HOUSTON -- In an impassioned and detailed breakdown of the events surrounding Houston Texans quarterback Tom Savage suffering a scary concussion and briefly going back into the game Sunday, head coach Bill O'Brien was emphatic Monday about one thing.
O'Brien said he never would have allowed Savage to resume playing if he had viewed the viral, disturbing video shown during the game broadcast of Savage lying on the ground in the end zone with his arms and hands twitching after absorbing a crushing blow from San Francisco 49ers outside linebacker Elvis Dumervil.
O'Brien extended that opinion of not placing Savage into potential danger to head athletic trainer Geoff Kaplan.
"At no point in time, is there anything more important to me than the safety of our players," O'Brien said. "I love our players and I care about them and I cannot stand when players get injured. With benefit of seeing the video that people are seeing, I would've never put him back in the game, but I don't see that.
"I'm not passing the buck. Anybody that's been on the sideline of a football game knows that, from a coaching standpoint, you really can't see things like that, especially when the ball's in certain areas of the field."
The NFL and NFL Players Association have launched a joint investigation into if the concussion protocol was handled correctly. There's no timetable for when the investigation would conclude.
During a conference call Monday, NFL spokesman Joe Lockhart said the league and the players' union will work together to "conduct a thorough review of the incident focused on whether the protocol was properly followed, but we're also continuing looking at the protocol to look for ways to improve and strengthen it."
The NFL concussion protocol and the league's response to head injuries are under major scrutiny again in the wake of Savage's injury.
The way the protocol works involves a team effort between spotters in the press box, independent neurologist consultants and team medical personnel.
Savage went to the sideline under the medical tent after the Dumervil hit, was quickly cleared and then went back in the game for one series. A trainer noticed something wasn't right with Savage, had him checked again and he was ruled out for the remainder of the game.
What can be done to upgrade the system to prevent future breakdowns like this one? Well, video isn't allowed on the sideline for coaches. Coaches just have access to tablets for electronic playbooks.
There has been injury video available on the sidelines for medical personnel, including team and those unaffiliated since January of 2012, according to the NFL.
Two certified athletic trainers are assigned to a stadium booth with access to multiple views of video and replay. They monitor the game and communicate with team medical staff by radio to make sure that a concussion evaluation is conducted on the sideline.
Both spotters file a report of all activity after each game for review by the NFL chief medical officer and NFLPA medical director.
"Obviously, this was more than a standard head injury evaluation," said Dr. Erin Manning, a neurologist for the Hospital for Special Surgery in New York. "What makes it hard for the physician is they're doing that evaluation on the sideline fairly quickly. You're doing it based on what the player is reporting and if you find anything. Sometimes, it's limited information, sometimes people don't start showing symptoms until long after they've had a head injury."
That was the case with Savage, whose symptoms didn't kick in until after the roughly five-minute period between when he went back into the game after being hit by Dumervil.
"The way the system is set up is unfortunate because people can have delayed symptoms and there will be people going back in who have symptoms later and can have delayed systems," Manning said. "In a way, the system works because they realized something was wrong and took Tom Savage out. That part did work."
There was a major disconnect between Savage taking the scary hit and being allowed to go back in the game that triggered an outcry in social media and broadcasting with incorrect speculation that the former Pitt standout had experienced a seizure and was coughing up blood.
"The audience feels like if they can see it at home, why can't the people on the sideline see it?" Manning said. "It's hard when you're standing on the sideline and you can't see everything on the field. That's why they put in the spotters to try to eliminate some of that.
"Even then, the spotter isn't necessarily seeing it. One answer might be to have one person designated on the sideline who can see that video and say, 'This looked really bad.'"
What did the arm movement mean?
"There's some abnormal movement, but calling it a seizure is an overreaction," Manning said. "Part of the reason is people have misconceptions of what a seizure looks like."
After Savage got hit when the offensive line was overwhelmed by a heavy blitz package, he went to the sideline and got checked out inside a medical tent and was quickly cleared and went back into the game for a three-and-out series during which he threw two incompletions.
Savage was ruled out after being rechecked inside the locker room after initially resisting leaving the game. He seemed fine afterward.
"The medical people on the sideline, they come to me and say, 'We're going to check Tom for a concussion,'" O'Brien said. "They take him into the tent, they check him, maybe two, three minutes. They say Tom can play, he's good to go. So, I make the determination, talk to Tom, 'Hey, here's the plays we're going to go with,' and we put Tom back out there. After that next series, they came back over to me, 'We're going to check him again.' I said, 'Thanks, OK, great.' I said to Kap at that point, our trainer, 'Look, I think we need to check him again.'
"It wasn't anything I particularly saw on the field, just said, 'Look, that was a quick check. Let's continue to check him and make sure Tom Savage is OK.' They were not satisfied with his answers to the questions they were asking him, and they pulled him from the game."
--Standing in front of his locker following another setback, Texans Pro-Bowl outside linebacker Jadeveon Clowney didn't hold back his disappointment and frustration.
The Texans were beaten, 26-16, by a San Francisco 49ers team that had won just two games entering Sunday.
"I'm very upset," Clowney said. "Man, we're 4-9. I'm upset about that. We're a lot better than what our record says we are."
The Texans allowed 416 yards of total offense and 20 first downs. They yielded 102 rushing yards, including 78 to Carlos Hyde with one touchdown.
"I'm tired of losing," Clowney said. "Yeah, it hurt."
The Texans' latest loss unfolded as 49ers quarterback Jimmy Garoppolo completed 20 of 33 passes for 334 yards, one touchdown and one interception.
"He's good, he nice," Clowney said. "He made some nice passes, some accurate passes, got the ball out of his hand fast. He's doing his thing."
The Texans have now lost six of their past seven games. Clowney attributed the decline to key injuries, not head coach Bill O'Brien.
"Bill O'Brien is a good coach, man," Clowney said. "You've gotta look around the locker room. We ain't got everybody."
Clowney briefly left the game with a leg injury, but walked it off on the sideline and went back in the game.
"I knew I was going to come back," he said. "I just had to let it calm down."
--Dealing with the aftermath of his third concussion of the year and being placed on injured reserve for the second time this season, Texans tight end C.J. Fiedorowicz still hopes to resume his NFL career.
Fiedorowicz is evaluating his medical options and the Texans are taking their time while he continues to recuperate and haven't made any decisions on his status. Texans head coach Bill O'Brien said he expects Fiedorowicz back next season.
Following an ESPN report suggesting Fiedorowicz could be forced to retire, Fiedorowicz's agent told The Chronicle, Fiedorowicz wants to play and will take his time.
League sources not authorized to speak publicly said that the Texans are concerned about Fiedorowicz's short-term and long-term health because of his history of concussions, but added no decisions have been made or imminent.
--Texans linebacker Brian Cushing made an emotional return Sunday and was effective at an unfamiliar position.
Although Cushing recorded five tackles and a half-sack and was a team captain in his first game back after serving a 10-game suspension for violating the NFL performance-enhancing drug policy, he didn't get everything he wanted.
"I've had time off, but it comes back kind of quick," he said. "It's one of those things you remember pretty fast once you get out there and you knock it out pretty quick."
--Texans kicker Ka'imi Fairbairn continues to struggle mightily.
The former Lou Groza award winner from UCLA missed an extra point wide left and had a 52-yard field-goal attempt hit the left upright.
He has four missed kicks in the past two games, including a pair of missed field goals in a loss last week to the Tennessee Titans.
Fairbairn has connected on 18 of 23 field goals and 30 of 33 extra points in his second NFL season.
NOTES: LB Dylan Cole got crushed on a sideline crack-back block that drew a penalty, but said he merely got the wind knocked out of him. ... WR Will Fuller V returned after missing the past three games with cracked ribs and made an immediate impact. Fuller finished three catches for 26 yards on five targets. He had a pair of first downs on catches in the first quarter.
REPORT CARD VS. 49ERS
--RUSHING OFFENSE: C - The Texans rushed for a season-low 53 yards last week. They improved to 90 yards this game.
--PASS DEFENSE: D - The Texans allowed quarterback Jimmy Garoppolo to complete 20 of 33 passes for 334 yards, one touchdown and one interception.
--RUSH DEFENSE: D - The Texans allowed 102 rushing yards overall as a team, including one touchdown run from Carlos Hyde.
--SPECIAL TEAMS: D - Ka'imi Fairbairn missed a field goal and an extra point. The return game was non-existent.
--COACHING: F - Play-calling could have been better and the Texans lacked intensity as they fell to the now 3-10 49ers.