KARNS CITY — After Brady Terwilliger, an Allegheny-Clarion Valley basketball player, hit his head on the court while playing against Karns City, the audience fell silent while athletic trainers tended to his injuries.

An ambulance arrived, he was taken to a hospital and the game resumed.

But that incident raises the question: How prepared are schools for treating serious injuries?

Terwilliger was injured Dec. 18. He was taken to Butler Memorial Hospital with head and neck injuries, but his father, Alan Terwilliger, reported he is doing well despite being in some pain.

Terwilliger has a concussion and a sprained back and neck, but X-rays show no other issues, according to Ron Kerlin, A-C Valley athletic director.

“He's actually kind of lucky, but he has a severe concussion,” Kerlin said.

When Terwilliger was injured at Karns City, both schools had athletic trainers there who evaluated the injury, said Brian Markle, Karns City athletic director.

The possibility of an injury is a risk associated with playing, Alan Terwilliger said.

“As a parent, you're always concerned about your child playing a sport,” he said. “But it's a risk you take.”

He was impressed with how the A-C Valley staff responded to the injury, and he is confident in the school's policies if anything were to happen again, he said.

Markle noted that sports without protective gear, such as soccer and basketball, can make players more vulnerable. Football, which has protective gear, is not immune from injuries because it is a collision sport, noted Mike King, South Butler School District athletic director.

Even noncontact sports can have the risk of serious injury, especially of the neck and back, said John Burnett, Karns City head athletic trainer. Swimming and diving and gymnastics can pose a threat, he said.

While the potential injuries might differ, no sport is risk free, said Heather Lewis, Seneca Valley athletic director.

“With that in mind, the Seneca Valley School District has as its primary focus the well-being of all student-athletes,” Lewis said. “The district employs two full-time, certified athletic trainers and has a team of doctors available through the district's partnership with Tri-State Orthopedics.”

In addition, the coaches are going through the PIAA-mandated Coaching Philosophy and Sport First Aid courses and are required to pass each course's exam, Lewis said.

Lewis said the athletic trainer, athletic director or designee are on site for the majority of all athletic events. The emergency contact numbers are shared among the athletic trainers, athletic administration and the coaching staff.

State-required paperwork includes a statement on “Permission to administer emergency medical care,” which all parents or guardians must sign before a student is eligible to play sports, Lewis said. That paperwork also includes “Understanding of Risk of Concussion and Traumatic Brain Injury” and “Understanding of Sudden Cardiac Arrest Symptoms and Warning Signs” that requires the signature of a parent or guardian.

Butler, South Butler and Karns City districts have similar procedures to handle emergency situations, according to each school's athletic directors.

All three districts have two certified athletic trainers on staff. At minimum, there is a trainer at all varsity games, but the trainers try to attend as many sporting events as possible.

For home football games, the districts have a team doctor and ambulance crew in attendance, but this is not the case for other sporting events.

When an injury does occur, the doctor or athletic trainers assess the injury and determine if emergency care is needed. In cases of spinal or neck injuries, the objective is to move the player as little as possible until help arrives, Markle said.

At all three districts, parents or guardians are required to fill out paperwork with emergency information and acknowledge the risk of injury, Butler AD Bill Mylan said.

Many districts have been fortunate not to have many serious injuries over the years, King said.

“We've had a couple instances here and there over the years,” he said, stressing that trainers are adequately prepared for emergency situations. “Most high schools, in terms of trainers, have excellent levels of training.”

“Truly, most injuries happen at practice,” Markle said.

He can count the number of serious injuries in his 32 years at Karns City on one hand, he said. More commonly, students end up with minor injuries like sprained ankles.

Burnett believes the best way districts can be prepared for emergencies is to have venue-specific emergency action plans, which athletic trainers are often taught how to prepare in school.

The field of athletic training also is in the process of making a master's degree a requirement for an entry-level position, Burnett said.

“We only want the best outcome for the student-athlete,” he said.

Eagle staff writer Whitney Randolph contributed to this report.