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 stayed down on the field with a head injury while he was evaluated by athletic trainers. The ambulance and 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, Wessinger 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 officials with the 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.

Now, as an orthopaedic surgeon who covers high school football games frequently, my instant reaction to the situation in Rock Hill and to my learning the nature of the coverage of games here 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?

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? Charleston County EMS only has five spare ambulances at any one time. And while catastrophic injuries in sports are devastating, they are likely 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 canceled. 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.

Dr. Geier is Director of MUSC Sports Medicine and an orthopaedic surgeon. For more information about football injuries and other sports medicine topics, please go to Dr. Geier's blog at