Trainers and paramedics sometimes interact on the football field, especially when a player is down with a neck injury.
In contrast to what happens between opposing players, these parties can't be at loggerheads.
A pair of UPMC trainers from western Pennsylvania spoke at a state conference Thursday at the Blair County Convention Center to about 50 EMS workers, helping to ensure the interaction is cooperative - not competitive, adversarial or non-existent.
Trainer Dwight Randall of Norwin High School recalled a time when he was holding the head of a player on the ground, and a newly arrived EMS worker, seeking to take over the scene, asked him to give way.
That's a no-no, because the less jostling the better, and a trade-off risked unnecessary movement, he said.
Better to work together for the best outcome for the injured player, said Joe McShane, trainer for Latrobe High School.
"A team approach," Randall said.
Still, there are roles best played by trainers or by ambulance workers, said Gary Watters, deputy director of AMED, who attended the session - part of this year's Pennsylvania EMS Conference and Pediatric Emergency Care Symposium.
Removing the face mask from football helmets when there's a potential neck injury, to clear the way for intubation if there's a breathing problem, is generally the responsibility of the trainer, according to Watters.
The intubation is the responsibility of the EMS workers, Watters said.
Still, there are times - often in youth football - when a trainer might not be available, and an ambulance worker, called to the scene, must remove the mask, Randall said.
Mask removal can be tricky, though, and the best techniques depend on the make and model of the helmet, the trainers said.
Generally, workers unscrew "strap loops" that hold the mask to the helmet shell.
A battery operated screwdriver does it with minimal jarring. But if a screw is rusted tight, its threads are stripped or its threaded socket rotates along with the screw, workers must cut the straps.
One helmet model has a clamp-like holder at the forehead position, which, when loosened, should free the mask for workers to slip off smoothly.
But even McShane struggled to remove it from a demonstration helmet, leading one EMS worker to observe that in an actual emergency, that would create dangerous jarring.
Fortunately, the manufacturer of that model has made improvements, and new versions are easier to work with, McShane said.
All the helmet manufacturers have been making improvements, which include a spring-loaded screw that releases after a quarter-turn and a spring-loaded fastener that releases with a pen point, McShane and Randall said.
The trainers also instructed the ambulance workers on concussions.
Big money - represented by the National Football League, which recently settled a lawsuit by concussed former players - has brought the subject to the attention of the entire country, Watters said.
His son plays for the Altoona Football League, and two of his teammates have been concussed, Watters said.
There are between 1.6 million and 3.8 million concussions a year nationwide, and about half happen in football games or practice, Randall said.
The trainers' employer, UPMC, pioneered concussion baseline testing for athletes, to provide data to compare with post-concussion capabilities, helping determine a safe protocol for returning to action, Randall said.
The tests includes working memory, visual memory, word memory, attention, reaction time, mental speed and processing speed.
High school athletes get baseline-tested once every two years.
After concussions, the return to action is gradual. It begins only after the patient is asymptomatic while at rest.
There are light, then moderate aerobics, non-contact practice, contact practice, then game participation.
It can be difficult, but if a high school football player is ready for his first contact on the Friday of a game, he needs to wait, because that first contact can't been in the "uncontrolled" chaos of a game, Randall said.
A doctor needs to clear the patient before his return.
By the new Pennsylvania Safety in Youth Sports Act, coaches now need concussion training.
They face suspension for the rest of the season for failing to follow protocol.
A second offense means suspension through the next season.
A third offense mandates a permanent suspension.
Returning too soon is dangerous for players.
"Second impact syndrome" - which occurs when a patient not fully recovered from a concussion receives a second one - is rare, but usually fatal, even though that second jolt is often milder, Randall said.
Fortunately, the problem is always preventable, if those in charge follow the protocols, Randall said.
Mirror Staff Writer William Kibler is at 949-7038.