John F. Oliveira, NREMT-P, CCEMT-P, FP-C
The city of Baltimore hosted a major concert last week, and I had the opportunity to be part of the team of Emergency Medical Service providers assigned to the event. The Irish rock group U2 played at M&T Bank Stadium, home of the Baltimore Ravens. My company, Lifestar Response of Maryland, partners with Medstar Health to provide medical services at all M&T Bank Stadium events. When assigning staff to stadium events, we often refer to “game day” coverage, to quickly determine the amount of personnel we will need, and what they will be expected to do. The U2 concert received a slightly larger response than a Ravens home game.
For a standard football game, we staff a transport Medic Unit at each ordinal gate, and one Medic Unit on the field which is designated for the players. We also have roving solo EMTs and Paramedics stationed throughout the stadium. Medstar Health provides physicians and nurses to staff first aid stations that are situated throughout the stadium. Each transport Medic Unit is assigned to a specific first aid station. There is a centralized Communication Center in the basement of the stadium where we have supervisors and dispatchers in the same room as every municipal public safety agency present, as well as the stadium’s own safety and custodial staff. Everyone is in the communications loop. Communication and scene awareness are critical in providing excellent medical services in a large scale environment, such as a stadium event.
The U2 concert required additional personnel since the field had been covered with temporary flooring to accommodate roughly 8,000 general admission fans that would be present, instead of the usual 300 or so players, coaches, and staff. There was also an enormous 162 foot tall behemoth of a stage taking up the entire neighborhood of the east end zone. Once the thrill of being in this new environment wore off, we returned to our usual game day preparedness. Regardless of the size of the event, EMS providers must adhere to the basic tenets of their training. An initial scene survey must be performed. You have to know where you are at all times. You have to know where you are supposed to be at all times. You have to know where your fellow EMS providers are if you need help. For a large stadium-style event, this scene survey is a dynamic assessment as the crowds, and in some cases the service area, waxes and wanes. Next on the check down list, but just as important, is communications. You need to have constant access to a controlling element of the standby. During your initial scene survey, you will have to identify who will be calling you for service, and who you will be calling for direction and/or assistance. Finally, you will have to have some sort of plan to deal with whatever medical request or transport you may receive.
My partner and I were honored to be chosen to be the medical team assigned to the band and stage crew. We arrived at the stadium with our colleagues and performed our scene survey. We normally are a transport Medic Unit and have had the same post assignment for several years. For the concert, we would be in close proximity to the band at all times, and would be moving accordingly. We had to navigate around the enormous stage and re-familiarize ourselves with an alien environment. We had the standard communications equipment and personnel in place, however, we had the addition of a designated band representative who would contact us directly if we were needed. We had to be in constant visual contact with this representative, so we had to quickly establish our posts, and remain there as needed. During the event, this band representative changed three times. For every personnel change, someone assigned to the band would contact the central communication center and request a supervisor. Our supervisor would then come out and introduce us to the new band representative, and we would go over any signals that would be used. The additional layer of communication, in addition to the added security personnel only caused only minor problems; most everyone there was familiar with the standard game day operations, and used that as a common reference base.
As a whole, the concert required an average response from our combined medical services, with approximately fifty patient contacts, and seven transports to an Emergency Department. The Baltimore Ravens do an outstanding job ensuring that the right people are in the right place and that everyone can talk to each other for every event held at their stadium. This continuity of excellence allowed us to overcome our worst condition at the concert – noise. While 70,000 cheering football can make quite a loud noise, radio communications are still possible with ear pieces. U2 was much louder. It became quickly apparent during the band’s sound check that our existing radio equipment would be useless out in the bowl of the stadium while music was playing. Since the stadium security personnel were familiar with both the Lifestar and Medstar staff, security would either locate us by recognizing our uniforms to bring us to a patient, or bring a patient to our known locations. This became most beneficial during the end of the concert when those 8.000 or so fans on the field were beginning to press against the security wall in front of the stage and had to be pulled out as they became weak or sick.
Since we work in conjunction with Medstar physicians and nurses, we have a ready-made transport plan in place. We triage our patients and they either get treated in a stadium first aid room or get sent to an appropriate Emergency Department. If we transport to a Medstar hospital, we have the luxury of a Medstar health professional calling ahead for us in lieu of a standard medical consultation. In some cases, we pick up a patient and take them directly to the hospital without making contact with Medstar staff at the stadium. In these instances, we follow Maryland protocol for treatment and medical consultation. The majority of patient contacts and transports at the U2 concert were for the expected heat and alcohol related injury. Lacerations and bruises from assaults and falls were also commonplace. I had the opportunity to perform my first tooth extraction as a paramedic, which gave me the added joy of watching my dispatcher figure out how to code that entry into the event database. As to my partner’s and my responsibilities, we quickly determined that while we were there for the band and crew, the crew was far more likely to provide us with a patient. Our primary post was directly behind the stage, and the amount of people running around, moving large items, changing electrical equipment, and generally moving in a frenetic pace kept us in a constant state of wariness. On our initial arrival and interview with the first of three band contacts, we asked what type of responses were needed before, how many crewmembers were we responsible for, were there any crew with medical conditions that we should know about, and what, if any, were any other special needs that we should be aware of. These were legitimate and responsible questions that were answered with a shoulder shrug and a terse, “just stand there and wait for me to call you.” As an EMT, this indifference to our job is common, and with experience, becomes less annoying. We know we’ll figure out what we have to in order to get our job done. Last Wednesday night, among 81,000 people, we did just that.