisberger and tight end Heath Miller took hits to the head and were removed from the game, only to come back minutes later with the Steelers trying to mount a comeback.

"I just reflect that I still did the right thing, and you move on," Yates said in an exclusive interview the Post-Gazette was granted with the Steelers medical staff on Sunday.

Yates, who has been with the Steelers since the 1980s, referred to an "HD fishbowl" that he and the doctors now have to work within.

"We can be second-guessed all the time," Yates said, "and it's tough (because) we can't go on the record and say, 'No, this wasn't the case.' We're still HIPAA bound, we're still physicians and professionals." HIPAA refers to the Health Insurance Portability and Accountability Act that prohibits the release of private medical information.

"It's very difficult. The clock is ticking, the coaches need to know if the player is going to come back, do they need to get a substitution in that position. ... But I can say that, throughout the years, our coaches have been great. They understand, and we understand the emotional part of the game."

Yates, Maroon and Bradley have gotten to see the evolution of the NFL's attitude toward concussions up close. Around 1990, Maroon remembers telling legendary coach Chuck Noll that his starting quarterback, Bubby Brister, shouldn't play the next week because Maroon felt the player had sustained a concussion. He advised Noll that Brister should sit at least two weeks.

"He said, 'What data do you have? What is the basis for that? If you want me to keep somebody out of football, I want objective data, not specious guidelines or your opinion,' " Maroon recalled.

Maroon felt Noll was right, and in response, he began developing a concussion test that would give the doctors a baseline for each player. That way, when a player needed to be evaluated, they could compare his results post-trauma to his results when lucid _ a practice that is now the foundation of determining whether a player has had a concussion or not. (The only difference is that now, Maroon performs the test with an iPad that contains detailed information on every player.)

"Initially," Maroon says, "athletes and their agents didn't want them doing this, but we convinced them that they could get back sooner if they did the test with us."

Says Yates, "So you can understand the walls upon which we strike our head, no pun intended."

As the concussion issue became more prevalent in the public eye, team doctors began to be heard more easily. Yates, who served as president of the NFL Physicians Society, got to sit on the NFL's competition committee. He believes good developments have happened with the help of about 40 rule changes geared toward lessening impacts to the head, and the numbers back him up.

The NFL states that, since 2012, concussions in regular season games are down 35 percent, and helmet-to-helmet hits are down 43 percent.

"We're witnessing a culture change," Miller of the NFL said. "None of that is saying that this is the end of the road."

On a recent Sunday, Maroon visited Biggerstaff in the booth, where he's surrounded by four screens and an assistant who performs all of the video duties so he can focus on the live action.

Before heading down to the field, Maroon smiled and said to Biggerstaff, "I hope I don't hear from you today."