On a Friday night in October, Orbel Alvarado collided with a player from Lincoln High, leaving him on the ground with too much pain in his left ankle to keep playing. He limped to the sidelines, where EMT Armando Jurado was waiting to have a look at him.

At a time when budget cuts abound at the Los Angeles Unified School District, sports programs are not immune. This year, Franklin High School’s athletics department suffered a 30 percent budget cut, and coaches are left, in large part, to pool their resources in the community to care for players.

“We got these resources on our own. Just by being fortunate and knowing people that came to Franklin and being connected to the community,” said Franklin athletic director and head football coach, Eric Jaimes.

In the world of LAUSD football, requirements are minimal. Coaching staffs are required to receive basic first aid and CPR training and pass a coaching education course. At games, the district requires home teams to provide a certified medical expert on-site—a role that can be filled by an EMT or doctor.

In October, The Los Angeles Times conducted a survey of LAUSD football programs to assess the level of care available at games. The report discovered stark contrasts across the board. While affluent schools like Harvard-Westlake had a team of athletic trainers on the sidelines, others had no more than a paramedic waiting in case of severe injury.

Armando Jurado, Sr. is the on-site resource at Franklin games. A member of the Los Angeles Fire Department and a paramedic, he meets LAUSD requirements.

Though he is only paid for home games, Jurado volunteers at every away game as well. He has worked at Franklin for 17 years, but his commitment to the school goes back much further. He played Franklin football, as did his son Armando, Jr. He said Franklin is more than just a school.

“I love the sport, I love the kids, I know the coaches very well. It’s a family so we stay together and work hard,” Jurado said.

The junior Jurado, now a licensed EMT, also volunteers at Franklin games when he has a free Friday night. He met Alvarado on the sidelines at the Lincoln game.

Jurado quickly taped Alvarado’s ankle, tightly binding a large bag of ice around it. Alvarado had no choice but to sit still with his eyes on the game. He said he was ready to get back on the field to help his team.

“If I go out there, I’m confident that it’s good,” said Alvarado.

As a former athlete, Jurado said he knows that players will ignore an injury to get back into the game. Immediacy often trumps the bigger picture.

Though the hitch in his step indicated he was in pain, Alvarado said he was feeling better. The ice was removed; he did a few drills without incident and was back in the game.

“If it hurts, you gotta stop,” Jurado said.

In the second half, quarterback Michael Orozco was knocked on his shoulder for the second time. When he did not jump up right away, the coaching staff knew something was wrong and ran out to bring him back in.

Orozco’s mother, Sofia Caldera stood by closely, arms crossed tightly across her chest. Though worried about her son's shoulder, she was confident in the coaching team’s ability to take care of him.

“Believe me. I’d be in their faces otherwise,” said Caldera.

Senior Jurado quickly peeled off Orozco’s jersey and ensured the shoulder was not dislocated. Then he placed ice on the shoulder and sat Orozco out for the remainder of the game. With no specialist around, the coaches referred Caldera to a local emergency room where her son could be seen by an orthopedist.

Expertise

The hot topic in the world of high school athletics is the certified athletic trainer.

CAT’s have a bachelor’s degree in athletic training (or a complementary field) and argue they have the expertise to recognize, treat and rehabilitate sports-related injuries with a keener eye than most coaches, EMTs or general practice doctors.

This year, the California Athletic Trainers Association partnered with California assembly member Mary Hayashi to pass legislation that would make it illegal for anyone without a degree to pose as a certified athletic trainer and require schools to purchase automatic defillibrators, remove from a game any athlete suspected of having a concussion or head injury and develop a heat acclimatization program.

Despite the seeming benefits of the bill, Gov. Arnold Schwarzenegger vetoed it twice. Then it was stripped of its most beneficial stipulations, only to include the protection of the certified athletic trainer title. Schwarzenegger vetoed the bill for a third time in September, stating, “there is no evidence regulating the use of the term ‘certified athletic trainer’ poses any threat to the public health and safety.”

[Editor's note: Hayashi is pushing legislation on a new bill, Assembly Bill 25, that will take decisions out of the hands of coaches and players when it comes to minors returning to games after head injuries.]

Mike West, president of CATA said the athletic trainer’s title should be protected to ensure parents and coaches are not misled. A trainer’s expertise, he said, allows them to assess a player quickly and decipher whether they are just hurting or truly injured. 

“Parents are telling them to suck it up get back out there, coaches are telling them to suck it up, get back out there. They are, and sometimes getting injured and getting hurt worse. That’s when you need that medical professional to delineate between the two,” West said.

Most coaches and administrators would love the advantage of athletic trainers. But it is not likely to happen any time soon in the cash-strapped LAUSD.

“In a perfect world there should be a certified athletic trainer at every single high school in the nation,” said Barbara Fiege, commissioner of the LAUSD Interscholastic Sports.

Fiege said the district has considered hiring athletic trainers, but they are a luxury that would require state funding.

Jaimes said athletic trainers help keep athletes safe and competitive as he and his coaching team have only minimal first aid training. He said they also provide an unbiased opinion from someone with no stakes in the game. It is much easier to listen to a trainer who insists on removing a player than to make the tough call himself.

“I check them out as best I can. But if I think he’s good, he’s going back to the game, and I may not know any better,” said Jaimes.

The Past

Some injuries cannot be prevented, but follow-up treatment is key. After returning to the field during the Lincoln game, Orbel Alvarado had not seen a trainer or doctor and the pain in his ankle forced him back on the bench by Monday.

There was a time when Alvarado would have had direct access to a trainer, but that opportunity was stripped in 2006.

In 1997, the Center for Athletic Medicine at USC University Hospital created the program “Excellence in Athletics.” It provided select LAUSD schools with athletic trainers and subsidized health insurance for athletes, giving them access to free Saturday clinics and doctors at the University Hospital at no additional charge.

“Excellence in Athletics” ended in 2006 when Tenet Healthcare, the former owner of University Hospital ran into financial troubles. In 2009, the University of Southern California purchased the hospital.

Leslie Ridgeway, a spokesperson for University Hospital, said the center has no plans to reintroduce the program.

Dr. C. Thomas Vangsness, an orthopedic specialist and chief of sports medicine at University Hospital helped lead the program and said its elimination was a major loss. Though he has mentioned its importance to administrators, he said, given the economy, “taking care of poor kids” is not the priority at the hospital right now.

Vangsness still volunteers at Garfield High School games. To him, keeping young athletes healthy is one step to keeping the social fabric healthy as well.

“If I can keep these kids in school and keep them healthy then they’ll graduate. If they graduate from high school, the world’s a better place. That’s my hidden mantra,” said Vangsness.

More Than a Game

At Franklin, football is a legacy. Like Jurado and his son, generations of Highland Park residents have represented the Franklin team.

For some players, the team is more than a sport but an alternative to the other lifestyles they could choose in the ebb and flow of the city.

Anthony Macias’ father played football and he loves carrying on the tradition. The team also keeps him out of trouble. Before football, he was hanging “with the wrong crowd.”

“Football changed my life," Macias said. "It’s making me do better for myself.” 

Alvarado said being a part of the Franklin team is like being a part of a family.

"The feeling you get when you win and when you make a big play, you actually feel appreciated,” Alvarado said.

Though the social benefits of team sports are often touted, footbal -- from the NFL down to Pop Warner -- has become the focus of a media storm.

The current was started in large part by New York Times reporter Alan Schwarz, who in 2007 reported that former Philadelphia Eagle Andre Waters suffered from trauma induced dementia that neuropathologist Dr. Bennet Omalu claimed was related to his depression and eventual suicide. Since then, multiple publications have revealed the deadly risks of concussions.

Now the spotlight is shining on the risks in youth sports.

On Dec. 7, the National Athletic Trainers Association hosted the “Youth Sports Safety Summit” on Capitol Hill to bring more awareness to concussions and other chronic injuries among youth. Last month, Pop Warner announced that it would require a note from a doctor before allowing a player with a head injury to return to the game.

Macias has heard the controversy, but he gives the dangers of football little thought. Like many young athletes, he carries an air of invincibility and thinks the safety precautions made by the NFL are going too far.

“The NFL is making so many rules that it’s not even football anymore,” Macias said.

Macias is not the only one who feels this way.

Michael Orozco, Franklin’s injured quarterback, said risk is part and parcel of the game and a key element to the entertainment value that sustains the NFL.

“Injuries are inevitable and it’s a lot of risk," Orozco said. "A lot of people love the game, so they’re willing to take that risk. I was and I still am. That’s why we have a helmet and that’s why we have all of this equipment."

But a recent report by Schwarz found that new and used helmets protect against skull fractures but are not formally tested against the forces believed to cause concussions. Schwarz also found that some companies that recondition used helmets sometimes overlook required safety procedures, leaving young players at risk. 

The majority of Franklin helmets are reconditioned with the exception of five new helmets purchased this season. Jaimes has not read the Times report, but he said he has always had confidence that helmets were protecting his kids. In uncertain financial times, he said they are one thing to depend on.

“The new helmets are phenomenal,” said Jaimes.

Connections

Luckily for the players at Franklin, there have been no head injuries this season, and, with the last link in their ad hoc system of resources, Orbel Alvarado finished his senior year on the field. 

Many of Glendale Community College’s former football players have become high school coaches in the area. Through an alumni network, the college’s trainers offer free services to high school players.

Aquiles Cortez, an assistant coach at Franklin, played for GCC and has referred many Franklin players, including Alvarado, to the program.

Jose Gomez is the head trainer at GCC. When it comes to high school athletes his main objectives are preventing kids from exacerbating injuries that could develop into lifelong ailments and, when possible, getting them back in the game quickly. General practice physicians, he said, often do not understand the objective of an athlete and will keep them on the bench longer than necessary.

“Pain and discomfort are part of athletics," Gomez said. "There are avenues to accelerate the healing process and to keep them on the field, as safe as possible."

After weeks on the bench, Alvarado said he was starting to see the bigger picture and went to Gomez, who assured him he was only suffering from a temporary (but notable) muscle strain. Gomez treated Alvarado and gave him a series of therapy exercises to get him back on the field.

Gomez said it is always a satisfying moment when he can assure an athlete that it is not serious, that they will play again.

“The look of relief on their face is fantastic,” Gomez said.

By the time playoffs rolled around, Alvarado was able to play again and see one last victory in the first round of playoffs.

“I hope that I helped the team win,” Alvarado said.