Referee Dan Dreger was on his hands and knees, blood streaming from his face and into a small puddle on the ice.

His palate, the roof of his mouth, was cracked in half lengthwise-from his upper teeth all the way to the back of his throat. When he closed his mouth, his upper and lower teeth didn't line up anymore.

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Facial bones on both sides of his nose were fractured.

The area between his upper lip and his left nostril was cut open, in need of three dozen stitches.

Dreger had been hit in the face by a slap shot from 6-foot-4, 220-pound senior Omaha defenseman Grant Gallo.

Dreger never saw it coming.

As soon as Gallo wound up to take the shot, Dreger turned his focus to two players battling on top of the crease, so he would know whether to count the goal if the puck went in the net or whether he'd have to waive it off for goalie interference.

The puck hit one of those players, and deflected straight toward Dreger, who was standing about 10 feet away. It caught him underneath his protective visor.

"I didn't lose consciousness," Dreger said of the Jan. 26 incident. "I just remember thinking very much how bad this sucks."

Dreger skated back to the medical room at Baxter Arena and the Omaha team doctor was already in there waiting for him.

After looking at Dreger, the doctor told the emergency medical technicians to pull the ambulance around.

Dreger responded: "Doc, I'm all right. Isn't there someone with a Chevy who can take me?"

Despite being injured so badly that he needed surgery to install four permanent plates in his face, two temporary brackets in his mouth, eight screws and 36 stitches, Dreger was already more concerned with the potential financial pain than his current physical pain.

This is a reality for college hockey referees.

They work as independent contractors and injuries sustained on the job are not covered by the leagues they officiate.

Dreger needed five hospital visits to fix the damage to his face and mouth. By the time he was done, his medical bill was $89,000.

Even though he has a good full-time job as a software engineer in San Francisco with strong health care benefits that picked up most of the tab, Dreger was still on the hook for about $10,000 out of his own pocket.

He made less than half of that working as a National Collegiate Hockey Conference official last season. So, the 36-year-old Dreger lost a couple thousand dollars by deciding to work a part-time job as a college hockey referee in 2017-18.

College hockey leaders acknowledge that this is a problem, but they have no ready solutions.

"When you have extensive injuries like with Dan's situation, those are tough ones, for sure," NCHC commissioner Josh Fenton said. "No question about it. We didn't know the severity the night it happened. Once Dan got back to San Francisco, we found out it was quite extensive. We've been trying to do what we can to check in with him and see if there's anything we can do to help."

Still, there are no guidelines for how a college hockey conference can help an official offset medical costs for injuries suffered on the job.

NCHC supervisor of officials Don Adam plans to raise the issue later this month at college hockey's annual meetings in Florida. He had brief conversations with his Atlantic Hockey counterpart, Eugene Binda, at the NCAA Frozen Four earlier this month.

"We're always trying to find something that could serve as a secondary insurance to better protect guys to help them out with some things they end up paying with deductibles or out-of-pocket expenses," said Adam, who once needed $10,000 of dental work done after he was hit in the face with a puck while reffing an American Hockey League game. "Those are all things we look into. Those are all things officials should look into as well. We'll continue to try to do that, because it was such an interesting year."

There were several minor injuries to officials in the NCHC this season.

Linesman Brandon Schmitt got knocked out of a game because of a rib injury when he got caught in the middle of a collision between players. Referee Nick Krebsbach nearly took a puck to the face one night after Dreger, but Krebsbach got his hand up in time to protect himself. He suffered an injury to a finger.

For minor injuries like that, the host school often provides immediate care for the officials for free.

But Dreger's incident was a different story.

"It was the most serious injury we've had in five years of the league," Adam said.

Dreger's road back

College hockey referees are typically paid between $375 to $450 per game, depending on the league. Linesmen are paid roughly $200 to $250. They are required to have liability insurance in the NCHC. The league takes care of travel expenses.

Dreger grew up playing hockey in Colorado, but now lives in San Francisco. He travels about two or three weekends a month to officiate college hockey games and has been with the NCHC since its inception in 2013.

It's something his co-workers in the tech world find baffling.

"California is not big hockey country," Dreger said. "This notion that I get on a plane and go to the Alabama football of college hockey, get screamed at by 12,000 fans on a Friday night, skate with players who will be in the NHL the next year, dodge pucks, sometimes not dodge pucks, is preposterous to them."

That was especially the case after what happened in January.

After Dreger got hit by the puck, he immediately dropped to the ice.

Omaha forward Zach Jordan, the nearest player, was the only one who noticed what was happening.

He looked at Dreger and yelled at him to blow his whistle, but Dreger couldn't because of the injury.

Finally, one of the linesmen recognized that Dreger was hurt and stopped play. The other referee, Tom Sterns, said: "Dregs, that's a bad one. We've got the rest of this game."

Dreger skated to the medical room on his own power and Sterns finished the game on his own.

Dreger did wind up taking the ambulance to Bergan Mercy South after an Omaha doctor, who was worried about possible brain trauma, promised him that the school would pick up the tab. Omaha did pay for it.

"They're amazing for doing so," Dreger said.

He spent the night at the hospital after getting 36 stitches. The following afternoon, he flew home to San Francisco, where he had surgery a week later.

Doctors installed four permanent plates into his face and two temporary brackets. The plates were to help fix the facial fractures and the brackets were put in to help his palate heal correctly. He also had his jaw wired shut for two weeks.

"I couldn't speak very well, which some people thought was the greatest thing in the world," Dreger said.

His girlfriend made meals that he could drink through a straw.

Three weeks after the initial surgery, Dreger had the lower bracket removed. Five weeks after the surgery, he had the upper bracket removed. In order to do that, they had to take out the screws that went through his gums and into the bone.

"I could feel the screw untwisting itself from the nerve of my tooth," Dreger said. "And that was terrible."

A second time

This wasn't the first time Dreger went through an incident like this.

In 2010, while reffing in the Central Hockey League in Hidalgo, Texas, Dreger was hit by a puck in the face. That time, he needed two permanent plates put in his face and two follow-up plastic surgeries.

Dreger now has six permanent plates in his face because of the two incidents.

Dreger is now back at home in San Francisco working his full-time job, but he still hasn't totally recovered from the January incident.

He still doesn't have feeling in his upper lip and is unable to blow out a candle or effectively blow a whistle.

Even so, Dreger said he's thankful that his injuries weren't worse.

"I had a friend in San Antonio that got hit in the forehead," Dreger said. "Guys get eye injuries, trachea injuries. I'm done in six weeks. I look like I've always looked. In four-to-six months, I'll have full feeling. This is not a longterm life-changing major thing compared to tooth damage, skull fractures, trachea injuries. It's a long six weeks, but six weeks to be in and out is not the end of the world."

Dreger said he was also thankful for the support of people in Omaha.

In addition to picking up the cost of the ambulance ride, he said Omaha athletic director Trev Alberts checked up on him and the Omaha Red Army fan section frequently reached out to him to see how he was doing.

"I don't know if I've ever felt so cared for as a referee," he said.

Future changes?

The well-being of officials is expected to garner conversation later this month at the meetings.

At the moment, visors are not required for referees. Not all NCHC officials wear them. They could be mandated in the future.

Dreger was wearing a visor when he suffered his injury.

It is unlikely that the NCAA or NCHC will require full cages for officials, because they need access to their whistles, and it makes communicating with players and coaches more difficult, Adam said.

The other topic will be brainstorming for ways to help offset out-of-pocket medical costs for officials who get injured while on the job.

Although officials in other college sports work under the same arrangement as hockey officials, they don't face the same level of risk.

Finding a good solution to situations like Dreger's could help the league recruit and retain high-level referees.

Whether any solutions are found or not, Dreger said he will likely try to officiate again-even after a nightmare season in which he ended up in the hospital and lost money by taking on the part-time job.

"Yeah, I think so," Dreger said about reffing again. "I wasn't allowed to do anything physical for six weeks. I'll continue to work to get back in shape, work to get my muscles going again, work to get my face and my lip working OK. And if everything works and fits and looks good. . . they usually make hiring decisions in May and June.

"People always ask me if I'll be scared going back. I guess you don't totally know until you do it, but I wasn't after the first time I got hit. I was more nervous about missing a call than getting hit."