I love Event Medicine!

It is days like today that I realize that my love of emergency medicine is alive and well. I worked out at Folsom Lake (a beautiful, albeit man-made lake just outside of Sacramento that provides a lot of the water for this region) for a friend of mine that runs an event medical service, First On-Scene EMS. It was a triathlon, and there were several hundred participants. This was a swim, a bicycle ride, and then a run. Its a lot of work for the participants. And sometimes a lot of work for those of us providing emergency medical care at these events. A lot of you know I also work for the Sacramento Rivercats, a AAA-affiliate Minor League baseball team. These two jobs have one thing in common. They are events. And event medicine is getting to be big.

The image that you see (on the left) is called the Star of Life. It is the multi-faceted approach to emergency care, with the ultimate goal of improving outcomes for those who are ill or injured. Notice the bottom phase, On-scene Care. This is where Event Medicine comes into play.

I started working in event medicine several years ago, and I love it! I thought I'd explain it a little more to everyone, so that you would understand what it is, and why it is important in today's society.

What is Event Medicine? Well, put simply, it is having emergency response personnel (EMT's and Paramedics) at events where large numbers of people are gathered. Rather than having someone call 911 when someone gets hurt or sick, a certain number of EMT's and/or Paramedics are on-scene to help stabilize and treat a patient and either transport them to the hospital, arrange for transport to the hospital, or release them from care (for minor injuries or illnesses that require no further treatment than provided).

Why is Event Medicine important?

Over the years, our activities have changed. Many people engage is what is considered "higher risk" activities than in the past. Soccer, baseball, football, wrestling, running, swimming, biking (including biathlons and triathlons), skating, surfing, skiing, you name it. Many people are aware of "ski-patrol". This is a form of event medicine. People who are specially trained in both emergency medicine AND skiing and its particular injuries and treatment do ski-patrol. At biathlons and triathlons, the situation is the same. People are trained in their emergency specialty, and also in the particular injuries and illnesses expected at this type of event. This is the same for baseball, and other sports. Non-sporting events include fairs (like county and state fairs), parades, etc. At almost all of these, there are event medical personnel, waiting in the background (or sometimes mingling with the crowd with their gear) to provide care as soon as it is needed. For some events, it is the people participating in the event (Triathlons). For other events, it is the crowd and employees that we are treating (The Rivercats, for example).

One of the problems with the "old system" was that many people who were injured or sick at events would have delays in obtaining emergent care. This resulted in higher death rates, and higher complications (like infection from wounds). Having EMT's and Paramedics on-scene lowers those rates dramatically. We can stabilize patients readily, providing the SAME CARE for many injuries that waiting for an ambulance would provide, just quicker. Stabilization includes splinting possible fractures, immobilizing people onto backboards for possible neck and spine injuries, providing oxygen as needed, dealing with diabetic emergencies, heart attacks, etc. We monitor breathing, blood pressure, oxygenation, everything you get on a BLS ambulance. We just do it out of a tent, small room, or even out of vehicles.

OK, I see ambulances at events. What is the difference?

There isn't really any. Except cost. For an event to keep an ambulance sitting and waiting (sometimes with no need that day) is prohibitively expensive nowadays. Hundreds of dollars per hour, just to sit and wait. But event medical services are much less expensive, and provide the SAME LEVEL OF CARE as typical BLS (Basic Life Support) ambulances that are seen all over the place. While some events (such as varsity and college football, for example) mandate a higher level of standby care (due to the much higher chance of needing Advanced Life Support services), most don't need that level to be just "sitting and waiting".

Some event medical providers also have ambulances and other support vehicles, but those are not typically used to transport patients to hospitals. Many times, they are used to help us transport a patient to another ambulance provider that takes them to the hospital. Seems odd, huh? Let me illustrate by example:

It was a busy day! Today we had that triathlon. We had a bicyclist injured on the ride. A serious injury (no, I can't go into what, but imagine taking a header off a fast moving bike on an asphalt road and you get the idea). We went out there in a Jeep Grand Cherokee (just like mine) with specialty medical equipment. We evaluated the patient, kept her neck from moving, placed her in C-spine (on a backboard, strapped in), and took her in the back of the Jeep with one of us with her in the back constantly evaluating her to near the entrance of Folsom Lake State Recreation Area, where an ambulance was pulling up. We transferred her to their care. Immediately, we were informed of another racer that had also crashed. While the first patient was being transported to the hospital, we raced back to the second patient. Similar injuries (similar mechanism). This patient was in a little better shape, but still needed stabilization. The first patient triggered a typical 911 call, so we also had a fire department engine as well as the ambulance that transported the first patient. They came out with us and assisted in stabilizing this patient. Another ambulance transported this patient. While all this was going on, other event medical personnel were starting to deal with yet another patient, this one was having trouble with temperature control following the swim portion of the race. We went back to assist them. We have an ambulance there, and it was running and pre-warmed just in case of this type of problem. It was incredibly windy today, and cool. Getting this patient into the pre-warmed ambulance, getting her out of her wet clothes, wrapped in special blankets, and warm fluids helped to stabilize her, and thus avoid further injury and hospitalization. She left us with her family, instead of by ambulance. If we had not been there, another ambulance would have been called. In that time period, she would have gotten worse, not better, while waiting for it to arrive. Of course, during all of this, other patients were seen, for blisters, sprained ankles, pulled muscles, cuts, scrapes, etc. Whew!If 911 had been called without properly trained personnel on-scene, the patients would not have been treated as quickly, and I believe firmly that the outcomes would not have been as positive as they were today.

This is the same concept at other events. Having emergency personnel on-scene improves outcomes. Thus, the need for this rapidly expanding and very useful segment of emergency medicine.

I hope you now have a greater understanding now of what it is I do during evenings and weekends. Some people bowl, some fish, some play golf. I like to assist people and save lives. :-)