It was a routine play, one of thousands that occur each Friday night at high school football games in the Augusta area.
Midland Valley senior quarterback Chad Hager took the snap from center, moved to his left and collided with a South Aiken defender after a short gain.
Chad did not get up. He lay still on the field.
Fortunately, medical personnel were on the scene. Chad walked off the field holding his ribs and was transported to Medical College of Georgia Hospital. Doctors found that he had ruptured blood vessels in his lungs and windpipe.
Safety on school playing fields and the procedures followed by personnel are concerns for officials in Richmond, Columbia and Aiken counties.
The Columbia County School Board was two weeks into a discussion of whether to pay for ambulance service at varsity football games when Greenbrier junior varsity player Phillip Hill suffered a head injury Sept. 18.
But there was no ambulance waiting for Phillip. His accident has expanded the examination of athletic safety.
According to research by The Augusta Chronicle, not all of the 19 public high schools in the three-county area have certified trainers or medical personnel at football games when players take the field.
Sometimes an ambulance on site can make a difference.
When Chad went down, the North Augusta/Belvedere Volunteer Rescue Squad was there to attend to him.
"When I got on the sideline, the ambulance was already there," he said.
His trip to MCG was less than 10 miles, but it was 45 minutes from the time the injury occurred to his arrival at the hospital.
"Several of those minutes were spent debating with Chad whether he had to go to the hospital, despite the big puddle of blood next to him," said his mother, Tami Hager.
Chad was cleared to play the next week against North Augusta. He participated in noncontact drills the week after his accident and has played in all of Midland Valley's games since.
Phillip wasn't as fortunate.
When Phillip came off the field that Thursday night, he complained of a severe headache, then became sick and passed out.
"At first they thought it was heat exhaustion," said Phillip's father, Michael Hill.
An ambulance was called but was delayed by construction on Washington Road, and Philip was airlifted to Medical College of Georgia Hospital. Until this week, Phillip, who suffered blunt head trauma, has been in pediatric intensive care. His condition has been upgraded to good, and he was moved to a regular hospital room Tuesday, Mr. Hill said Friday.
Mr. Hill said what happened to Phillip was "one of these one-in-a-million things that happened to my child versus somebody else's. There's nothing anybody could have done to prevent it from happening."
Though he realizes there are issues of money and availability, Mr. Hill would like to see ambulances posted at all sporting events.
He also would like to see the scope of medical training expanded for coaches and other personnel, moving beyond broken bones to head and neck injuries.
"If something good could come out of it as far as safety training or some type of first response kit or more EMT assistance at the ballgames, that would be great," Mr. Hill said.
THE NATIONAL FEDERATION of State High School Associations estimated that 1.5 million high school and middle school athletes participated in football in 2002. According to a study by the National Center for Catastrophic Sport Injury Research, five high school football players died because of heart or lung problems, and eight athletes suffered brain injuries.
"You can't stop an injury from happening," said George Bailey, the athletics director for the Richmond County Board of Education. "Last year someone asked me what kind of year did we have in terms of sports. I told them we had a good year because we didn't have a serious injury. I don't look at it in terms of the number of ballgames we win. I look at it in terms of our kids being safe throughout a season of football, basketball and all the other sports that we play."
In Georgia last year, three high school athletes died in heart-related incidents. Two football players died during practices, and one cross country runner died after a meet.
"We have some doctors who say, 'If we could have done this or that, we could have saved those kids.' I have other doctors who say those situations never could have been predicted. They were just time-bombs, and no one knew about it," said Ralph Swearngin, the executive director of the Georgia High School Association.
"So we're a little confused about the whole situation in terms of what we can do."
Columbia County School Board Trustee Roxanne Whitaker, a surgical nurse and a mother whose son plays football for Harlem High, has been an advocate for improving school medical care. But she admits it all boils down to money and the best way to spend it.
The board last month voted unanimously to spend $8,000 a year to post ambulances at varsity football games. She would like to see ambulance coverage at junior varsity and middle school games as well.
ON SEPT. 30, at the Greenbrier-Riverside Middle School game, an eighth-grader broke his collarbone on the field. Jackie Creasy, Greenbrier Middle School's principal, said a cardiologist and pediatrician came out of the stands to attend to him until the ambulance arrived 20 minutes later.
"The week before, there were two ambulances at the game, but this week there were none," Mrs. Creasy said. "It certainly makes me feel safer to have the ambulance there, because we are in an isolated location. In an ideal world, we would have one at every game."
For at least five years, Mr. Bailey said, the Richmond County school system has paid to have ambulances at football games. The school system budgeted $30,000 for this service, which covers 105 varsity, junior varsity and middle school home games during the season.
The system does not provide ambulance service for other sports, but certified coaches are trained in CPR and first aid.
At Hephzibah, head football coach Todd Booker is in a unique situation. His school is less than a minute away from a firehouse where an ambulance is stationed. His entire football staff is trained in cardiopulmonary resuscitation, or CPR.
Mr. Booker's school, however, is 15 miles from the nearest hospital.
"I guess if it was an extreme emergency and they had to get to the hospital real quick, being so far out could be a disadvantage," he said.
RIDGE SPRING-MONETTA in Monetta, S.C., is the only school in the tri-county area that doesn't have ambulances at its varsity football games. A volunteer fire department is nearby, but the closest hospital is Aiken Regional Medical Centers, about 22 miles away. If there is an emergency, the closest ambulance is about 15 miles away.
Unlike the other two counties, Aiken County's school board doesn't earmark money for ambulances. Instead, the seven high schools handle safety procedures on their own.
"Money is a problem because we can't even pay the ambulance to sit here, like some schools do," said Vicky Soper, Ridge Spring-Monetta's associate athletic director.
Money is also an issue when it comes to equipping schools with defibrillators and other medical supplies. An automatic external defibrillator is an easy-to-use device that delivers an electric shock to the heart to halt rapid and chaotic heart activity, commonly known as sudden cardiac arrest, and restores normal heart rhythm. It costs about $2,000.
"When someone goes into sudden cardiac death, they lose 7 to 10 percent chance of survival for every minute that passes where they are not defibrillated," said Robert Rosier, the captain of the Martinez Fire Department and chairman of Columbia County Public Access to Defibrillators - a division of the American Heart Association.
None of the 19 public high schools in Aiken, Columbia or Richmond counties has a defibrillator.
"I would not be surprised for us to have one in the near future, all schools in Columbia County," Greenbrier athletic director and head football coach Mickey Derrick said.
Aiken County Deputy Superintendent William Gallman agrees that it's just a matter of time before all schools have them.
"I do believe that is the wave of the future," he said.
MANY SCHOOLS RELY on coaches trained in first aid and CPR.
"We ought to have at least one coach on every staff who is at least proficient in CPR," Mr. Swearngin said. "I think in most places that is the case."
In Aiken County, at least one person in every school is trained in CPR. In Richmond County, all certified coaches are. In Columbia County, not all the coaches are trained - something Mrs. Whitaker would like to see changed, to handle emergencies not only on the field but also in the schools.
"You need people there that are able to respond immediately," she said. "You can't wait for somebody to come 30 minutes away to dislodge a piece of food out of a child's throat, or they will be dead. I think we need to offer it to anybody in our schools."
For the most part, schools rely on volunteers to make up for the medical personnel they don't have. A volunteer certified athletic trainer from Sports Plus Physical Therapy goes to Aiken County high schools every afternoon.
Richmond County is served by athletic trainers from the Medical College of Georgia. Private orthopedic groups serve several Columbia County schools. For example, Harlem High relies on volunteer physicians from Sports Medicine Associates of Augusta. Otherwise coaches are the primary caregivers when injuries occur.
Physicians from Doctors Hospital Center for Sports Medicine volunteer their services for three to four games a week, including varsity home games for Burke County, Evans and Westside.
PHYSICAL EXAMS could be the best place to start to find out more about a student athlete's health.
The Georgia High School Association requires that every school have on file a physical examination form that clears each athlete to play. This year, the association has expanded the form schools use regarding an athlete's family health history. Mr. Swearngin said the form will help doctors discover more athletes who have hidden problems.
Physical exams include height, weight, blood pressure, heart and lung checks. If an athlete passes those tests, he is cleared to play. If something comes up, such as a heart murmur, the athlete is transferred to a specialist before he is allowed to participate.
Coaches and administrators agree that all the equipment and training cannot prevent sports injuries.
"I get a little uneasy with the word 'safe,"' Mr. Swearngin said. "We try to do everything we can with rules and procedures to minimize the risk that something is going to happen to someone.
"But I think we all need to be smart enough to recognize that if you're sitting at home or if you're walking out of your home, you're not immune to risk."
"It certainly makes me feel safer to have the ambulance there, because we are in an isolated location. In an ideal world, we would have one at every game." - Greenbrier Middle School Principal Jackie Creasy
Reach Melissa Hall and Chris Gay at (706) 868-1222.