The Joys of Special Event EMS

Concert and special event EMS is sort of my jam. Don’t get me wrong, I love working in the box, but there’s something super special about working special events. These shifts are usually fast paced, chaotic, and tend to push providers past their comfort levels. Concerts present their own special considerations for patient treatment. Logistically, the concert venue setting limits your resources and really makes you consider your options. How are you going to move your unresponsive patient in row 30 when first aid is located on the ground floor? Is it really worth it to stair chair this patient down 40 flights of stairs or is there an elevator nearby? From a gear perspective, what are you bringing into the field? Does it make sense to travel with a full first in bag or is it more effective to have bare bones supplies and transport to a central triage area? All of these are important considerations and honestly there isn’t a correct answer. The location you work at will determine your logistics. A convention center downtown will have much closer resources than the concert venue 30 minutes away. 

Event EMS also opens up the door for high risk sign offs/refusals. I’m not saying you won’t encounter high risk refusals in the field, I believe that by their very nature refusals are high risk, both for yourself and the patient. However, the special events world produces a higher frequency of these scenarios. The intoxicated patient presents the pinnacle of these high risk sign offs. Now, for the most part, intoxicated patients are not intoxicated enough to warrant a trip to the ED. If the patient's only complaint is intox, then really there’s no reason to sign them off as long as they’re safe. However, the real risk with these patients is that I as a provider have absolutely zero idea what is going on with this patient to even an 85% degree of certainty. That 20 year old who walked in with his friends and security? He could be fine and just a bit drunk, or he could be diabetic and be hypoglycemic. A 24 year old female who you signed off to “sober” friends? Turns out she did not go home in an uber like promised, and instead decided to polypharm, leading to a whole list of issues. All of this is to say that there is a legitimate risk to patient sign offs in these fast paced, deceptive environments. 

Unfortunately, there is not a one size fits all solution for a perfect special events EMS system. However, I do believe that there are some steps that can be taken to improve patient outcomes. These are all based on personal experience. For starters, there needs to be some sort of unified command at these events. Ultimately, someone needs to dispatch crews into the field and be responsible for how first aid runs. Secondly, paramedic level providers should remain in first aid in order to triage and treat patients. EMT’s can be sent into the field to stabilize and transport patients, but keeping your Paramedics in one spot guarantees you will never have to wait extended periods of time for ALS interventions. On a similar topic, there needs to be a dedicated transport rig at these events, with the possibility to call in more units from the county as a separate option. For slower events, one transport rig can handle it. These are the basics for special event EMS, and while unique challenges are presented during these shifts, a little organization can go a long way.