High school football’s medical tightrope

No doctor was waiting on the sideline when JaVion Hartford limped off the field in the second quarter.

No trainer came over to examine his painful right knee. No one hurried to bring him ice.

The linebacker from tiny Animo Leadership High sat alone on the bench until an assistant coach checked on him, followed a while later by the head coach, who could only guess that Hartford had suffered a hyperextension.

“Don’t try to be a hero,” Coach Jamar Hamilton told him. “I don’t want you to play.”

Football accounts for nearly three times more injuries than any other high school sport, according to an annual study by the Center for Injury Research and Policy in Columbus, Ohio. Yet, in Southern California, there is no standard for medical care at hundreds of games played each weekend.

Some organizations that govern prep football require the presence of trained personnel, while others merely recommend it. The Times visited varsity teams throughout the region during the first month of the season and found a wide disparity in how injuries are handled. Players from lower levels of competition — the junior varsity and freshmen teams — receive less care.

On the same day that Animo Leadership played at Lucerne Valley High — with nothing more than an ambulance standing by — players received far better treatment at Harvard-Westlake School in North Hollywood.

The private school employs four athletic trainers who scurry about the sideline in matching uniforms. A volunteer orthopedic surgeon attends every game.

“We have a situation that’s better than some colleges,” Coach Vic Eumont said. “It makes a big difference.”

The discrepancy between haves and have-nots is of growing concern to medical experts, school administrators, coaches and parents. They point to games that have only one medic — often a trainer, registered nurse or emergency medical technician — for both teams.

“It’s like when you drive through a neighborhood and think, ‘Dang, there should be a stop sign,’” said one coach, speaking anonymously for fear of angering his administration. “Everyone knows it, but they don’t do anything until someone gets hit.”

Small, poor struggle most

Every game The Times attended had some form of trained personnel on site, even if only in the form of an ambulance parked near the field. Medical experts say that is sufficient for emergencies such as loss of consciousness or spinal cord injuries.

In such instances, “all you can do is give CPR or put the player on a backboard and get him to the hospital,” said Dr. Jerry Bornstein, a volunteer advisor to the Los Angeles City Section. “Any nurse or EMT has been trained to do that.”

The problem arises in diagnosing more-frequent injuries such as concussions, torn knees and separated shoulders.

“In a perfect world, it would be great if schools had an athletic trainer and a physician at every game,” said Bruce Howard, a spokesman for the National Federation of State High School Assns. “But we know that, in reality, that can’t happen.”

The Los Angeles City Section, which oversees about 100 schools, requires the home team to provide some form of medical care. The Southern Section, with more than 570 schools ranging across much of Southern California, has no such regulation.

“If something happens on their campus,” Southern Section spokesman Thom Simmons said of his member schools, “they are liable, and that’s why it’s left up to them to make the decision.”

Small schools and those in poor neighborhoods are most likely to struggle with sideline care.

When Lee Vining High traveled to Calvary Baptist in LaVerne on a scorching afternoon, two Lee Vining players became overheated, vomiting beside the field. A team member’s parents hurried around with water, ice and wet towels while a grandmother who is a registered nurse volunteered to help with another player who injured his neck.

The player with the neck injury later asked Coach Dan LaRue whether he could return to the game. Before LaRue could answer, the grandmother shouted “No!”

Noli Indian High in San Jacinto contracted paramedic Hope Ruiz for a trip to San Pedro to play Torrance Pacific Lutheran in a recent eight-man game. She addressed both teams beforehand, insisting they inform her if they felt any symptoms of a concussion such as headache or dizziness.

“If we tell you,” one player said, “our coach is going to get mad and take us out of the game.”

“No, you need to tell me,” Ruiz responded. “And it’s not going to be them taking you out of the game — it’s going to be me.”

Hurt or injured?

Nobody has to tell Jimmy Nolan about the need for sideline care. Eleven years ago, as an assistant coach at Fountain Valley High, he watched one of his strongest linemen collapse during practice.

“Scotty was a big jokester, so our first thought was, ‘Stop messing around,’” Nolan recalled. “Then we noticed that he was having seizures.”

Despite the efforts of a trainer on the scene, 16-year-old Scotty Lang died of an undiagnosed heart condition. The memory sticks with Nolan, now the head coach at Compton Centennial, every time a player gets hurt.

Even for trained personnel, deciding who should or should not return to action can be difficult. Cuts, bruises and pulled muscles are a part of football — if medics benched every player who felt pain, the field would quickly empty.

The key is distinguishing between serious injury and what merely hurts.

Players often lie about how they feel because they want to be in the game. When doctors told Mychael Tarr, a Venice High running back, that he could not return against Chaminade, he compared it to “telling someone that they can’t see someone they love.”

Fernando Gomez, the coach at Noli Indian, understands. As a player, he once argued his way back onto the field — and now has a permanent knot on his left wrist, the remnants of a fracture that did not properly heal.

“It hurt like hell,” Gomez recalled, “but I wanted to play.”

So medics must be forceful.

“What I say goes,” explained Malia Reynolds, the trainer at Villa Park High. “Being hurt, you can still play. Being injured, you’re coming out.”

The job gets trickier when there is limited medical help, leaving coaches to make the call. At Animo Leadership, Hamilton lamented that each minute spent assessing Hartford was a minute diverted from the rest of the team and the game.

“I shouldn’t have to step away to see how he’s doing,” Hamilton said. “It’s unfair.”

Other coaches feel caught between a rock and a hard place. They want their players to be safe, but they also need their best athletes on the field to win.

At Calvary Baptist, which cannot afford a trainer, the decision often falls to assistant Lincoln Dial, who studied some kinesiology in college. He says he errs on the side of caution, but worries that he is putting his team at a disadvantage.

“It’s not that other schools are doing it wrong,” Dial said. “It’s just that when there’s a doctor, he can look at it and know immediately, ‘Hey, you’re fine. You’re not going to injure yourself any more.’

“I look at that and I think, ‘You’re done until I hear from a doctor, a parent, something.’”

Making do

The trainer’s room at Harvard-Westlake — located just steps off the football field — has padded tables, an ice machine and an array of rehabilitation equipment. Clean towels are stacked on the counter.

At St. Paul High in Santa Fe Springs, a doctor and three trainers attend every game, carrying full medical kits and communicating by walkie-talkie between the field and locker room. A school administrator estimated the program spends more than $25,000 a year on medical supplies.

“Obviously, you’ve got to dig that money out of somewhere,” Coach Marijon Ancich said.

Too often, administrators and coaches face limited resources. Coach Jim Lamb would like to hire a trainer at Bolsa Grande High in Garden Grove, but that would mean sacrificing the stipend used for a badly needed assistant, so he tapes ankles himself.

Coach Chris Klinger does the same at Lucerne Valley, where the school saves money by shutting off the air-conditioning in the classroom that doubles as his training room. The temperature reaches 95 degrees on some afternoons.

“Programs that have doctors volunteer their time are lucky programs,” said Klinger’s cousin, Jake, an assistant. “I don’t know if we have a doctor in town. We have a dentist.”

Volunteer physicians have become far less common over the past 20 years — they are either too busy trying to keep their practices afloat or scared away by potential malpractice suits, several doctors said.

The City Section tries to fill the gap by paying for 60 or so medics to work a portion of its games. Nonprofit groups such as Team HEAL and the West Coast Sports Medicine Foundation also provide sideline care for teams in need.

But even simple medical supplies can be a challenge.

At Compton Centennial, Nolan has to pay for tape out of his own pocket. When a player limped off the field during a recent game against Los Angeles Douglass High, trainer Amanda Rosette took extra care wrapping his ankle.

“I understand that we’re working with a small budget,” she said. “We don’t have a lot of tape today.”

The situation probably will not improve — not at Compton Centennial or schools like it — as the 2010 season proceeds through the final weeks of the regular season and into the playoffs.

There has been talk of tougher rules, such as requiring schools to hire physicians for every game, but that could mean cutting the sport on many campuses.

For now, the responsibility too often falls on lone medics and coaches who are hardly experts in sports medicine. They know that parents are counting on them to keep players safe.

“You just do what you have to do nowadays,” Garfield Coach Lorenzo Hernandez said. “It’s the economic hard times.”

Times staff writers Baxter Holmes and Eric Sondheimer, and correspondent Mark Medina contributed to this report.

david.wharton@latimes.com

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