In 18 years of Special Events medicine, with more than 10,000 events under my belt I have realized there are three rules every event planner should be aware of.
Rule Number 1:
This is not a mass casualty incident (MCI) , but simply a special event.
Rule Number 2:
No matter how much money you spend or resources you allocate there will be some patients.
Rule Number 3:
You can not do anything about rules 1 & 2 .
Too often EMS agencies treat a gathering of people as a potential mass casualty. I understand the world has changed since 9/11. Just because we haven’t been attacked in 12 years doesn’t mean we wont be in the future and we must be vigilant in our preparation. The challenge facing Event EMS is that no event or EMS service can afford to find the MCI boogie man at every gathering. A MCI response is an expensive endeavor and by no mean am I say don’t be vigilant or prudent. What I am saying while there is a ever so slight possibility of an event turning a mass casualty incident as a general rule they rarely do.
If Event Medicine is to continue and grow then a change in attitude is a must. We must treat each event’s potential as an MCII exactly how we treat each airplane take off and landing as an MCI. There is always the possibility a plane may crash, but we do not place every resource we have on the run way every time a plane lands or takes off. How long before the shear cost of that would cause the whole industry to grind to a halt. The same hold true for events, plan a good response and have a MCI plan ready and practiced.
Rule Number 2: I was involved in a shared public/ private response recently for a medium sized event. After a period of time the EMS chief and I settled on a plan for the event. The planned used historical data, concluding that the maximum expected attendance on on any single day to be less than 40,000. As the race drew closer the local EMS chief demanded at the last minute that we add additional medical carts above what we already supplied. I told the chief the plan we have is fine at current staffing levels. Remember he doesn’t do this type of response often and has little if any experience and if you add the conventional Fire Department dogma dictates over whelm problems with resources. This year that option was not available to them hence they where forced to construct a fiscally responsible response plan.
At the last minute the chief started demanding more resources as he got more and more unsure and nervous. I stopped and asked him one simple question, “what is the goal of your response “? He looked at me for a moment and responded ,” We don’t have anymore people and if you remember last year we got busy on the last day”. I said, “ that may be true if you call 16 calls over 12 hours busy, but I don’t by SEMS standards”.
I started to think the Chief doesn’t understand the rules and it is impossible to do anything in life if you don’t first know the rules. I explained first my guys are not being paid to sit around so if they are busy that is fine, very unlikely but fine. I continued to explain that he had to realize that there will be patients no matter how much money we spend or people we bring in there will be some patients. We all need to remember cops ride around in large numbers to deter crime and criminal behavior, large numbers of EMS assets will never deter someone from becoming ill.
My next blog I will talk more on this subject but remember base on my experience I have found the average patient load , all things being even to be about 1% to 2% of the total attendance.
Rule Number Three: There is nothing you can do about rules one and two. While there are no absolutes in EMS or life these rules generally stand for the average event. There are always the rare event that breaks the rules like WTO protests , a fair being struck unexpectedly by violent weather, like what happened at Sugarland and the July 2012 Stage collapse in Toronto, Canada. The fortunate thing for everyone is these are exceptionally rare happenings and a MCI plan was in place and executed. In my 18 years I have only been involved in 1 or 2 exceptional events making the odds pretty good that the event your planning will follow rules 1,2 and 3.