As school districts have cut costs over the years, one of the items often on the chopping block is having ambulances stationed at every football game.

"When you have the ambulance at the top of the hill, you only gain a few hundred yards," said one superintendent in Minnesota way back in 2003.

However, a few recent severe injuries to high school football players have some districts rethinking their policies.

In Utah, linebacker Garrett Blanc was knocked out during a game, and medical personnel decided he needed to be taken to the hospital. With no ambulance on-site, it took 25 minutes for one to arrive and transport Blanc, a junior, to the hospital.

"That was pretty disgusting to be honest," Blanc's father and the team's head coach told the Sun (Carbon County) Advocate. "What if he had broken his neck out there? You've got to have things like this treated right away."

According to the school's principal, Bruce Bean, the reason there wasn't an ambulance on-site was all about money.

"The cost of having the emergency personnel from our area, who work as volunteers, be at the games was too costly for the district," Bean said.

There are also factors based on a school's location and size. According to the Deseret News in Salt Lake City:The fact that every school deals with unique circumstances and its own school community and school board make it difficult for the Utah High School Activities Association to make blanket mandates, assistant UHSAA director Kevin Dustin said.

In Florida, a school district is revisiting its ambulance policy, which it eliminated in 2004, after a similar incident. According to WTSP in Clearwater:

Pinellas County is finding a way to get ambulances closer to its Friday night high school football games, after a Largo student took a frightening hit last month.

But the district says it's doing so thanks to volunteer measures, and no official changes yet in policy.

Thank goodness Taj Taylor is all right. But the Largo High School football player's injury exposed a potential shortfall in Pinellas County's safety net for its young athletes.

In 2004, the district opted to cancel its ambulance contract for Friday night football games, opting instead for six-day-a-week athletic trainers at all sporting events and practices... not just Fridays, and not just football.

Still, Athletic Director Nick Grasso says he took Taj's injury - and his parents' concerns - seriously enough to convene a panel of medical and emergency experts.

The outcome? Some cities in the area have stepped up and said they will voluntarily provide EMS units at Friday night football games.

Last year, school officials in Georgia reversed their decision to discontinue having ambulances on-site at football games. The decision was originally made to save the school system $24,000 a year. However, the Richmond County Board of Education decided the savings were not worth the risk.

In the end, the decision to have ambulances on-site isn't an easy one. As Bean told the Deseret News:

"There are also issues like if you do it for the varsity, should I have it at sub-varsity? Where do you draw the line?"

Those are decisions every school district should at least consider.

By ridding your high school games of those pesky ambulances you're basically saying saving $24,000 is worth more than a child's life. Better hope you, as a school district, have good lawyers.
Point well taken, but we can't say, 'at any cost'. I'm also not a fan of, 'if it only saves one life, it will be worth it'.

We have to realize that there are inherent risks to these activities. We make reasonable (that is a subjective term) efforts to mitigate those unnecessary risks, but some risks remain.

Why just have an ambulance? Shouldn't we have a helicopter stationed on the grounds to transport the patient to a better facility? How about spending that $24,000 to hire a nurse or pay a doctor to be at the games? Why not just a hire a doctor for the school - regardless of the cost?

At some point, money will be a factor, because we can no longer afford to play the game.

Additionally, some districts will be short an ambulance if they cover a game. Then, if multiple schools are hosting home games,they are spread even thinner.

Football has received a lot of attention in the media lately. But how many times has an ambulance had to transport a player to the hospital this year? Also, football isn't the most dangerous sport. Shouldn't we have an ambulance on site anytime the cheerleaders are performing?

I don't claim to have the answers, but from working in EMS, I know that there isn't a single answer to solve every problem. These are tough decisions & schools need to work with EMS to do the best they can.
Stephen Kanter, DPT, ATC Wednesday, 02 October 2013
Unfortunately, there is not a 'right' answer, even though most would agree it would be best for athletes in high risk sports, such as football, to have emergency personnel and a certified athletic trainer (ATC) on-site. The role of the ATC should not be underestimated. The ATC is the healthcare professional who is responsible for creating an emergency plan and communicating this plan with the local EMS and hospitals. EMTs and Paramedics play an important role (obviously) in life-threatening emergencies. On a sports field, an ATC is trained and with the correct equipment, can also manage many severe injuries (including head and neck injuries, heat illness, as well as diabetic and asthma related issues). The best scenario is having the ATC work with the local EMS to create and practice emergency plans - this can be done even with limited resources.
Topper Van Backer EMT Wednesday, 02 October 2013
As a trainer, coach and EMT, I will tell you without hesitation that if you are going to provide a venue for sport, you need to include an onsite ambulance in your staffing. I have transported athletes from various athlete venues and can tell you that as much as having a trainer onsite is advantageous, you MUST be prepared for the potential worst case scenario (particularly in contact sports). The equation and cost analysis goes like this: for every minute the brain is deprived of oxygen, the potential for a 10% reduction in normal brain function increases...for every measured head impact, there exists underlying symptoms that need immediate attention, diagnosis and potential treatment....its goes on and on....the value of a life, and or compromised life cannot and should not be associated with dollars and cents; it should be included in the budget. Time is not money, its lives. Ask yourself, in an emergency would I find it acceptable to wait for educated and professional help to deal with the situation?...Do you find yourself impatient when they haven't opened another check out register in a supermarket...I implore those whose responsibility is the fiscal part of budgeting for programs to put themselves in the position of needing immediate life saving care, and perhaps NOT receiving it in time.
I think it is an interesting question. Our EMS provides the ambulance, as far as I know, free-of-charge. We're fortunate it seems. I'll tell you it was a little unnerving Friday night when I did not see the ambulance by the gate at game-time. I'm not sure when it did arrive, but there was one there by half-time and throughout the remainder of the game.

I'd be interested to know, Topper, what equipment you carry as an athletic trainer. Personally, for a football game, I carry most emergency equipment and I know some ATs are now carrying oxygen with them as well.

I agree with the one Florida district who believes having an AT there 6 days a week for all sports is more beneficial than to have EMS only at football games.

Every Athlete Deserves an Athletic Trainer #AT4ALL
Topper Van Backer EMT Thursday, 03 October 2013
That's a good question. As I am dual- credentialed, I carry both a full trainers kit, as well as a full EMT jump kit, including oxygen. I am very sensitive to the costs entailed and understand the fiscal challenges that we all face, and am respectful of the equations entailed. I would be surprised to attend a college football, lacrosse,hockey,or basketball game and not see an ambulance and staff attending the event. The pros- goes without saying (yes, they have helicopters as well). In looking into schoolboy sports, consider the fragility of adolescent athletes and in doing so please remember that the injuries that they sustain are in many cases identical to the professionals, and unfortunately they are not as physically developed to withstand some of the trauma that occurs. The real bottom line is how soon can an injured athlete in a critical situation get care which is proportional to the trauma. That's really where we need to start in assessing costs and values placed on lives. The immediacy of the time to attain care is the real consideration.
As a former NCAA D1 Football and Basketball games and facilities manager, what you have to realize is that the ambulance on site, stays on site. It doesn't transport anyone anywhere. The Paramedics/EMT's onsite stabilize the injury and wait for another ambulance to arrive for transport of the injured.

That's why major injury delays at games are so long. It's not usually that it takes a long time to stabilize,(although it can) it takes a long time for the transport ambulance to arrive.
Jo Dale, ATC, EMT Friday, 04 October 2013
Hi Topper,

What are you dual-credentialed with? I see an EMT listed - what 'trainer' are you? Athletic Trainer? Personal trainer? I wondering if you are an AT, why you don't use the proper terminology - Athletic Trainer, not just trainer.