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."
