Event EMS in America

[Melclin]

In order to gain some practice in basic patient care and to make my resume a little more impressive, I got involved with St John Ambulance, a volunteer organization that provides event first aid, about 18 months ago.

I've never heard anything about St John and now much about event EMS on this forum so its had me wondering: How does American event EMS work?

-Is there an equivalent first aid organization?
-What kind of events do they cover? A football match, for example, may have between 50,000 and 100,000 people attending. They must have some EMS capacity. What about school fetes, fun runs, concerts etc?
-What level to members practice at?
-In what sense are they related to other EMS services around them (our state ambulance service and St Johns are entirely separate and very different organizations but often work together in many ways)?

Give me a rundown of event EMS in your area.

 

[Madmedic780]

Locally the local rodeo association pays our fire dept $13 an hour to have one medic with a med box and radio on site during the shows. My department has open sign ups for our EMT's and Medic to sign up for time slots and get paid $12.50 an hour. The thing is that these shows usually guarantee at least two trauma victims (especially jr. rodeos) and one or two medical calls per 8 hour shift. When that happens we radio for our medic to respond and then work to stabilize and prepare the patient for pick up and transport.

Thats my experience for Event EMS.

 

[medicRob]

Example: Bonnaroo

There are three divisions of Event Medicine in Bonnaroo:

1. Venue Medical (The people who walk around the event on foot or drive carts)

These individuals are usually First Responder, EMT, or Paramedic.

2. Tent Medical

There are tents setup all across the venue, these tents are staffed with:

1 MD, Several RN's, Paramedics, and EMTs

3. Management (They oversee operations in the tents, venue, and arrange services such as police escorts when we have to get a patient to the chopper)

-----
Upon checking in to one of the ID centers of Bonnaroo, you show your medical license, they look you up on the list, and issue you the proper bracelet and a sticker for your vehicle which allows you to park in a specific medical parking and camping area.

Once you have got past the check points, you will go into the main medical compound where you get your assignment.

They will say something along the lines of, here is your event shirt, you are working Centeroo tent today or you are working Venue today beside the What stage.


The Venue

If assigned to a venue tent, you are given a lift to your assigned location and are put into teams of 2. One person has the radio. The locations of the teams are alternated at regular intervals throughout the entire event.

The job of these individuals is to respond to dispatched medical emergencies called in by the event staff on radio and to either walk the patient to one of the medical areas (if condition permits) or to get one of the medic carts to come pick the individuals up and take them to the tent where they can be treated.

One of the smartest things we do when working venue is to pack our pockets full of extra bottles of water to pass out to patrons who we feel could use them.

The Tent

The tent will mainly consist of several RN's, One Physician, and a slew of EMT's, each individual is allowed to act within his/her scope of practice as mandated by TN Law. We have full jump kits, narc box, ACLS meds, IV Drip sets and fluids, bandaging/burn care/anaphylaxis supplies and meds, as well as personal hygiene items such as tampons, etc.

One of the main things we see at this event, since it is held in June are heat related emergencies. Each medical tent has several hundred bottles of cold water available and the team is encouraged to pass them out to event patrons and to try to encourage any patient who comes in to drink.

One of the most common treatments we perform for basic heat emergencies are letting the patient cool off as we run 2 Liters of Saline to rehydrate them. We are allowed to d/c the IV and release the patient as we see fit. This usually involves d/c of the IV, then asking the patient to drink some water as you assess their vitals, whether or not they can stand without dizziness, etc.

When someone comes in needing something along the lines of an aspirin, bandaid, etc. We sign them out in the supplies list and the patient is on their way.

With regard to emergent or critical situations where transport to a medical facility is warranted, we have Coffee County EMS at the event on Standby where they have several ambulances. For the more critical, time-sensitive patients, we have 2 Medical Choppers stationed at the event (Air Evac Life Team and Vanderbilt Life Flight).

Having the MD available is also a god-send because he is right there to give the treatment orders, he brings an expanded scope to the field (such as the ability to suture a patient on site), the ability to use and mix the medications we have in our kits in ways that might not be that familiar to Nurses or paramedics to elicit very specific effects. Moreover, the diagnostic capability (while limited to low tech means) that the physician brings is fantastic.



Other Services

I work for several other event medicine services aside from National Event Services (Whom is over Bonnaroo) throughout the year. The other services handle all types of events:

1. Sporting Events

Football, Hockey, Basketball, etc

2. Concerts

CMA Awards, Bonnaroo, etc.

3. Private contracted events


While NES is pretty lenient with what we can do (Within our scope of course), some agencies restrict things such as IV administration and management to Registered Nurses and MD's only.

 

[MrBrown]

From what Brown has seen the event medical market is mainly contracted out to private agencies or PUM/third service providers who pay the applicable hire rate; not unlike when Bathurst pay the ASNSW to come cover them.

 

[abckidsmom]

When I worked in the city, standbys were hired by the event coordinators. They ordered up a truck, or a bike medic, or very occasionally a walking team, and the company added those shifts to the day, to be taken by part timers or full timers on OT.

The biggest standby event in my immediate area are the NASCAR races at Richmond, which function a lot like Rob's description. Quite a while ago, some friends of mine were doing a standby there and there was a light rain just before the race. They had all the ambulances go out and drive on the track to dry it up. That *almost* made me want to go out there for a standby sometime myself, only I'm allergic to mass quantities of drunk people.

Also driving in circles. System status management has cured me of any desire I ever had to drive in circles.

Locally in our rural county, the only regular standby we have are the high school football games, which are very well-attended (10,000 +, which is about 1/3 the population of the county). Usually two trucks sit in the designated ambulance spots right off the end zone, and one of them is for the first walk up patient while the other is for the football players. These are usually extra trucks in the system, but sometimes they are the standard duty crews (cause really, everybody's at the game!)

 

[MEDIC802]

The service I work for provides the medical coverage to a major division 1 college, this includes football, baseball, basketball, soccer, womens softball, womens basketball, equestrian, swiming and diving as needed, concerts, student activities events, also highschool football for 7 different schools in the county, plus other multiple events as needed.
I will focus on college football, our towns population increases by about 90,000 between friday afternoon and saturday at kickoff, we usually staff about 50 medical personell on campus at kickoff, depending upon being an SEC game or non conference game staffing numbers will change, we have 4 aid stations set up around campus pregame, staffing usually includes 2 paramedics 2 basics and 2 first responder per tent, each tent has a medical transport cart assigned to it which is staffed by the personell assigned to the tent, the stadium has 6 first aid rooms of which the main first aid and cardiac room are assigned doctors, nurses and paramedics, the main first aid and cardiac room is set up as ALS, also the medical transport carts are set up as ALS and the paramedics operate within the scope of practice.
I have been involved with event medical services for a long time what we have here works well.

 

[DesertMedic66]

the company i work for has employees from EMT-Basics all the way up to Doctors. we do event from concerts, polo games, rodeos, motorcycle events, all the way up to the Baja 1000 in Mexico.

 

[Melclin]

Thanks for your replies.

I'm interested to know, what role an EMT has in these environments. I suppose it differs depending on the state, but there seem to be quite a few places that simply have EMTs transport with oxygen. If their main role is transport, how does this work in an environment where most people don't get transported.

If someone comes up and asks for a paracetamol, can an EMT do that? Can a first responder? What sort of framework exists for hand balling jobs to higher care?

Even paramedics..how do they fair in an environment where transport is rare. Or do you transport everyone?

I look at how we do things, and knowing the things I do about American EMS, I just find it hard to fathom how what we do could work in America. It seems were are similar when it comes to larger events, although you don't seem to have as many hands on deck as we do. How many patrons and staff do you think you'd have at Bonnaroo, Rob? We had about 90 for 50,000 at the one day Big Day Out festival, ~40 for 28000 at Pyramid rock festival. Both times we were run off our feet. How does that compare?

I'm also interested in the smaller events. I get how FRs and EMTs function at larger events with supervision, but what about a school fete, or a community festival with 500 people. Here we might send two first aiders/FRs along (FR here is roughly: AED, Oxygen, ASA, Paracetamol, Albuterol, Antacids, and various methods of treating scrapes, cuts and boo boos). They are volunteers and have zero transport ability. Mostly they are there just to lend an atmosphere of safety and sit along side the token police car with kids climbing all over it, but occasionally work pops up. I don't understand how there could be an equivalent in America where strict protocols and medical control rules. Is there an equivalent community based first aid presence?



I think there are a lot of good things we do in event EMS but also a lot of bad things, so I'm hoping to get some fresh ideas from your collective experience.

 

[medicRob]

If someone comes up and asks for a paracetamol, can an EMT do that? Can a first responder? What sort of framework exists for hand balling jobs to higher care?

The EMT would go to the supplies, get the tylenol (paracetamol), have the pt sign their name on the sheet and send them on their way.

Even paramedics..how do they fair in an environment where transport is rare. Or do you transport everyone?

Think of their role more along the lines of an in-hospital paramedic functioning alongside the nursing team and under the physician as opposed to your common image of what a prehospital medic does. At bonnaroo, we rarely have to transport anyone to medical centers, we can usually just treat them and release once we see fit. It is a lot like fishing.

How many patrons and staff do you think you'd have at Bonnaroo, Rob? We had about 90 for 50,000 at the one day Big Day Out festival, ~40 for 28000 at Pyramid rock festival. Both times we were run off our feet. How does that compare?

100,000 Patrons in 2010, 200 Medical Personnel.

I'm also interested in the smaller events. I get how FRs and EMTs function at larger events with supervision, but what about a school fete, or a community festival with 500 people. Here we might send two first aiders/FRs along (FR here is roughly: AED, Oxygen, ASA, Paracetamol, Albuterol, Antacids, and various methods of treating scrapes, cuts and boo boos). They are volunteers and have zero transport ability. Mostly they are there just to lend an atmosphere of safety and sit along side the token police car with kids climbing all over it, but occasionally work pops up. I don't understand how there could be an equivalent in America where strict protocols and medical control rules. Is there an equivalent community based first aid presence?

I'm not quiet sure on this one, we mainly utilize EMT, EMT-Paramedic, RN, and MD at all the event services companies I work for.

 

[DesertMedic66]

From what I have seen at different events that I was attending, if a patient needs to be transported the event medical staff will call in for another ambulance company and do a hand off so that they can remain at the event.

 

[medicdan]

From what Brown has seen the event medical market is mainly contracted out to private agencies or PUM/third service providers who pay the applicable hire rate; not unlike when Bathurst pay the ASNSW to come cover them.

You've got it. Generally, private ambulance services are contracted to have these details or standbys. The service that has primary response for that area (whether fire, third service or private) sometimes has a say (or first right of refusal for the detail) over who covers the event, but otherwise it's all up in the air.

Different venues have different policies. I have worked both at a classical venue (doing stanby EMS) and from the world of Collegiate EMS and event, where college students (EMTs) cover sporting venues on a regular basis, and there is a entire skill set (sub-specialty within EMS) devoted to determining what resources are required and how to best allocate them in a given venue.