Your Captain Speaking: Rock On! EMS Support for Music Concerts and Sports Events

Samantha, let’s grab a cup of sludge-thick station coffee. We need to talk about "standbys." We’ve seen the look on some EMS faces. Many think a standby is a free ticket to the 50-yard line or a chance to hear a rock legend for free while getting paid time-and-a-half. Some think it’s a "break" from the street. But, when you’re assigned to a stadium, a parade route, or a concert hall, we aren’t spectators. You are the chief medical officer of a small, temporary, and usually very chaotic city. Whether it’s 500 kids at a high school football scrimmage or 80,000 screaming fans at a pro stadium, the principles of mass gathering medicine don't change. If you treat a standby like a nap with a view, you’re going to get steamrolled when the "big one" or the hard-to-notice “quiet one” happens. There will be lots of 250th Anniversary of America events in the near future, so let’s break down how we support these events without losing our cool—or our patients.

1. The Pre-Game: Intel is Everything

You wouldn't run a cardiac arrest without an assessment, so don't run an event without one. Before the first gate opens, you need to know the "Three Ds": Density, Demographics, and Dangers.

• Density: How many bodies are we talking? A packed crowd creates "fluid dynamics." If someone drops in the middle of a mosh pit or a bleacher row, how are you getting in? More importantly, how are you getting out? Personally, I got smoked when showing up for a Metallica concert—a full two hours prior to the advertised start. Obviously, we were well ahead of the start time, but it was an early evening summer concert and people had been lined up for hours in the afternoon heat. We never even got inside the perimeter as we had to stop to assist the many spectators dropping like flies outside the venue. Communication was poor with the venue as we never got inside to pick up the radios, the medical control was still setting up, and I desperately wish I had several cases of bottled water with me. It was a mess. Learned big time from that! There are some standard ratios of EMTs, paramedics, and ambulances to the crowd size. Here’s a tough supervisor decision: Organize the staff to go out to the venue in the days prior to review the setup and make changes as necessary. Get other players in the event there to improve coordination. Intensely hard to schedule, and pay, people who otherwise are not on duty but super important for the “new faces” to the event support. These are not on-the-job training type occasions.
• Demographics: A Jimmy Buffett tribute concert (RIP to the Mayor of Margaritaville) brings a very different patient profile than a heavy metal festival. One is a sea of chest pain, respiratory, and dehydration; the other is trauma, poly-substance abuse, and exhaustion. Know who your "citizens" are and what solutions you need to have on hand such as Narcan, D50, normal saline, etc. Samantha mentioned that on one instance, the fire chief went out and basically commandeered multiple golf carts to move responders and patients around. Be prepared to think outside the box for support. Do some of this “what-if” thinking prior to the event. What is the makeup of the people who will be attending?
• Dangers: Check the weather. If it’s 95 degrees with 90% humidity, your primary problem is the sun for both you and the crowd. Heat-related calls for help are the norm. Cooling buses were set up for a NASCAR event here locally and worked wonderfully. Cooling tent(s) have the advantage that they will draw people to them rather than EMS having to transport them there to cool down. If it’s a high school football game in November, start thinking about hypothermia and slipping hazards. Is there a history between the rivals? Likelihood of a terrorist threat? Has a threat assessment been done? Where are the “hot-spots” where an assault is more likely to occur, such as the security entrance, or where the crowds are higher density. If there is a crowd panic and surge, are you going to be in the middle of the stampede? Remember to consider both a primary explosion site or vehicle ramming attack followed by a secondary location to attack the first responders.

2. The Logistics: Don't Get Pinched

In the rig, you have everything within arm's reach. At an event, your rig might be parked three parking lots away behind a locked security gate.

The "go-bag" philosophy: If you can’t carry it, you don't have it. Your event kits need to be streamlined. You need high-cycle interventions: Narcan, bleeding control (to include bandages), airway management, AED, and ACLS meds. Leave the bulky OB kit in the truck unless you’re expecting a very specific kind of "Labor Day” parade. We secured in-place Med Sleds® at the top of bleachers with the plan to move a patient unable to ambulate downward.¹ Much easier than moving a patient uphill in a stadium. A Stokes basket could also be used.

Communication: Standard radio channels die at major events. The cell towers get overloaded and the airwaves get cluttered. You need a dedicated event channel and, more importantly, a face-to-face plan. If you need help or equipment, know how to state where you are and what you need. Know where the first aid station is, know who the event security lead is, and for heaven’s sake, make sure you have a backup way to talk to your partner when the drums and bass guitar drop so hard you can't hear your own thoughts. My bad while supporting a mosh pit. By the way, they passed the injured out of the pit over their heads until she got to me at the edge—expect the unexpected.

Tracking Patients: EMTrack® is an excellent program for tracking patients and people, and uses triage tags and barcoded bracelets to assist in both the tracking and record keeping.²

Samantha mentioned a great idea by a dispatcher to bring AT&T out to a venue with a signal booster for FirstNet, which is a federally authorized network for first responders. Very helpful!

3. Footprint and Flow: The "Safe Harbor"

Every event needs a "safe harbor"—a stationary first aid room or a designated casualty collection point (CCP).

Captain’s Tip: Never set up your medical tent at the bottom of a hill or at the end of a bottleneck exit. If a crowd surges, your medical tent becomes a speed bump.

Your goal at these events is "treatment in place" whenever possible and to allow spectators to return to the event. If you transport every teenager who faints at a concert, you’ll drain the county’s ambulance resources in 20 minutes. Create a space where patients can cool down, hydrate, or wait for their ride. You are the gatekeeper for the local ER. Only send the ones who truly need the bright lights and the white coats.

4. Special Considerations: From Friday Night Lights to Pro Turf

The scale changes the math, but the medicine stays the same.

• High School/College Sports: You aren't just there for the fans; you’re there for the athletes too. You need to be synced with the athletic trainers (ATs). They know the players; you know the pharmacology and the transport protocols. If a kid takes a hit and has a suspected spinal injury, that’s not the time to argue about who’s in charge. If there is an injury on the field, don’t “stay and play” but rather get the player off the field or into the ambulance and gone.
• Professional Venues: These are corporate machines. There will be multiple agencies—private security, fire marshals, police, and VIP medical teams. Check your ego at the gate. You are a cog in a very large wheel. Follow the ICS (incident command system) structure, or you'll find yourself or your ambulance service sidelined.
• Parades: These can be a nightmare. You have a moving target and a porous perimeter. People cross the lines constantly. Use bike teams or utility vehicles. An ambulance trying to push through a parade crowd is just an expensive parade float that can't move. Tip: If your ambulance is surrounded by people and you activate either the siren or horn, you will instantly anger everyone nearby. You situation just got worse, not better.

5. The "Big One": Planning for the Worst

We don't like to talk about it, but we have to: The mass casualty incident (MCI). Whether it's a structural failure, a fire, or—God forbid—an active shooter, large events are targets. When you arrive for your shift, look for the exits. Not just the ones the public uses, but the service tunnels and the loading docks. Identify where you would stage a fleet of ambulances if the world went sideways. If you don't have a triage plan in your head before the event starts, you're already behind the curve.

6. Professionalism: You are the Brand

This is where I get "old school" on you. We don't care if it's the fourth quarter and your team is winning. We don't care if the headliner is playing your favorite song. You don’t cheer, you don’t take selfies, and you don’t eat a stadium hot dog in front of the crowd while wearing your uniform. You’re there to be the most composed person in the building. When the crowd is screaming, you’re calm. When the drunk fan is heckling you, you’re professional. People look to the uniform for cues on how to react. If you look panicked or distracted, they will follow suit.

More Resources

You don’t have to reinvent the wheel. Several organizations specialize in the "science of the crowd." If you want to move beyond being just a "medic in a tent" and become an expert in mass gathering medicine (MGM), look into these resources:

• The American Academy of Event Medicine (AAEM), https://www.eventmedicine.org/
  This is the "pro league" for event medical professionals. They host the Mass Gathering Medicine Summit, which is the premier conference for this niche. They also offer the Certified Event Medic (CEM) program to standardize care at large venues.
• The Event Safety Alliance (ESA), https://eventsafetyalliance.org/
  These folks are the gold standard for overall event safety. They published the Event Safety Guide (often called the Purple Guide in the U.S. adaptation). They focus on everything from stage rigging and weather monitoring to crowd dynamics and medical planning.
• National Association of EMS Physicians (NAEMSP), https://naemsp.org/
  The NAEMSP has a dedicated Mass Gathering Section. They provide evidence-based position statements on how many medics you need per 1,000 attendees and what equipment you should carry to be effective.

Final Thoughts

Event medicine is a specialty, not a hobby. It requires a different brand of situational awareness. You are balancing clinical skill with public relations and disaster management. Every person in that crowd paid for a ticket to have a good time. They didn't plan on meeting you. Your job is to make sure that if they do have the worst day of their lives in the middle of a celebration, you’re ready to move. Now, check your rig, bags, test your radios, and get out there. And for the love of all that is holy, stay hydrated and safe yourself. Remember personal care. You’re no use to us if we have to treat you for heat stroke.

References

1. Med Sled by Ethos, https://www.medsled.com/
2. EMTrack by Juvare, https://www.juvare.ca/emtrack/

About the Authors

Dick Blanchet, (Retired) BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, MO, and in Illinois for more than 22 years. As a captain with Atlas Air for 22 years on the Boeing 747, he has more than 21,000 flight hours. A USAF pilot for 22 years, he flew the C-9 Nightingale Aeromedical aircraft. A USAF Academy graduate with a bachelor of science degree, his masters in business administration is from Golden Gate University.

Samantha Greene is a paramedic and field training officer for the Illinois Department of Public Health Region IV Southwestern Illinois EMS system, a paramedic and FTO for Columbia (Ill.) EMS, and works full time at the St Louis South City Hospital Emergency Department as a paramedic. She was recently recognized as a GMR Star of Life.