Steeplechase News – By Joe Clancy - May 13, 2009
 The horse falls. The radio call goes out. “Jockey down at Fence 12. Unit 2 respond.” A specially outfitted John Deere Gator, Unit 2 races to the scene with two paramedics, a backboard and a host of equipment packaged specifically to deal with traumatic injuries.
Once on the scene, the paramedics go to work. They assess the injured jockey, stabilize his injuries, prepare him for transport, place him on the backboard and on the Gator. Slowly, safely, surely, the Gator transports the jockey to the ambulance stationed in an area designed to speed exit from the property. The ambulance then transports the jockey to the hospital.That’s the plan anyway.A customized, step-by-step medical protocol for a steeplechase meet looks something like the above – especially in Maryland. The Grand National, Maryland Hunt Cup, Shawan Downs and several point-to-points work with Special Events Medical Systems, a Baltimore-based company that specializes in emergency services for events and mass gatherings. Working with Dr. Jeff Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center, and other doctors, SEMS crafted a steeplechase plan several years ago and continues to hone the services offered.

“How do we get care to the jockeys? That’s the big question and it underlies everything we do,” said Clay Richmond, president and owner of SEMS. “Most ambulance services have a hard and fast rule that you don’t take ambulances off a hard surface. They just aren’t made for it, they could flip, they could get stuck, it’s not a good idea.”
And that’s where the Gators come in. No ordinary farm utility vehicle, the SEMS Gators have special suspensions and are customized to carry an injured person in the most efficient way possible.

The NFL, NASCAR, motocross races and college sporting events all use Gators or other small vehicles to transport injured participants.

Richmond’s company began by servicing 5K road races and walkathons and moved on to equestrian events, motorcycle events, monster-truck races and more. Started in 1997, SEMS will provide medical services for 1,000 events this year and now offers a steeplechase certification program – including helmet and boot removal, the potential injuries involved, a site tour – for paramedics planning to work a race meet.

“The biggest thing we’ve learned is the value of pre-planning,” Richmond said. “We have a plan, we work that plan and we continue to improve that plan. We can’t predict where an injury will happen or when, but we are prepared for it all.”

Doctors such as Sternlicht are part of the equation. The course physician at the Grand National for the past seven years, he has studied steeplechasing like any other cause of an emergency situation. The sport brings with it inherent risks, but also carries a subset of issues centering on location, space, weather, animals, spectators and more.

Sternlicht considers jump racing full of unique situations for medical personnel and remembered his first impression.

“It was very intimidating and it still is intimidating,” he said. “You never know what’s going to happen. The courses are spread out, the terrain is rough, you’re doing medical care in a field . . . it’s much simpler to be in my controlled emergency department at the hospital.”

Considering GBMC sees tens of thousands of emergency patients per year, that statement carries some weight.

The third link in the equation involves the Baltimore County Emergency Medical Services program. The Maryland meets often call on Baltimore County ambulances to transport injured jockeys to the hospital, leaving the on-course ambulances in place to serve later races in the day. Part of SEMS’ work also involves notifying hospitals of race meets and the potential for injuries.

Perception isn’t reality
Maryland timber meets have faced their share of medical emergencies – Irv Naylor at the Grand National in 1999, Blair Waterman and Polly Gundry at the Maryland Hunt Cup in 2002, Ellen Horner at the Grand National in 2007, Stewart Strawbridge at the 2008 Grand National and others.

Under the current system, expertly trained emergency personnel respond in Gators and treat injured jockeys in the field. Older systems may not have been as equipped, as trained, as organized, as ready.

To anyone not versed in emergency response, the actions still might look rushed and risky when in reality they are rehearsed and rational.

“We’ve been criticized for not bringing the ambulance on to the field, but there is a clear cut reason not to do that and it’s safety,” said Sternlicht. “You risk having a problem with the ambulance, you risk hurting your own people and you risk putting the patient in more danger.”

The Gators – which aren’t mere Gators – serve as field ambulances with the express purpose of safely moving injured jockeys to the full-size ambulances for transport to the hospital if necessary.

This year Sternlicht, Richmond and race organizers at the Grand National will take the added step of creating a medical tent as “home base” for medical personnel and for evaluation.
Injured jockeys can be brought to the tent where medical personnel can work in a more controlled situation. The tent will also be used to evaluate jockeys who fall and need to be cleared to ride in a later race on the day.

“Sometimes concerned people are a real challenge,” said Sternlicht. “They want to be involved, but my advice would be to let the medical people evaluate, assess and make treatment decisions.”

Sternlicht and others compared steeplechase medical response to that of a ski patrol at a ski resort, where medics respond, stabilize the patient, get the patient to a first-aid center, make a proper assessment in a controlled area and then have the patient transported to a hospital (if necessary).

Sternlicht and Richmond (whose work includes two pending books on emergency procedures at events) see their protocol as a potential national model for steeplechase meets. Both serve on the National Steeplechase Association Medical Advisory Board headed by NSA senior steward and medical professional Gregg Morris.

“The perception in the past may have been that there was no plan, but that’s not the case at all,” said Morris, a physician’s assistant and former jockey. “There are very good, talented people involved and a great process. I’m hoping this tent idea gets off the ground. It might be something that gets recommended to all meets someday. It’s another step, another level of procedure that improves care.”

The Grand National overhauled its medical protocol eight years ago under the direction of Dr. Mark Wheeler, another GBMC physician with emergency experience. The system comes with a pricetag – Richmond and his Gators do not work for free – but the race meet sees it as a worthwhile expense. Sternlicht and the other on-site doctors (between five and eight) donate their services.

“(SEMS) charges us, but the expense isn’t so much,” said Grand National race director Peter Fenwick. “The time, thought, planning and volunteer efforts are pretty substantial and these guys are very qualified for the job. It’s a lot of work on their part and on our part, but it’s worth it and we are very happy with the system we have in place.”