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Rider down

“Rider down, he’s not moving”

Event organizers have a lot to consider when it comes to medical coverage


teamEMS riders in the Tour de Steamboat 2012

Steamboat Springs, Colo (May 03, 2013): Do you think anyone will hit that tree or lose control on this turn? What will we do if someone has a heart attack at the midway aid station? Should I have an ambulance at the finish line or recruit volunteer EMT’s? If you have ever directed or produced an athletic event of any kind you have certainly asked yourself these, and many similar questions in the planning process. As an event producer you assume responsibility for providing a safe and enjoyable event. You take-on the task of assessing the size and scope of your event to determine how you will meet that responsibility for not only are your participants but also your staff and spectators. Granted, not every event requires a full complement of ambulances lining the course, which would not be practical from a monetary or logistical standpoint. You do however need to assess the risks of your event and put in place the most cost-effective system for responding to medical emergencies. From small club gatherings on local routes to multi-state stage races there are shared inherent risks and unique hazards specific to every event. Consider the size of your field, standard ability level of your participants, distances and elevations traversed, access to local emergency medical services, cellular and other communication limitations, time of year your event will be held, and on-course resources for hydration and medical care. Taken individually or collectively these risk considerations can help determine the most effective and financially feasible method for ensuring your event is prepared for medical emergencies.

A large event, greater than a few hundred participants, may not in itself increase the risk of injury or illness but it does raise your odds. A large event with a projected standard ability level to be novice increases the chances of rider collisions while a smaller field of more advanced riders may have a higher incidence of speed related falls or car versus rider accidents.

Adding to the analysis is the course itself; longer rides bring greater incidence of dehydration and fatigue or fatigue related accidents. Mountain bike events look for epic single-track which are typically long distances from Ambulance access points while longer road tours often travel between rural communities with unpredictable access to Advanced Life Support (ALS). Other course considerations should include elevation changes and rider workload which add to increased downhill speeds. Also on the topic of course considerations, serious injuries often need rapid helicopter transport to a definitive trauma facility. Most Air Ambulance providers operate aircraft small enough to land on highways for road accidents but identifying a suitable and easily accessible landing area for the off-road events can be challenging.

teamEMS mountain bikeTying into the course assessment and access to 911 responders is the ability to communicate within your event and with those emergency responders. Road courses in those rural areas may not always have cellular service and will probably span distances to vast for two-way radios. Backcountry races face the same challenges. How will you, as the race director, know when there is an emergency and how will you coordinate with “911” to ensure timely and accurate information is provided to facilitate an expeditious response, extrication and transport. A common problem can be multiple calls for assistance when a rider is ill or injured. When several people call 911, all in an effort to help, there can be conflicting information with regards to the patient’s location and injuries which can all lead to confusion and delays.

We touch on the topics of weather and aid stations to finish up our event analysis. Obviously we cannot predict the weather but we should consider seasonal norms. Fall and spring events can bring extremes on either side of the hot or cold spectrum, consider how one or both of these conditions could affect your participants both during the event and at the finish line. Consider the peak summer season where hot and dry conditions can cause dehydration and heat related illness. Factoring in the weather and other components of the course, you as the race director, will have to analyze where you will put aid stations and marshals and what you will equip them with. Do you have radios for everyone, how much water and other nutritional support will be available, how will you get people and supplies to those points and which stations if any will have medical support? One last consideration for your aid stations and medical staff is the matter of supplies. Will you provide the aid stations with medical gear, if so, where will you acquire these supplies and how many “band aids” do you actually need?

Access to local public emergency responders should always be a consideration. Often times an event producer will satisfy their medical needs by planning to call 911 if there is a medical emergency. This is certainly a reasonable option for some events but then there is the dilemma of coordinating these emergency responders. Where will they park, how will they know where the ill or injured patient is located and how will they access them? But let’s start with some basic background into your local emergency medical responders. First and foremost remember that “911” is a public system designed to serve the needs of the local population. When your event hosts hundreds of participants, staff and spectators is it unrealistic to expect that an Ambulance will always be available to immediately respond to your event. In other words, if there are five nearby ambulances and six people have called 911 before you, depending on the severity of your emergency there may be a delay. Emergency medical response systems and assets vary, none better or worse than others but differences you as the race director should be aware of. Ambulances may be public or private, paid or volunteer (or a combination of paid and volunteer), Fire Department integrated EMS or stand-alone Ambulance, and may be staffed by Advanced Life Support (ALS) providers or Basic Life Support (BLS). ALS means there is access to advanced medications and procedures while BLS is limited to less invasive treatments and medications. Most counties have publicly funded Search and Rescue (SAR) teams that can access those remote areas but are not typically designed to respond with the same quickness as an Ambulance. Helicopters staffed by critical care Nurses and Paramedics are within a reasonable distance to most rural areas throughout the county. Each of these components to the emergency response system work together on a day-to-day basis providing quality medical care and transport all over the county. But remember, your event is a gathering of people and activities that adds a demand on the system which should be planned and coordinated properly through all phases of your event.


Now, what to do with all this information and all of these variables? After all, this is only the medical component; you still have to worry about permits, sponsors, marketing, food, bathrooms, registration and timing just to scratch the surface. Fortunately for you external help and support is available depending on your risk and budget. There are advantages and disadvantages to some of the more common medical solutions that we will discuss. Some come at no cost but your time while others require a new line item in your budget. As previously discussed you can choose to call 911 if there is an emergency, you can invest extra time and leg work to recruit local volunteers with medical experience, hire an ambulance dedicated to your event or bring on a dedicated medical team to consult and staff your entire event.

For smaller events choosing to call 911 is a very reasonable choice. If you are planning a large event and/or one that travels to distances or locations far removed from the nearest Ambulance this option should include pre planning for proper communication with 911 dispatchers and ensuring all your participants know the course well enough to effectively relay locations of ill or injured parties. Be prepared to provide 911 dispatchers with an accurate location of the patient, any and all physical barriers that could impede ambulance access, known or suspected hazards at the location of the incident and details of the patient’s injuries or current condition.

A popular and common alternative is to contact a friend of a friend who knows some people. Off-duty ski patrol, EMT’s or other medical professionals are often eager to volunteer at your event. They enjoy helping as much as they love the sport itself, a free lunch and a cool t-shirt. This is popular because the costs are minimal; provided you have the time or someone you can trust to coordinate these volunteers for you. As the race director and even the volunteer you should consider a few things about this option. First, not to take anything from the well-intentioned volunteer, what supplies will they have to provide the care they are trained and maybe certified or licensed to offer? Without the proper tools your volunteers can be rather limited in their ability to offer the care and treatment they have been trained to provide. In-line with this topic is the plan for proper disposal of blood soaked bandages and documentation of the care that is provided. Does the event or volunteer carry insurance that will cover medical costs or lost wages if they themselves suffer an injury? Remember, this doesn’t have to be physical trauma but can also include blood borne illnesses transmitted while irrigating or bandaging wounds. CRS 13-21-108 is the Colorado Good Samaritan rule that exempts licensed health care providers from liability when there is no compensation or obligation to provide care. When the volunteer agrees to serve your event in exchange for lunch, a t-shirt and/or goodie bags have they then been compensated as part of a predetermined arrangement thus excluding them from Good Samaritan protection?

Hiring a dedicated Ambulance to standby at your finish line is an effective option that saves time and reduces the some of the concerns regarding volunteers. With regards to time this can also be an effective alternative because, in many instances, one phone call to the ambulance operator with the date(s) and time(s) you want them there can meet your needs. Some local ambulance operators may even offer to have an on-duty Ambulance at the finish line at no cost, provided there is not another public call for service. Here are some things to be aware of when you hire a dedicated Ambulance. Costs for this service can add up quickly, ranging from $100-$200 per hour. Is one Ambulance at the finish line enough or will you need one somewhere on course? Be sure to ask if this Ambulance will transport patients and if you will be provided with ALS or BLS staff. Sometimes you are paying the Ambulance to be at your event, this means that they will provide care and treatment but may not always transport the patient to the hospital and will instead summon an additional transport Ambulance, at the patients cost. One last thing to consider about hiring an Ambulance is the knowledge of their staff with regards to the intricacies of your event. In some instances your dedicated Ambulance could be staffed with healthcare providers with little to no knowledge of sports injuries or injury patterns consistent with your sport.

EMS Unlimited EMT's provide basic life support aide tent medical care

The final choice we discuss here are specialized event medical companies that act as your medical foreman or consultants. These companies bring time savings that come from making one phone call, the reduced workload of pre-planning for an emergency and also staff your event with a balanced blend of healthcare providers that meet your budget and safety needs. A quick internet search can find several companies around the nation that provide these services. A Colorado based company, Event Medical Solutions Unlimited, LLC (EMS Unlimited) specializes in giving you the ease of full-service and turn-key medical support to your event at a cost that can be tailored to your event. Throughout the nation a growing number of events are choosing this option to capitalize on the many benefits that come from outsourcing this portion of their event. Among many other events, the Steamboat Stinger has this to say about outsourcing the medical and safety component of their race, “EMS Unlimited was an integral part of the Steamboat Stinger 2012 and we look forward to continuing this great partnership to maintain high quality and professional safety standards on-course for all of our race participants.  When it comes to on-course and finish line safety measures, EMS Unlimited has every base covered, which makes the job of a race director much easier and less stressful.” EMS Unlimited provides pre-event planning and consulting, on-site staffing and transport coordination and even post event clean-up and debrief that collectively combine the advantages of the other options described earlier.

From event producers planning their first race to the seasoned veteran organizer these safety and medical components are always analyzed. Whether it is intentionally or from years of experience, you examine the number of participants, their projected ability level, location and hazards of the course, availability of medical resources and many other aspects of your event. Providing medical standby services to your event is one which should be taken seriously in order meet your assumed responsibility to offer a safe and hazard free event. There are several options for achieving this goal based on the risk assessment of your event. Taking the extra effort to provide comprehensive and quality medical care to your event is a bit like car insurance, where the high deductible is less painful on a monthly basis it stings a lot more when you get into an accident.

About the Author:

Event Paramedic

Ebin Latrimurti is a seasoned and veteran healthcare provider and professional. He is a certified Flight Paramedic and licensed as a Paramedic in Colorado, New Mexico, Texas, Louisiana and Hawaii. He writes about these issues facing event organizers after working and volunteering for special events such as the Honolulu Marathon, Collegiate Football and many competitive races over the last ten years. Having grown up in Palisade Colorado he is no stranger to the outdoors and with eight years in the United States Navy he knows the importance of delivering consistent professionalism. Ebin draws his expertise in safety and risk management from his current position as a partner with EMS Unlimited while also serving as a Flight Paramedic for a specialized Helicopter ALS Search and Rescue program. Having seen how event organizers often struggle with making informed choices with regards to effectively and efficiently preparing for and responding to medical emergencies this information is provided to deliver a baseline level of information needed to keep your event safe and follow the EMS Unlimited motto of “…do it again tomorrow.”

About EMS Unlimited:

Event MedicalEvent Medical Solutions Unlimited, LLC (EMS Unlimited) provides full-service event medical solutions offering organizers a quick, easy and affordable way to provide events with licensed and insured event medical services. Services range from pre-event consultations to Advanced Life Support (ALS) staffing and off-road response/extrication/rescue. Remote access medical care and other event medical services provided by EMS Unlimited are offered to public and private, competitive and non-competitive events throughout Colorado. EMS’s specially trained event paramedics and EMT’s are unique because they’re athletes themselves and understand the physical and mental challenges, the equipment, terrain and geography. Event organizers choose EMS Unlimited because it reduces their workload and stress by enhancing event safety and mitigating risk. For more information about EMS-Unlimited visit www.ems-unlimited.com, email info@ems-unlimited.com or call 970-658-0367.