Community Ambulance’s owners Rob Richardson and Brian Rogers, and Special Events Division Manager Glen Simpson hope these lessons learned from the Route 91 Harvest Festival are of use for other EMS providers that offer special event medical standby services.
Emergency medical services providers offering special event services all over the world took a step back for some self-evaluation after the heinous mass shooting during the Route 91 festival that took place at the Las Vegas Village, located next to the Mandalay Bay Resort in Las Vegas on Oct. 1, 2017.
After such a mass tragedy, can anyone in EMS sleep well at night, knowing our current special event medical standby practices need updating and an infusion of industry know-how?
Standby services are often overlooked and understaffed
Private ambulance services, fire departments and advertised “special event medical standby” businesses across America offer spectators and event participants first aid stations, bike medics and roving EMS teams as part of their standby EMS services for concerts, rodeos, festivals, car races and high school football games. Very often, light-duty medics, trainees and newly-credentialed EMS providers are chosen to staff these “extra” EMS assignments week-after-week.
In many cases, standby medical services are offered free as a community service, and therefore might not get as much operational consideration as the 911 calls a company responds to day after day. Typically, the equipment used for these standby assignments often need maintenance, and older, more-outdated ambulances are assigned.
Community Ambulance, located in Henderson, Nev., however, is a full-service division dedicated to planning, scheduling and serving special events. Providers are applying modern technology and innovative, unique solutions for serving demanding and complex event participants’ and spectators’ needs, right down to the jump bag design they’ve crafted. The company uses an ATV on-site in addition to bike medics at outdoor festivals to quickly mobilize and reach patients in the crowd.
Community Ambulance’s owners, Rob Richardson and Brian Rogers, are both paramedics themselves, and offer services for more than 1.5 million event spectators and participants every year.
For the recent Route 91 Festival, Community Ambulance delivered full-scale pre-planning and provided the right people, in more than industry acceptable numbers for the Route 91 Festival’s audience, staff and entertainers. Community Ambulance personnel performed heroically during the event and after, carrying on the daunting administrative fact-finding work that only such an altering event can manifest.
Fortunately, we in EMS can learn from each other when a large-scale tragedy occurs. We can compare what we do with what worked for another agency, as well as enhance training, require additional resources and investigate new equipment and service delivery methods. Due to the sheer number of events the division covers each year, division managers are now in a position of counseling event planners and promoters about how important it is to plan early for every contingency.
Through experience, the owners of Community Ambulance have learned a number of ways to best offer emergency medical services during special events. The importance of the services cannot be overstated, and will be scrutinized.
“No matter the size or scale of an event assignment, our attention to detail, and the professional resources and equipment we assign has to hold the same priority,” Community Ambulance’s Special Event Manager, Glen Simpson, AEMT, said. “If something happens, we will be in a media fishbowl.”
The following are takeaways intended to guide special event medical standby services interested in professionalizing and reinvesting in this crucial EMS service offering.
1. Organization and early preparation are key for standby services
Community Ambulance’s staff have been part of planning for EMS at events for years, including the Electric Daisy Carnival music festival, which sees up to 150,000 attendees on each day of the three-day event. Relationships mean everything during a large-scale event.
“Long before anything happens at a large-scale event, relationships need to be in place that guarantee an immediate response by law enforcement, fire services and other EMS responders,” Rob Richardson said.
No one in authority is going to call out “all the king’s horses and all the king’s men” if the request doesn’t come from someone credible. If your special event standby leaders aren’t on a first-name basis with local public safety officials, your call for help could be met with skepticism. That’s not what’s needed when an incident like the Route 91 festival occurs. During the crisis, help came immediately after the on-site crews notified their communications center they were “under fire.”
The lesson here is to meet regularly with your fire department chief, fire department EMS chiefs and the chief of police so they understand the capabilities of the onsite medical services. In Las Vegas, the METRO police department has its own special events division, with officers dedicated to serve during events, that Community Ambulance communicates with regularly.
There is also a benefit to knowing that your company can scale up with other resources if there is an immediate need. Community Ambulance’s special event medical standby teams are equipped with 800UHF frequency radios, which is the same system that the Clark County Fire Department uses, establishing a direct connection. In effect, Community Ambulance’s event communications are part of the 911 communications system, should it become immediately necessary.
The company also uses one of the most high tech computer-aided dispatch systems so that all call information related to the event is recorded, time-stamped and immediately accessible for all public safety dispatch centers. As such, the company’s records are part of the incident’s overall investigation.
2. Determine the right number of medical standby services
There is a substantial need in Las Vegas for expert special event standby teams. Community Ambulance and its focus for crowd safety is especially relevant at events like the Electric Daisy Carnival, National Finals Rodeos, South Point, the Mandalay Bay-located House of Blues and The Colosseum at Caesar’s Palace.
Community Ambulance special event teams were ICS trained, well-equipped, prepared and heroic in their professional reaction to “raining bullets” from the 32nd floor of the Mandalay Bay Hotel during the Route 91 festival shooting. The fact that Community’s event medics were bringing order to chaos as quickly as possible, offering care for hundreds and facilitating the response of scores of other responders within those first few minutes has been lauded, not only by the chief detectives who reviewed every megabyte of video footage, but also by their local and fellow EMS professionals.
There were 16 people and four ambulances scheduled to cover the concert’s approximate 25,000 spectators. Community Ambulance based their standby operation from a first-aid tent located in between the venue’s main entrance and the main concert stage. Four off-duty employees and one former employee visiting from California stayed and assumed on-duty status, rather than run from the danger. The company’s communications center immediately self-responded available Community ambulances from the 911 system and alerted the county’s 911 center of the need for additional resources.
How many resources are enough? This is an important question for event planners. Fortunately, in Southern Nevada Health District, EMS regulations specify a special events medical standby application for host organizations to complete for health district approval. Approved applications are accepted by the health department and providers use the district’s regulations as a guide.
“Typically, and based on the type of event and demographics, we more than cover the minimum requirements,” Simpson said. “[Often], the major event promoters aren’t as concerned about costs as they are about ensuring enough resources.”
These promoters rely on and trust the event medical teams’ experience and expertise. For planning purposes, Community Ambulance considers the size and type of standby venue. Division managers pre-plan, considering the type of event, the venue’s egress points, anticipated attendance numbers and demographics, day or night coverage and a number of other variables.
3. Every special event showcases your EMS agency
As previously noted, many special event medical standby assignments are performed free as a good will gesture from a municipally-contracted ambulance service, or an IFT service aiming to gain more exposure as a healthcare system ally. In some cases, fire departments have been charged to act more like a business, giving special event medical standby services the option to become part of a city or county’s revenue stream or allowing these agencies to perform services for free.
Regardless of the reason your ambulances and personnel are staging ringside, track side, stage right, on the apron or next to a football coach, they are on display. Like it or not, your standby teams are involved in “community theatre,” so act like it matters. During the heat of a medical emergency, emotional bystanders might not notice the ambulance is dirty or the personnel are ill-groomed. But, if they become bored during a low-scoring game or between musical sets; it’s your crews they’re looking at. And, if something tragic happens, your crews will be even more scrutinized.
4. Setup standby services in a place of prominence
It’s important that injured or ill persons are able to find help quickly. Before, during and after the Route 91 festival, Community Ambulance was on notice. The company deliberately made their special event standby team noticeable by including the location of first aid services on the venue map itself (the map was part of a printed program that was handed out to all attendees).
With the goal of serving as an extension of the MGM Resorts Team, Community’s crew located closest to the stage were responsible for checking in with the security supervisor so that security could immediately locate EMS when needed. At some venues, the standby crew wears special shirts with MEDICAL written on the back in bold letters. These shirts associate the crew with the venue staff.
Video footage from the Route 91 festival shows that when the bullets starting downing people where they stood, Community Ambulance personnel heroically pulled as many of the injured as they could into the first aid structure, as well as under stages and behind bars – even in the face of personal injury. In the tent, they rendered aid to the first victims and, within seconds, a flood of new patients who were dragged or carried to the station arrived. The Community Ambulance teams began assessing, triaging and treating the wounded.
Simpson was on-scene, and ran the incident as the ICS-trained, boots-on-the-ground commander for the first 20 minutes, as automatic gunfire echoed for more than 10 of those minutes against the mirrored canyon wall of the Mandalay Bay Hotel’s façade. Community Ambulance co-owner, Brian Rogers, took over as soon as he arrived on scene, minutes after the shooting started.
Responding ambulances were asked to stage until the shooting stopped and they were released to help others. This proved to be very frustrating for the crew members and very confusing to the event spectators fleeing from the event.
5. Be appreciative of the help of citizens in a crisis
Community Ambulance recognizes that a lot of good people tried desperately to do the right thing during and after the incident. The death toll would have been much worse if it weren’t for the bravery and selfless actions of the off-duty firefighters and former members of the military in the audience and who stayed to help. The scores of citizens who helped the injured get to hospitals in their personal vehicles also contributed to saving countless lives. The on-duty responders in the county’s 911 response systems worked as a well-orchestrated team, and Las Vegas businesses near the event provided safe havens for fleeing victims.
After the incident, Community Ambulance filmed and broadcasted the company’s thank you message to everyone who immediately responded to help. Most importantly, Community’s owners met with their employees to express their gratitude for a job well done. However, there isn’t much they can say to truly mitigate the emotions and impact of such a devastating event. The company offered on- and off-site counseling services available for those who were affected by the event.
Pre-planning event EMS checklist
Remember these key points for event planning:
- The special event medical standby service managers should have first name basis relationships with local public safety officials.
- Special event medical standby services require professional pre-planning, assigning the appropriate number of well- equipped, visibly uniformed, ICS-trained resources staged strategically throughout the venue. Ambulances should be well marked and located near at least two points of egress.
- Standby crews should visibly demonstrate their customer service attitude, as they are on-notice at special event gatherings.
- Should an event or incident occur, ICS should be set up immediately by a trained ICS manager.
- The special event medical standby service should have enough off-site resources to be immediately scalable. The company should be able to immediately communicate with its off-site, and accessible, resources. Often, event planners can’t, or won’t, fund additional resources. It is necessary to have at additional resources ready to respond, even if they are part of your on-duty staff.
- The company’s communications center tech will be instrumental in the overall success of the incident’s management. For optimal success with incident management, ensure your communications center is robust enough to handle a large-scale incident, and that it is linked with the local 911 system.
- Your special event medical standby service should give credit when it is due, and should understand that sometimes there isn’t enough thanks to mitigate the impact that comes with responding to tragic events. Should that be the case, responders should be offered psychological counseling and ongoing support.
