Imagine you are the parent of a star high school quarterback. He is sacked in the second half of a game and is lying on the field motionless. As his parent, you are naturally terrified. You look all around, frantically searching for the ambulance.

Now, imagine you are one of the paramedics at the game. You have been watching for over three quarters, and you haven’t been needed. You receive a 911 call to respond to a multiple vehicle accident with possible fatalities. What do you do? Do you respond to the motor vehicle accident or stay at the game, even though you are not obligated to do so and where you haven’t been used all season?

Fortunately it is a dilemma that almost never happens. But a similar situation did occur recently at a game in Rock Hill. Rock Hill High’s Corey Wessinger was tackled and laid on the field with a head injury, while athletic trainers evaluated him. The ambulance and its paramedics at the game were no longer there, as they had left minutes before to respond to another call. Spectators claim that it took 15 minutes for another ambulance to arrive. Fortunately he was assessed at the hospital, treated, and released.

School officials and parents were upset to learn that Piedmont Medical Center provides an ambulance and EMT services to the stadium for football games for free but with the understanding that if another emergency arises, they might have to leave. And while this arrangement might not seem adequate, it is likely very common throughout the country, especially here in Charleston.

In light of the events in Rock Hill, I discussed EMS coverage of football games in Charleston with Charleston County EMS. They have no official contracts with any school. A school can put in a request to have an ambulance and paramedics present, and they try to honor those requests. There is no fee charged to the school, but if another emergency arises, the ambulance and its crew might have to respond.

I discussed this issue with Richard Luden, athletic director at West Ashley High School. He responded, “Over the years, we have inquired about EMS being at the football games. I have been told that they want to be paid ($500 plus) for sitting at our site. I have also been told that they are stretched thin and need to be centrally located to be able to service all over the county. We would love to have them on site during our home games; however, I don’t think it is something that we should be required to pay for.”

I wondered if the same agreement applied to other sports in the Lowcountry. According to Marie Lockhart, president of the Lowcountry High Rollers roller derby team, “We are required to have EMS at all of our bouts for USA Roller Sports (our event insurance provider). We pay for our crew (2 people from a private company) and they will not leave for another call. We don’t have a written contract with them, but we’ve used the same company since our very first bout without any problems. If someone were to get injured and the EMS would need to leave the track, then we would have to suspend our game until a back-up crew arrived or just end the bout early. Even if the EMTs are just out of the main arena because they are evaluating someone, we will wait until they return to track-side before playing again.”

Now, my instant reaction to the situation in Rock Hill and to my learning the coverage of games here, as an orthopaedic surgeon who covers high school football games frequently, was that EMS should be obligated to be present at every game and stay until it’s over. I’m sure most of you reading feel that way. But is that level of coverage feasible? Tweet this opinion.

So let’s discuss some options. First, the state legislature could pass a law mandating that EMS be present at every game. But is that an effective use of resources? If an ambulance and crew had to stay at every game across a county, does EMS have enough staff and ambulances to adequately respond to other emergencies? Currently Charleston County EMS only has five spare ambulances at any one time. And while catastrophic injuries in sports are devastating, they are far less common than emergencies in motor vehicle accidents, fires, and crimes.

Maybe we should put the responsibility on the school. The school can pay EMS to be present, or the game is cancelled. Ignoring the limited number of spare ambulances for a moment, that idea is easy to enforce. But where do you draw the line? Should that rule apply to other sports? Cheerleading, for instance, has one of the highest rates of catastrophic injuries. Should we mandate that EMS be present at every cheerleading competition? And what about practices? Most deaths from heat stroke occur during practices in early August, when EMS isn’t present.

And even if there were spare ambulances and crews available, is charging schools the answer? You could argue that it is no different than paying security guards to be present. But while football generates significant revenue in concessions and ticket sales at larger schools, could schools with 20 players and 50 spectators afford to pay?

Now please don’t assume that I am arguing that we don’t need paramedics at sporting events. As a sports medicine physician, I have had to work with EMS on several occasions to stabilize athletes. I agree with most parents and coaches that having them present is vital. Figuring out a way to make it a reality on a consistent basis is the challenge.

What do you think? Should EMS presence at high school football games be mandatory? Do you have ideas on how to make that possible?

Note: An abbreviated version of this post appears as an article in the September 28, 2011 issue of The Post and Courier.