Medical Guide for Event Organisers

IMPORTANCE OF MEDICAL PROVISION

 

The enjoyment factor of an event lies not just in its entertainment, level of challenge, or in its execution but intrinsically in the well-being of its participants. Any organised sporting event should be built on having a foundation of safety and preparedness at its core. In this section, we dissect the essential elements of medical provisions, illustrating why they are of paramount importance to any event whether it’s on the open water or scaling the highest summits.

 

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POTENTIAL RISKS

 

Every event is a dynamic entity, brimming with variables. Whether it's a low-key evening Fell Race with the risk of soft tissue and Musculoskeletal injuries, or an Ultra Distance Trail Race where attendees may collapse or get injured, potential medical issues are a reality. These risks don't merely exist; they can easily escalate if not addressed promptly.

 

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FACTORS TO CONSIDER

 

• Number of competitors. A larger number of competitors will logically require a larger medical resource. Event dynamics and timings may also have an impact on numbers.

• Type of event. A small off road run in a confined location such as a park, will require a significantly smaller and less specialised medical resource than that of an ultra-distance event in a remote environment.

• Types of terrain. For example: open fell, rough trails, open water, technical descents et.

• Access to event/course. Can this be via; vehicle, 4x4, ATV, or on foot? How will a potential casualty be extracted?

• Weather. Are competitors suitably equipped for the kinds of weather they may encounter, not just when competing but what would they do should they become injured? Do they have kit to stay warm and keep dry?

• Duration. A multi-day event will likely need more resources and maybe even 24hr medical cover.

• Time to nearest Hospital with Accident and Emergency Department.

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MEDICAL RESOURCE PROVISION

 

When specifying levels of medical cover to an event, judgment should be made based upon a number of factors:

1. Industry recommendations are stipulated within the purple guide: www.thepurpleguide.co.uk

2. Risk assessment scoring

3. Following consultation with the event organiser, utilising any previous years data for casualty figures if available for the event

4. Any recommendations made by the Event Safety Advisory Group.

5. Any requirements laid down by the sport’s governing body.

 

Once a specification has been agreed the resource provision can be planned for:

• Medical Centre: Essential for nearly all events, regardless of size. For larger/longer events, multiple strategically located stations are crucial. These are a clear Point of Contact for participants as well as providing a location to treat and diagnose ailments. The medical Centre could be within an existing building or temporary accommodation such as a Gazebo, the size of which will be partly dictated by the expected number of competitors and relevant Risk Assessments.

• The Medical Team should be comprised of resources, kit, and staff suitable for covering the type of event.

• Specialised resources may be required to help aid in deployment of medical teams, e.g. 4x4 Ambulances, ATVs etc.

• For most sports events where an element of risk is involved, simply relying on a First Aider is not appropriate. Most events should require at least one Paramedic (Registered Health Care Professional) to be present. These can provide advance life support and are specifically trained for dealing with trauma and medical emergencies in a pre-hospital setting. Having this level of cover also helps to lower the events reliance upon statutory services.

• For larger events there may be specific requirements to provide additional medical resources such as an Ambulance for conveyance of patients to hospital.

• Some events may look to rely upon local voluntary emergency services e.g. Mountain Rescue (MRT), local Search and Rescue Teams to provide the medical cover. If this is the case its worthwhile raising the following questions on top of the points already made:

1. Is the cover “ring fenced” e.g. will the team still receive call outs for mountain rescue jobs unconnected to the event which may leave you with reduced or no medical cover

2. If they are providing cover to your event, can they still cover their obligations should a call out be received whilst your event is in progress?

3. Do they have the relevant insurance in place? Most Mountain Rescue Teams falling under the jurisdiction of Mountain Rescue England and Wales (MREW), do not have the relevant insurance in place, and would only be able to deploy and or deal with an incident/injury if tasked via the usual channel of dialling 999, and requesting “Police, Mountain Rescue”.

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MEDICAL STAFF ROLES

 

Behind the safety of every event lies the competence and dedication of the medical professionals and support teams. All staff are trained and geared towards one mission: ensuring the well-being of each competitor, and understanding their needs.

Roles can be distinct and even specific for certain events. It’s important that the correct level and makeup of cover is proposed and provided to each event, the specification should be drawn from pre-event conversations, risk assessments, previous experience, event specific information and any recommendations received from the Event Safety Advisory Group.

 

​PARAMEDICS

These are frontline autonomous practitioners registered with the Health & Care Professions Council (HCPC). Trained to handle severe medical emergencies and able to administer a wide range of drugs and treatments. Their expertise extends from trauma care to advanced cardiac life support.

 

DOCTOR

A registered physician that has relevant background in emergency or prehospital healthcare. Generally speaking many GP’s would not have the relevant skills/experience for practicing within a pre-hospital setting.

 

EMERGENCY MEDICAL TECHNICIAN / FREUC5 (EMT)

EMTs may operate as a single responder to an incident or support a Paramedic. They have many of the same skills as Paramedics, such as being able to assess, triage and provide lifesaving treatment. Managing patients at the scene, reducing the need for them to be admitted to hospital if it is appropriate to do so. By either referring service users to alternative care provisions or safely discharging them on scene.

 

FREC3 / FREC4

These are non-healthcare professionals and are the unsung heroes at any event. They hold relevant advanced first aid qualifications such as First Response Emergency Care Level 3 (FREC3) and FPOS etc. While they might not handle critical cases single handedly, they generally work alongside a Paramedic and their presence ensures that minor injuries or illnesses are addressed swiftly, preventing escalation. Many hold additional specific skillsets for the environments they are working in e.g Mountain Leader (ML), Swift Water Rescue Tech (SRT) etc.

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EVENT MEDICAL MANAGERS

Overseeing the entire medical team, these individuals are responsible for planning, logistics, and ensuring that medical staff collaborate effectively. They act as a liaison between event organisers and the medical team, and have usually been involved in the lead up with the planning of the event. Most will hold additional qualifications such as MIMMS (Major Incident Medical Management & Support) etc.

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INTEGRATING WITH EMERGENCY SERVICES

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Depending upon the emergency, both the Ambulance Service, Police, Fire and Rescue, and Coastguard may play crucial roles. The expertise of these category one responders goes beyond medical care and extends to: evacuation, rescue, and maintaining public order.

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BEST PRACTICE

• Ensure all relevant Statutory and voluntary services are kept up to date with the progress of the event, this should be via the Event Safety Advisory Group (SAG), especially if there are any changes or unforeseen challenges. For larger events consider joint service drills to ensure seamless interoperability during any crises.

• For large events operating from a single site ensure a dedicated access route for emergency vehicles is setup and clearly signed.

• Understand Hospital Capabilities: Not all hospitals are equipped the same way. Understand their specialties and limitations to ensure the right patient goes to the right facility.

• If the event/medical provider is providing the capability to convey to hospital ensure this is included on any EMP that is submitted to the SAG. The provider will have a requirement to phone ahead and “Pre-Alert” a receiving Emergency Department prior to their arrival.

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RELATIONSHIPS

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The outdoor sports sector is a fairly closed knit community, and given the niche market its all the more important for event companies and medical providers to forge strong relationships.

This is in the best interest of all those involved and allows for a seamless delivery on the day, each party knowing their responsibilities helping to deliver a safe and well managed event. Relationships should be built upon trust, communication and a clear understanding of what each event encompasses. This allows for all involved to be well briefed with a clear understanding of the event.

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When initially selecting a medical provider its important to ask the following:                              

1. What is their clinical governance model? It’s important to understand the ladder of accountability within the medical provider and how this is managed. There should be an appointed “Clinical Director”, he/she will be responsible for the medical policies and procedures and oversee the compliance of all medical staff, and clinical equipment. Most clinical directors will likely be a Doctor or a Nurse Practitioner.

2. Do they have experience in providing to similar events? It’s important to gauge the experience of the provider and that they have a thorough understanding of what the event entails, so they can provide the correct kit, vehicles and people for the job.

3. What have they based their recommendation on? Have they consulted the purple guide for guidance on best practice?

 

Case Study 1 –Gravel Enduro

The biggest Gravel Enduro event in the UK extends for over 200km across the vast Kielder and Wark Forests in Northumbria and attracts riders from across the UK and Europe. The event takes place in April each year and can have a mixed bag of weather from blistering heat to arctic whiteouts!

The event has been running since 2016 and this year is expected to reach up to 2000 riders. The organising company has a longstanding relationship with the medical / safety provider and both companies operations are well embedded into the delivery of the event. The medical / safety provider is responsible for the following aspects of the event:

• Provision of multi-channel radio communication system covering nearly 500km2 to support the running of the event as well as medical teams, with on-site engineer support.

• Event control, co-ordination of all medical assets, event marshals and key event staff, operating on separate radio channels. Two coordinators provided to manage medical and event comms.

• Provision of Medical Centre at Event Village

• Provision of 2x 4x4 medical response vehicles, double crewed with Paramedics / EMTs

• Provision of Ambulance for conveyance. Given the isolated location on the English / Scottish border this was critical. Even on a blue light run time to nearest hospital is over 60 minutes away.

The complete service provision ensures the highest-level of interoperability between the organising team and the medical team. Without the level of communications organising an event in an area as remote, and without terrestrial cellular network coverage would be almost impossible, and certainly not safe. Medical teams are dispatched based upon location to incident, utilising the GPS tracking of the in-vehicle radio sets allowing for accurate tracking of resources. Medical teams are well versed with navigating in remote locations to quickly access and deal with any incidents reported.

 

Case Study 2 – Trail Run Event

Following concerns with previous medical provision, approached a company with greater experience of this type of event to provide medical cover. The price of the new cover was considerably more expensive than the previous provider but came with a higher level of capability.

 

During the event, a runner was taken seriously ill at a remote location. An event paramedic was on scene within 10 minutes. The event doctor then arrived 5 minutes later. The team worked on the patient for nearly 45 minutes. Given the remote location and serious nature, the HEMS team were mobilised by the NHS Ambulance Trust and flew direct to the casualty site. The casualty was handed over to the HEMS paramedic led team and was flown direct to hospital. Had it not been for the advanced clinical skills and the ability to quickly respond to the remote location, the end outcome for the patient would have been a lot different. Thankfully, due to the early intervention the casualty made a full recovery and is now back running.

 

The above example illustrates that sometimes choosing the correct provider for the type of event can literally be a matter of life and death. The event organiser later admitted that engaging with the new medical provider was the best decision he had ever made. He now understands that as an organiser he has a responsibility to ensure that the best level of care is available to anyone partaking or working on their event.