How Safe Is It?

Three weeks after suffering a concussion, Ricky Elias was playing defense and running back for the Panorama City St. Genevieve High football team. His parents, Rosa and Ramon, watched nervously from the bleachers.

An aggressive 5-foot-6, 133-pound bundle of energy, Elias was determined to return to the team after his injury, even though his parents wanted him to reconsider. Rosa said her brother, a physician, had told her, “All those years he’s been playing, all those hits he’s been taking, don’t let him play anymore.”

But she couldn’t persuade her son to quit.

“Every time something is in the news, I tell him, ‘Look at this. Here’s what happened,”’ Rosa said.

The news, indeed.

After a summer of headlines about football players dying of various causes, from pro star Korey Stringer, to college player Rashidi Wheeler to at least 13 middle and high school football players nationwide--one death struck particularly close to home.

Matt Colby of Costa Mesa High, a senior linebacker and a veteran of the hard-hitting high school football wars, wobbled off the field during a game Sept. 28 against Huntington Beach Ocean View. He collapsed on the sideline, was never again responsive and was taken off life support two days later.

In the days leading to his death, Colby had complained to friends of headaches after two earlier games. In those games, he had taken some blows to the head, as high school players do. His coach and the team trainer knew of his headaches. His doctor had ordered Colby not to participate in contact drills in the days preceding the Ocean View game. But he wanted to play Sept. 28 and his doctor, school officials said, cleared him to do so.

Autopsy results are pending, but Colby’s death has served as a wake-up call for Southern California high school football programs, raising awareness about the safeguards needed to protect teenagers in a sport with collisions becoming increasingly violent.

Players today are bigger, faster and stronger and are also more inclined to emulate what they see the pro and college players doing on television.

The weekend after Colby’s death, The Times sent reporters to examine medical preparedness and readiness at 25 high school football games, from Ventura County to Palm Desert. They found that safety precautions--including willingness to allow kids back into play after being struck in the head--vary widely.

* Some schools had a doctor, a certified trainer, and several trainer assistants going full throttle. Some had no doctor. Others were without trainers, and there were instances of players taping each other’s ankles before the game. One athletic official recalled a game at which the doctor on duty was an obstetrician/gynecologist.

* Some schools had an emergency plan in writing, including assignments as to who would open which gate to guide in medical personnel and even who would run down the street to hail and guide an approaching ambulance. Some schools said they had general plans in mind and were guided by “common sense.”

* Some schools had staff specifically assigned to constantly monitor the air pressure in players’ helmets--proper inflation means a better fit and increased protection for the player’s head. At other programs, poorly fitting helmets were blamed for two head injuries so far this year, and one player was seen charging back into a game after failing to find a replacement for a helmet that was loose.

Although many parents, team doctors and other sports-injury experts voiced concern about the lack of uniform standards, there are roadblocks to change.

The California Interscholastic Athletic Federation (CIF) is the sanctioning body for the state’s 600,000 high school athletes, yet it has no say about medical preparedness at most of its games. That responsibility during the regular season is left to the schools and their districts. When the CIF does take that responsibility, in the playoff games it sanctions and organizes, it mandates full-fledged medical doctors along the sidelines. CIF officials say they have tried to find a way to set medical standards for all games but have never been able to find the funds or a workable plan.

“It wasn’t for lack of trying,” said Barbara Fiege, director of athletics for the CIF’s City Section. “We just haven’t gotten to that point.”

*

The game program contains 28 mini-bios of Lakewood Mayfair High players. One question asked of all was, “What do you enjoy most about football?”

Eleven answered, in some form, “Hitting.”

Ibrahim Atalla said, “The violence and when we score.”

Danny Baker said, “Smashing people.”

Jonathan Mercado said, “The feeling you get when you just flat-back someone.”

And Kenneth Sutton II said, “Hitting, hitting and more hitting.”

Fred Hayes Jr., a former Mayfair player who is a chiropractor and oversees the team’s medical needs, said parents, players and coaches all need to be more vigilant about responding to players’ head injuries, no matter how minor they might seem.

“I think parents don’t realize the impact of those ... they are brain injuries,” Hayes said. “It’s not just, ‘My kid got his bell rung.’ No, your kid got his brain impacted against the inside of his skull.”

Hayes added, “I think you can compare it to driving down the road at 25 mph and jumping out and tackling a mailbox.”

Despite the attention given football players’ deaths this summer, fatalities have actually held steady in recent years. And the sport is far safer today than it was decades ago, thanks to improved equipment and changes in tackling rules.

But serious injuries involving brain and spinal cord damage remain a constant problem: There were at least 15 high school and college players’ deaths linked to the sport last year, and at least 26 serious brain, neck and spinal cord injuries, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina.

Frederick O. Mueller, the center’s director, said he believes that number would drop if referees took a zero-tolerance policy toward tackles involving the head, and doctors, coaches, parents and others would treat all head injuries with urgency.

“Someone needs to get on it, get the kid examined and not just return to play,” Mueller said.

On sidelines across Southern California, doctors, trainers and others say they do their best to quickly assess injuries and would never knowingly allow a player with a head injury back into a game.

But often, such assessments are made in just seconds, with the emphasis on getting the player back on the field.

In Alta Loma High’s game against Upland, Alta Loma receiver Robert Herbert started cramping. Failing to get the attention of the coaching staff, he hobbled off the field on his own. As a trainer attended to him there, fans from the stands yelled at him to “shake it off and get back in the game.” Assistant coach Donald Martin approached as Herbert was stretching and said, “You better stretch that leg because you aren’t coming out on offense. You better stretch like you’re Gumby.”

Around the same time, Alta Loma running back Kameron Hart took a helmet-to-helmet hit and remained flat on his back for about a minute before a trainer helped him off the field. There, Chris McGilmer, the team’s medical doctor, shined a penlight into Hart’s eyes.

After insisting he was OK, Hart returned to the game on the next series.

Blows to the head such as Hart’s put doctors and trainers in difficult situations, because players aren’t always truthful about their injuries and on-the-spot checks can’t reveal everything. And sometimes a larger threat looms behind a less-serious blow: It won’t cause a player to black out but can cause just enough damage to make him especially vulnerable if hit again. Doctors call it “Second Impact Syndrome” and some experts believe this condition may have played a role in Colby’s death.

Most medical personnel treating injuries on the sidelines look for clear eyes and quick, logical responses to basic questions, such as “What day is this?” and “What is the coach’s name?”

Sometimes, no matter what the trainer or doctor do, the player wants so badly to return to the game that he tries to sneak back in.

Nicolle Flynn, a certified trainer at Long Beach Jordan, has devised a solution for such a situation.

“What we do now,” she said, “is take away the kid’s helmet, or have one of our student trainers baby-sit him.”

*

Under ideal circumstances, sports injury experts say, an ambulance, an orthopedic surgeon, a physician specializing in internal medicine, and several certified trainers would be at each game.

But at a minimum, a certified trainer is a necessity, said Keith Feder, a prominent Manhattan Beach orthopedic surgeon who works with the L.A. Kings and is especially active in high school sports.

Part of a rapidly growing field in athletic health care, trainers specialize in preventing and treating sports injuries.

Many schools have trainers, but far from all are certified, which Feder and others consider necessary. He and his colleagues are in the midst of surveying California’s roughly 1,200 high schools, and so far have found that fewer than 50% have certified trainers.

Legislation signed by Gov. Gray Davis on Oct. 8 aims to further explore whether the presence of certified trainers in high schools reduces injuries and improves treatment. Bill AB 760 appropriated $500,000 to fund two pilot projects.

Of the 25 games attended by Times reporters, 10 had no ambulance on the scene. At the Los Angeles Fremont-Hollywood game, an emergency medical technician was there, but in his own van. At the Thousand Oaks-Moorpark game, the usual ambulance was not there because it had been dispatched to a nearby traffic accident.

Of the 25 games, four had no physician on hand, leaving the schools to rely on trainers or, in one case, the school nurse. Of the remaining 21 games, four had chiropractors taking the lead sideline role.

Most medical personnel were volunteering their time, though a few were paid token amounts, around $50. One, chiropractor Barney Musselman, was bartering his services to Long Beach St. Anthony for use of the school’s track for his son’s school, Bethany Lutheran.

“If we rented the track, it would be $35 an hour,” Musselman said. “Or, they said, I could come be their team doctor for their last three home games.”

After the start of St. Anthony’s game against St. Genevieve, though, Musselman was told he was acting as team doctor for both teams.

Medical readiness drastically varied from sideline to sideline.

At Garden Grove Pacifica, physical therapist Andrew Einhorn, who has volunteered his services for 17 years, came equipped with a fold-up training table, oxygen, splints, towels, sterile gloves and plastic bags to make ice packs.

At other schools, basics were sometimes lacking.

At St. Genevieve, a student who helps manage the football program and takes a lead in caring for players, found herself out of ice when Anthony Negrearytt hurt his knee. Leslie Rodriguez improvised, scooping some out of a Gatorade cooler, stopping first to drain off the green liquid.

On the sidelines at the Compton Dominguez-Long Beach Jordan game at Dominguez, Flynn, the certified trainer from Jordan, oversaw a staff that included a certified trainer as an assistant, as well as seven student trainers.

Trainer Davion White of Dominguez--who has an undergraduate degree in athletic health care and is preparing to take his certification exam next month--worked his sideline alone.

White added that doctors along the sidelines are not always the benefit they might seem to be: “One time,” he said, “they sent me an OB/GYN.”

There is more to sideline duty than medical preparedness.

Making sure equipment fits--especially helmets--is critical. A helmet that is too small or too loose or is not properly inflated leaves players susceptible to head and neck injuries.

“We’ve had two head injuries this year, and I can honestly say that they were because their helmets didn’t fit,” Flynn said.

Poorly fitting helmets are not uncommon. When Fontana A.B. Miller High played Riverside J.W. North, Miller quarterback Kyle Jacobo’s helmet popped off twice. Both times, he retrieved it, snapped the chin strap and went back in.

In the San Fernando-Woodland Hills Taft game, San Fernando running back Will German came off the field after a play, complaining that his helmet was too loose. He ran up and down the sidelines, asking teammates if he could switch helmets with them. He found no takers, so he ran back onto the field, loose helmet and all.

When an Anaheim Western player came off the field to report a loose helmet during its game against Hacienda Heights Los Altos, he received immediate attention. Field and equipment managers sprang into action with a pump, and he was soon back in the game.

Paying the costs of ambulance to remain on standby during a game, or hiring certified trainers, is often more than school budgets can handle.

Many schools rely on volunteer community programs, such as the one Feder runs, Team to Win.

Headquartered at Centinela Hospital, the nonprofit program provides certified trainers on football game nights to 24 area high schools, and offers follow-up care to about 12,000 athletes. Similar programs exist elsewhere in Southern California, sometimes costing more than $300,000 a year, funded by donations.

But not all schools are lucky enough to become affiliated with such programs.

Einhorn, the Garden Grove physical therapist, said the lack of medical standards is something he has long worried about. He said Colby’s death has spurred him to bring the issue to the attention of the Garden Grove Unified School District.

“Most schools in this district don’t have trainers. That’s pathetic,” he said. “It’s seriously dangerous.”

This isn’t the legacy that Verna Hoggatt had wished for in the wake of her son’s highly publicized death.

Eric Hoggatt, 18, was playing for Reseda High on Sept. 12, 1996, when he suffered a head injury in a game against Chatsworth.

He complained about dizziness and numbness that night but whatever sideline diagnosis was made proved to be inadequate. He was sent home on a late-night school bus, went to sleep and never woke up.

At the time, Hoggatt’s case was expected to spur improved medical care and safety procedures. The Los Angeles Unified School District did change its policy to alert parents immediately when a serious injury occurs, but Verna Hoggatt said she is still waiting for more meaningful change, such as better medical care for injured players.

“When my son died, I thought he would be an example for any other child that had the same symptoms of head injuries,” she said. “But it seems like nobody cares, or is doing anything about it.”

Edward and Jodee Johnson credit certified athletic trainer Teresa Cazett with saving their son’s life earlier this season.

They were watching Branden play for Chino Hills Ayala when he became caught between two other players.

“He was limp before he hit the ground ... like a rag doll. His legs were all intertwined,” Jodee Johnson recalled.

Her husband leaped a fence to get to his son. When Jodee arrived on the field, she found Branden unable to move.

“I thought he was paralyzed,” she said.

Cazett had the situation immediately under control, assessing Branden’s injuries, and keeping him perfectly still while arranging for a helicopter to land on the playing field and airlift him to a nearby hospital, Jodee Johnson said.

The paralysis from the spinal cord injury was temporary, and Branden has recovered completely, although his neurosurgeon barred him from contact sports for an indefinite period. Johnson said schools should find the money to hire more people like Cazett.

“I know that it’s probably costly, but just for this one instance alone, it just paid for itself, there’s no doubt,” she said.

*

As he watched his son Ricky, the St. Genevieve running back, Ramon Elias seemed convinced that the boy would be more cautious coming back from a concussion, an ordeal that included spending a night at the hospital and being held out of a game before a doctor cleared him to play again.

“I think he is going to be more aware,” Ramon said. “He’s not going to play like before. He got scared. I know he did.”

Yes, the son confirmed. The hit he had taken three weeks earlier had been “scary.” He said he knew what had happened to Matt Colby.

But the lesson he said he learned from both is something his parents might find unsettling.

If he had a recurrence of his concussion symptoms, the son said, he would still play.

“Now I go full speed, because I have nothing to lose,” he said. “Now, I know every play can be your last.”

*

This story was reported by Times staffers Dan Arritt, Ben Bolch, Mike Bresnahan, Lisa Dillman, Helene Elliott, Rob Fernas, Martin Henderson, Steve Henson, Mike Hiserman, Gary Klein, Rene Lynch, Melanie Neff, Robyn Norwood, John Ortega, Eric Sondheimer, Eric Stephens, Elliott Teaford, Mike Terry, Lonnie White and Peter Yoon and Times Inland Valley staffers Joel Hood and James Lee.