Special Events Medical Operations Form Instruction Sheet

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1 Special Events Medical Operations Form Instruction Sheet Philosophy Monterey County has a vested interest in a safe environment during recreational events hosted at County facilities. Events hosted at Laguna Seca are of the nature that large groups of spectators means the possibility of injuries and unexpected illnesses are more likely. The Special Event Medical Operations Plan that you have been given to complete will provide us an insight as to the type of activities and the scope of medical coverage onsite. This information will serve as a guideline to all public safety services that may be called to the site to provide coordinated and integrated emergency medical care. The Medical Operations Plan will be reviewed by Salinas Rural Fire District (EMS first responder agency responsible for Laguna Seca Park), the EMS Agency Medical Director and the County contract paramedic service (if they are not expected to provide onsite medical coverage). The Plan must be completed and submitted to Monterey EMS Agency at least 30 days before the planned event. The EMS Agency staff is available to assist you in completing the plan as may be needed. The office number is (831) and the fax number is (831) Instructions for Completing the Plan COMPLETED BY: On this line is the name of the individual that compiled the Plan. DATE: The date that the Plan has been approved by appropriate staff of the sponsoring event. 1. General Information A. Name of Event: Use the name that will be used for advertising purposes. B. Event Dates: In this section, month, day and year should be included. If the event spans more than four days, add a sheet on the back of the plan including all the information listed in this section for each additional day. 1. Time(s): List here the formal event start and closing times for each day 2. Total Daily Attendance: In this section, estimate the total expected persons for each day of the event. 3. Number of Participants: The number of persons who will directly participate in the event including event officials. 4. Number of Spectators: An estimate of how many persons are expected that will not directly participate but observe. 1

2 5. Overnight Attendance (camping): The park does allow onsite camping. In the plan, give an estimate of how many will be expected to overnight. 6. Total Number of Ambulances Each Day: Monterey County contracts with a single provider of paramedic transport. Only this contractor is allowed to provide onsite paramedic ambulance service. Arrangements for this service can be made by calling American Medical Response (831) C. Description of Event: In this section, describe the overall event and the major activities expected. Include for this section, a copy of the Laguna Seca map that shows the areas of expected activity (map available through SCRAMP administration). D. Overall Event Contact: In this section, the name of the contact person, sponsor address, the daytime telephone number and fax number. E. Event Medical Coordinator: The name, address and telephone number of this person should be the one who may be contacted for plan clarification if needed. The person s title should be their professional designation as appropriate (EMT-1, RN, LVN, MD, etc.) II. Spectator Medical Operations Plan This section of the plan should be completed if the event planners expect a spectator gathering e.g. auto or motorcycle racing, concerts, etc. A. Spectator Medical Contact: If this person is the same as the Event Medical Coordinator please complete this section as before. If the person is other than the Medical Coordinator, list daytime address and phone numbers. B. Spectator Medical Related Hazards/Problems Anticipated: Consider heat problems, injuries that might be caused by a rowdy crowd, fire hazards or hazards caused by racing cars and motorcycles that could cause spectator injuries. C. Spectator First Aid/Medical Stations: Racing events often separate the planned event activities that could cause injuries from that of spectator observation areas, e.g., auto racing events generally don t allow spectators in the racing areas and therefore by necessity set up two separate medical/first aid sites once inside the racing area and another in the spectator area. In any event, describe the fixedbased facilities that will be provided for spectators (if any). 1. Complete Please complete page 5 with this information. 2. Staffing: List how many persons will be assigned per fixed facility. 3. Staff Training: List how many physicians, RNs LVNs, EMTs per fixed facility. 2

3 4. List Medical Equipment: List here first aid equipment if this level of care expected or other equipment/supplies e.g. IV s medications, suture supplies etc as may be the case. D. Spectator Ambulances: Complete this section if different than ambulances that will be dedicated to participants. If ambulance coverage is intended for all event coverage, complete this section, list the ambulance coverage here only. 1. Complete location: For this section, complete the information noted on page Replenishment system: A brief note regarding how expendable supplies will be replenished. Of importance in this section is whether or not the ambulances will have to leave the site to restock. E. Other Information: Complete this section if unusual medical coverage is to be provided, i.e., medical staff are to be mobile and not fixed base. If no other information is indicated, mark this section NA. III. Participant Medical Operations Plan A. Participant Medical: This section is to be completed only if the medical support system has a dedicated and separate medical support program than will be provided to the spectator group. If this is not the case, mark the section NA. B. Participant Medical Related Hazards/EMS Problems Anticipated: An example of how this may differ from the spectator portion of the plan, consider auto racing. In this case, fractures, multi-systems trauma, burns, etc. could be expected. If no distinction is made between the spectator and participants as example a car show, mark this section NA. C. Participant Sanctioning Body: In this section, list the sanctioning body as appropriate, e.g., NASCAR. If the event does not require a sanctioning body, mark this section NA. D. Medical Requirements of Sanctioning Body: List here any special requirements of the organization listed in section C. An example is that the injured must be transported to a trauma center or the event is now allowed to continue without on scene medical coverage, etc. If there are no special requirements, mark this section NA. E. Participant Fire Aid/Medical Stations: As noted earlier, if the event is not expected to provide separate first aid care for participants and spectator, mark sections A-F See section II. However, if a separate system is intended, detail this section as per instructions for section II. 3

4 F. Air Ambulance: If air ambulance coverage is planned even if not required to be stationed onsite, complete this section; otherwise, mark this section NA. G. Other Information: Use this section to explain or detail your program not otherwise noted in the plan. If no other information needs to be explained, mark this section NA. IV. Event Medical Coverage Plan The type of coverage refers to items A-D. The Date and Day columns allow you to detail variances in the medical coverage based upon differing activities for each day as indicated. Please fill in the appropriate areas as completely as you can. The importance of this document is that it will be used as a guide for all of the agencies who will be providing medical support during the event. V. Agreement with Local Policies A. Private Physicians: This section should be initialed noting that all physicians regardless of event assignment must be familiar with EMS Policy A copy is attached to these instructions. B. EMT-Ps: This section requiring the familiarity of paramedics with local treatment protocols is intended for paramedics who ARE NOT accredited to practice in Monterey County. Paramedics who staff county contracted paramedic ambulance service are already accredited and have working knowledge of the treatment protocol and therefore this section does not apply. C. EMS Agency during Event: In most cases, EMS staff will perform an onsite evaluation of our event as it relates to your medical plan: It is essential that Agency staff be allowed into the various event sites without hindrance. If a pass is needed for this purpose, then four each passes must accompany this plan. Parking passes (if needed) must be provided as well. Notice that the initials for both the event sponsor and medical coordinator are required in acknowledgement of this requirement. D. Medical Aid Assurance: Initialing by both the event sponsor and medical coordinator indicates that the following three paragraphs have been read and agreed upon. VI. Signatures This section is self-explanatory. VII. EMS Agency Approval 4

5 Do not write in this section. The EMS Agency is responsible to circulate the plan to Salinas Rural Fire District and the EMS Medical Director. As we review the Plan, you will be contacted for clarification as needed. Otherwise the plan will be signed and returned to the Events Coordinator for Laguna Seca and distributed to the appropriate agencies. Special Events Medical Report (Enclosed) Please note that included in the Special Event Medical Operations Plan packet are four sheets titled Special Event Medical Report. This record is intended for risk management purposes. Therefore, the sheet(s) are to be completed with the information as noted and copy (or the original if it is going to otherwise be discarded). Must be sent by mail or fax to the EMS Agency within 15 days after the event. You may make as many copies as needed. Instruction on how to complete the sheet is printed on the back of the record. 5

6 SPECIAL EVENT MEDICAL OPERATIONS PLAN Monterey County EMS Completed By Date I. General Information A. Name of Event B. Event Date(s) 1. Time(s) 2. Total Daily Attendance 3. Number of Participants 4. Number of Spectators 5. Overnight Attendance (camping) 6. Total Number of Ambulances each day Day 1 Day 2 Day 3 Day 4 C. Description of Event (attach copy of completed Parks Department Special Event Site Map) D. Overall Event Contact Name Agency Address Telephone # FAX # E. Event Medical Coordinator Name Title Address Telephone # FAX # 6

7 II. Spectator Medical Operations Plan A. Spectator Medical Contact Person: Name: Title: Address: Telephone #: FAX # B. Potential Spectator Medical Related Hazards/Problems Anticipated: C. Spectator First Aid/Medical Stations: Yes No How Many Are they separate from the participant medical stations? Yes No Contact Person: Title: Telephone #: FAX #: 1. Complete location and coverage times on page five. 2. Staffing: (Number of staff per station): 3. Staff training levels and scope of practice: 4. List of medical equipment available: D. Spectator Ambulances: Yes No How Many Are they separate from the participant ambulances? Yes No Company/Contact Person: Telephone #: FAX #: 1. Complete location, type and coverage times on page five. 2. Replenishment System: E. Other Information 7

8 PARTICIPANT MEDICAL OPERATIONS PLAN A. Participant Medical: Name: Title: Address: Telephone #: FAX # B. Potential Spectator Medical Related Hazards/Problems Anticipated: C. Participant Sanctioning Body: Name of Organization: Contact Person: Title: Address: Telephone #: FAX #: D. Medical Requirements of Sanctioning Body: E. Participant First Aid/Medical Stations: Yes No How Many Are they separate from the spectator medical stations? Yes No Contact Person: Title: Telephone #: FAX #: 1. Scope of Service: 2. Staff Credentials: 8

9 III. Participants Medical Operations Plan Continued F. Participant Ambulances: Yes No How Many 1. Are they separate from spectator ambulances? Yes No Company/Contact Person: Telephone #: FAX #: Complete location, type and coverage times on page five. 2. Replenishment system: G. Air Ambulance: Yes No How Many Company/Contact Person: Telephone #: FAX #: 1. Complete location, type and coverage times on page five. 2. Interface plan with ground ambulance and local hospitals: H. Other Information 9

10 EVENT MEDICAL PLAN COVERAGE Plot all the locations of resources listed below on the event site plan 1. Type of Coverage A. Medical Facilities: 1. Spectator # Date: Day: Location & Date: Date: Day: Day: List Daily Coverage Location & Location & Date: Day: Location & Contact: (1 st Aide, Hospital) 2. Participant # Contact: Location & Location & Location & Location & (1 st Aide, Hospital) B. Ambulances 1. Spectator (BLS/ALS) 2. Participant (ALS/BLS) C. Air Ambulance: Onsite Location Only Contact: D. Onsite Med Dispatch: Frequency: Frequency: Frequency: Frequency: 10

11 V. Agreement with Local Policies Read and Initial Sections A through D where indicated. A. Private Physicians (Medical Initial Here) Initial here to acknowledge receipt of EMS Policy No entitled, Physician On Scene, and agreement that physicians utilized during this event are oriented to this policy. B. EMT-II/Ps (Medical Initial Here) Initial here to acknowledge your agreement that EMT-IIs and EMT-Ps will only function under the basic life support scope of practice during this event. (This does not apply to Monterey County personnel onboard ambulances operated by Monterey County approved ambulance companies.) C. EMS Agency Access During Event / Sponsor Initial Here/Medical Initial Here Initial here to acknowledge that EMS Agency staff designated by the EMS Administrator have personal and vehicle access to review the medical facilities and onsite ambulances. If special event credentials or vehicles passes are required to access these areas during the event, such items will be provided to the EMS Agency prior to the start of the event. (a minimum of four each). D. Medical Aid Assurance / Sponsor Initial Here/Medical Initial Here This plan provides for emergency medical care for both spectators and participants of the event. The plan differentiates the types and resource distribution between spectators and participants. This plan reflects the agreed to priorities of the emergency resource distribution between spectators and participants. It is the sponsor s commitment that the event contractor/officials and the ambulance company have a plan/procedure to redistribute the emergency medical resources to assure that medical aid will not be withheld from any spectator or participants as a result of this plan or any other agreement. VI. Signatures A. Signature: Event Medical Coordinator Date Print Name 11

12 B. Signature: Event Sponsor Date Print Name VII. EMS Agency Approval Salinas Rural Fire District has reviewed this plan Yes No Approved Disapproved EMS Agency Director Signature: Date: I. Purpose The purpose of this policy is to establish guidelines for scene management where: A. A physician requests to assume patient care responsibilities, or B. A private physician who is on scene and providing care for their previously established patient requires Emergency Medical Services. II. Procedure A. Physician on Scene The Monterey County EMT-P on scene shall maintain responsibility for patient care and receive medical direction from the Base Hospital unless the physician can clearly identify him/her as a licensed physician and agrees to assume responsibility for care and accompany the patient to the hospital. When a California licensed physician is on scene and requests to assume patient care responsibility the EMT-P must: 1. Initiate patient care. 2. Obtain proper identification, consisting of a California Physicians and Surgeons License. 3. May use State of California card on physician involvement with EMT-Ps to assist in giving them their direction on scene. 12

13 4. Contact Base Hospital. If the on scene physician wants to provide direct patient care and/or order treatment, Base Hospital Physician approval must be obtained. Effective Date: 1984 Supersedes: Revision Date: November 9, 1994 Review Date: November 1996 Approved: Approved: Robert J. Melton, M.D., M.P.H. Director of Health Chris Le Venton, EMS Administrator 5. The Physician must assume responsibility for the patient and accompany patient to the hospital if they render direct care at scene. 6. In the event of conflict, follow Base Hospital County Patient Destination Policy. 7. Patient destination will be according to Monterey County Patient Destination Policy. B. Patient s Private Physician on Scene The Monterey County EMT-P may assist the patient s physician provided the EMT-P operates with Monterey County approved ALS Scope of Practice and there is collaboration with the Base Hospital on treatment rendered at scene and enroute. When a private physician is on scene and providing care for their previously established patient the EMT-P must: 1. Obtain proper identification consisting of a California Physician s and Surgeon s License. 2. The patient s physician may administer medication from the private physician s drug inventory. Advise Base Hospital of any such treatment rendered. 3. The EMT-P may follow the patient s physician s orders if they do not conflict with Monterey County ALS Scope of Practice and Field Treatment Guidelines. 13

14 4. Contact Base Hospital to inform regarding treatment rendered. If there is conflict regarding treatment on scene, Base Hospital should discuss treatment with patient s physician. 5. Patient destination requests by private physicians may be granted provided Base Hospital is in agreement and patient is medically stable for transfer. III. Distribution Monterey County EMS Policy and Procedure Manual. IV. References A. California Health and Safety Code, Division 2.5. B. California Code of Regulations, Title 22, Division 9. Instructions for completing Special Event Report Prepared by: (A) Report Date: (B) Date (C) Time (D) Name (E) Spectator Participant (F) Location of Injury (G) Chief Complaint (H) A or D (I) A. Prepared by: Name of the individual completing this report. B. Date of Report: Please use separate pages for each day logged. C. Date: Date of incident or injury. Note: If injury occurred on a day other than the event day logged, please make the appropriate notation in block G (i.e., Patient originally injured in a fall last week). D. Time: Time of incident or injury. See NOTE above for injuries occurring at other times and locations. E. Patient Name: Patient name or patient ID. F. Please check Spectator if patient is a Spectator or Participant. G. Location of incident/injury: Identify the location as specifically as possible (i.e., Turn 11; 1.3 miles from the starting line; grandstands; parking lot C; etc.) 14

15 H. Chief Complaint: What brought the individual to the attention of medical personnel? If multiple complaints are presented, list only the top three problems. I. A or D: Check this block only if Patient alcohol or other drug intoxication is suspected to have contributed to the incident/injury. Transportation Treatment Provided None POV Amb Air Disposition T M J. Treatment Provided: Brief synopsis of the treatment provided (i.e., cleansed wound, ace wrap, ice pack applied, etc. Note: Please use as much space as needed to complete this section. K. Transportation: Check one as follows. None: No transportation needed. POV: Private vehicle. Amb: Ambulance utilized. Air: Air lift utilized. L. Disposition: Disposition of patient following treatment (i.e., treated and released; advised to go to hospital, released to ambulance, etc.) Provide final disposition if known (i.e., X-rays negative, released from hospital after 8 hours observation, etc.) 15

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