When Spanish River High football player Miles Levine sustained a serious head injury during a preseason football game Aug. 17, a Palm Beach County Fire Rescue crew was on hand to attend to the boy, place him in an ambulance and rush him to a hospital for emergency brain surgery.
“First responders were on him immediately,” said Adam Levine, his father.
Miles Levine was lucky, and not only because he’s expected to make a full recovery.
The Palm Beach County School District does not require that emergency-medical services personnel be present during football games, mandating only that a certified athletic trainer be on the sidelines.
Despite the lack of any formal agreement, county Fire Rescue and local municipalities with their own fire departments say they send an emergency vehicle and a team of paramedics — free of charge — to games in their service area depending on availability.
That’s why there was a county rescue team on hand at West Boca High when Levine, a senior defensive back, sustained his injury.
But the same night in Wellington, there were no medical first responders on site when two people were shot during a game at Palm Beach Central.
The county school district is in compliance with the rules of the Florida High School Athletic Association, the governing body for high school athletics. It requires only that schools develop an emergency action plan to deal with serious and life-threatening injuries.
“Some school districts in the state require each school to have (EMS) on site,” the FHSAA said in a statement. “Some districts do not ... Since the state is so large and the difference between the metropolitan areas and rural areas so vast, we cannot apply a ‘One-size fits all’ application to this ...
“That is why we recommend it but cannot require it.”
Palm Beach County schools actually go a bit further than FHSAA guidelines by stipulating that an athletic trainer staff games and that all coaches receive certification both in CPR and in how to use an external difibrillator.
Principals and athletic directors in Palm Beach County also are directed by the school district to meet with station chiefs at their respective firehouses to address emergency issues, including those at football games.
But other counties do more.
Broward County requires not only an EMS crew to staff football games, but also that a doctor and athletic trainer also are present, according to spokeswoman Nadine Drew.
In Martin County, Fire Rescue is on the field for all games, spokeswoman Jennifer DeShazo said. The service is complimentary, she said.
Miami-Dade County does not require EMS at games, a spokesman said.
Dr. Jonathan Hersch, an orthopedic surgeon at West Boca Medical Center, has been a volunteer doctor at high school football games for about 20 years.
Hersch said certified athletic trainers are capable of handling nearly all on-field injuries he’s witnessed.
“I can count on one hand the number of times we’ve needed Fire Rescue,” Hersch said. “Most of the games I show up to, at the end of the game I realize I really didn’t need to be there.”
But given the choice, Hersch would prefer to have a Fire Rescue truck and paramedics standing by for that “one-in-a-thousand hit or injury.”
Certain injuries, specifically those related to the spinal cord and cardiovascular events resulting from South Florida’s heat, can become life-threatening quickly, Hersch said.
“Minutes may matter,” he said.
According to the National Center for Catastrophic Sport Injury Research, 24 high school football players were killed between 2005 and 2014 after sustaining either traumatic head or spinal cord injuries. Of that group, 20 died on the field.
Since 1995, an average of three football players — most of them high school students — have died of heat stroke each year, according to the National Center for Catastrophic Sport Injury Research
“Current best practices include access to athletic trainers for practices and competition and maintaining emergency medical services onsite during competitions,” according to the Centers for Disease Control and Prevention.
Assistant superintendent Peter Licata has been a principal and administrator in Palm Beach County for two decades and said he can’t recall a player sustaining a life-threatening injury while on the field.
Having an EMS crew at games “is something we could always explore” but many schools are “right next door” to a firehouse or substation, Licata said. Most high schools in the county are two miles or less from a station.
“They’re quick to react when they hear ‘high school,’ ” Licata said.
Valerie Miyares, the district’s director of athletics, said the company that’s contracted to provide schools with certified athletic trainers also coordinates the presence of medical doctors at football games.
Although district policy does not require doctors on the sidelines, Miyares said she’s been assured a physician is at every game.
Dr. Manuel Brito, medical director of the pediatric concussion center at Palm Beach Children’s Hospital in West Palm Beach, said while doctors on the sideline provide a level of comfort, Fire Rescue trucks are specifically equipped to handle “catastrophic situations.”
“Without the tools available to a first responder, I would be limited,” Brito said.
Brito said he’s never seen any data or study that shows having Fire Rescue standing guard at high school football games has “changed anything” and adds that athletic trainers are capable of tending to most injuries.
Still, Brito said whether school districts mandate EMS crews at games should be a “tough decision.”
“Is the community prepared to have that one catastrophic event happen and not have first responders there?” Brito said. “That’s a question that has to be asked. It’s extremely unlikely but if it did occur, you’d have a community clamoring for it.”