Ambulance access remains an issue

      Athletic trainers are skilled professionals who know how to deal with sports injuries, but they're not Emergency Medical Technicians, said Rob Richardson, coordinator for special events with American Medical Response ambulatory services.
      "Those guys are fantastic and their level of expertise is wonderful," he said. "But when we're there, we assume the high liability of the medical care. And now that we're not, well, now we're not there."
      The Clark County School District recently entered a partnership with Sunrise Hospital and Medical Center and HealthSouth to supply on-campus athletic trainers at local high schools. Funding for the program was set up in thirds, with district athletics director Larry McKay making room for his office's share by eliminating ambulances from home sites during football games.
      Richardson contends it was not a wise decision.
      "There is a disappointment, you get to wonder what the driving force is," Richardson said. "I understand the importance, but these kids are stronger, bigger and faster."
      EMT's rank at three levels -- basic, intermediate and paramedic -- and are likely to provide a higher level of care in an emergency situation, Richardson said.
      "I agree, we're not EMT's, no one said we are," said Jim Porter, regional outreach coordinator for HealthSouth. "What we are is highly trained athletic trainers who are competent in managing athletic trauma. There are carryovers in what we do and what EMT's do.
      "Our job is to take care of athletic trauma. Their job is take care of trauma outside of an emergency room."
      Athletic trainers are required to have a bachelor's degree and 1,500 hours of internship before they can even test to become certified.
      EMT's need 132 hours (plus 32 hours in clinical training) to reach the basic level, an additional 80 hours (and another 32 in clinical training) to become an intermediate and roughly 1,200-1,500 total hours to become a paramedic.
      "The difference between an EMT-Basic and an athletic trainer is nil, they have the same skills," Porter said. "An EMT-Intermediate or EMT-Paramedic can deliver drugs, which an athletic trainer can not. That's the only difference."
      Richardson said the minimum level EMT American Medical Response puts at football games is an intermediate.
      "By having an ambulance on site, not only can they provide support to the athletic trainer, they can (tend to) cardiac arrests in the stands, the security guard who may get assaulted or the little kid who gets stung by a bee," Porter said. "What is the most likely thing to happen at a football game though, a player breaking his ankle or someone getting stung by a bee?
      "I'm in total support of AMR having units at certain events. We're both needed and we need to find the funding to take care of both. But don't cheat the athletes the entire school year for a matter of nine football games."
      McKay feels this was a favorable swap for the district, and its student-athletes.
      In replacing ambulances with on-campus trainers, roughly 45 hours of ambulance time at freshman, junior varsity and varsity football games was exchanged for 720 athletic training hours at each school.
      "And the trainers are covering all sports throughout the school year," McKay said. "So what in reality did we give up? ... You don't have ambulances at practices, but we do have trainers there throughout the week. It's nice to have units at games, but a lot of what goes on in football happens at practice.
      "In effect, we're providing a lot more medical service during practice."
      The district is also saving money by reallocating funds once used in a matter of 10 or 11 weeks, to a year-round program that puts health professionals on campus for 20 or more hours a week.
      Eliminating ambulances at football games will save the district an estimated $48,000, based on the district's master schedule of 226 freshman, junior varsity and varsity games for at least three hours at a rate of $70 per hour. Ambulance staffing at playoff games brings the tab to nearly $50,000.
      "We are accomplishing a lot more with trainers on campus than having an ambulance just sitting there," McKay said. "Certainly if we had a greater amount of money, it would be a consideration (to bring them back)."
      Through September, McKay said he was unaware of any emergency situations.
      There have been a few incidents, though, at schools that needed an ambulance to respond.
      One member of Durango High's football team went down with a dislocated shoulder during a game and was in need of immediate attention.
      "The ambulance response time was less than five minutes," said Dan Reese, Durango athletic administrator. "And the treatment he was given on the field was happening the same time the ambulance was arriving."
      Two weeks later at Durango, a Peninsula, Calif., player was injured and was in need of assistance. However, the out-of-state team's orthopaedic surgeon told Reese it was not a life-threatening situation.
      Less than eight minutes later, and about two minutes after the player was taken off the field, a unit arrived.
      Hosting a football scrimmage prior to the season, Cimarron-Memorial athletic administrator Andre Denson said an ambulance took less than four minutes to arrive when a Basic player was in need of assistance.
      In case of emergencies, McKay said, an understanding with American Medical Response has somewhat been worked out where certain units may spend their down time near, or at, school parking lots.
      Both McKay and Richardson confirmed there are ongoing negotiations to bring ambulances back to football games for the 1999 season.