ORGANISATION OF MEDICAL COVERAGE OF MASS SPORTING EVENTS

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1 Studia i Materiały. Miscellanea Oeconomicae Rok 15, Nr 1/2011 Wydział Zarządzania i Administracji Uniwersytetu Humanistyczno Przyrodniczego Jana Kochanowskiego w Kielcach Z a r z ą d z a n i e i b e z p ieczeństwo Robert Gałązkowski Robert Socha 1 ORGANISATION OF MEDICAL COVERAGE OF MASS SPORTING EVENTS All issues related to safety, licensing procedures and the scope and rules of responsibility of organizers and participants of such events as well as rules for collecting and processing information about the safety of mass events are laid down by the Act of 2009 on the safety of mass events. In the context of this Act tasks involved in the organization of medical coverage of mass sporting events are submitted in this paper. Security is one of the most important needs which set out the conditions of development of human civilization. This problem regarded as one of the priorities of world politics - has always triggered off waves of activity for a long time. Joint management and anti-crisis measures taken in this respect are a matter of prime importance to Governments and organizations that must cooperate to achieve the desired results mostly dependent on prevailing legal regulations and the legislative activities undertaken to combat violence, hooligan antics and all other violations of law likely to arise during the organization of events and festivities with a massive turnout, as well as on prevention. International cooperation and exchange of information give a better chance to provide protection against terrorist threats which make a dangerous phenomenon of the modern world. Health is commonly specified as "a state of complete physical mental and social efficiency and reasonable accommodation to the environmental conditions" PhD Robert Gałązkowski, Polish Medical Air Rescue; PhD Robert Socha, College of Health and Safety Management in Katowice. Polski Słownik Medyczny, Wyd. PZWL, Warszawa 1981, p

2 However, the disease is referred to as a "reaction of the system to the agent of the disease, leading to exhaustion of the adaptability of the system, to disorders of interaction of organs and tissues, and may result in functional disorders and organic changes in the tissues, organs and systems throughout the body" 3.. On the other hand, the term organization has been known for a long time but it has been ambiguous and open to various interpretations. The concept of organization is very old and derives from ancient Greek and Latin etymologically derives from words such as: organom, organizo, Latin organizatio all of them mean the creation of individual organs parts of ordered harmonious whole 4. In the present paper J. Zieleniewski s definition which claims that organization is a whole whose components contribute to the success of all 5 is used. It should also be noted that management is closely related to the functioning of the organization understood as a group of people with a common goal, task, plan or program of action 6. According to Clause 5. 1 of the Act on safety during public events their organizers bear full responsibility for them. Security of mass events means that their organizers are obliged to comply with requirements of ensuring the safety of people participating in such events as well as the protection of public order; security in terms of medical care as well as ensuring an adequate technical state of buildings which must be provided with installations and technical equipment guaranteeing fire protection and sanitation in particular. Medical coverage is the whole of operations and activities undertaken to prevent health loss, to provide medical assistance, to keep the greatest number of the diseased and injured alive, as well as to participate in the liquidation of consequences of using weapons of mass destruction and the prevention of diseases (especially infectious) in all organizational structures of health service in all the areas of its operations 7. Medical coverage includes: preventive health projects, medical and emergency projects, sanitary-hygienic and anti epidemic projects, sanitary protection and supplies of medical materials. It should be noted that medical protection includes all participants (both players and spectators) of mass sporting events, as well as those responsible for their safety. The very basic objective of providing medical coverage of mass sporting events is protection of life and health of their participants affected by unfavorable developments. Medical coverage in mass sporting events is concentrated on the security of spectators watching events taking place at Polish stadiums. However, it cannot be limited to the premises where there is a significant temporary increase in the number of people. Medical coverage must be understood in the broader context includ Ibidem, p Podstawy organizacji i kierowania. Wybrane problemy, red. nauk. A. Misiuk i K. Rajchel, WyŜsza Szkoła Policji, Szczytno 2007, p. 9. J. Zieleniewski, Organizacja i zarządzanie, PWN, Warszawa 1969, p Ibidem. Por. Leksykon wiedzy wojskowej, Ministerstwo Obrony Narodowej, Warszawa 1978, p

3 ing medical logistics and emergency medical services rendered to those in need in hospitals. Analyzing the security in pre-hospital coverage during championships attention should be paid to three aspects: access and exit of fans, their participation as supporters at football matches and other sporting events before and after them as well as their leisure time which they spend sightseeing or taking part in other accompanying events. Having chosen locations where matches are to take place, even today one may be tempted to analyze ways and means of reaching such places. Casualties are then conceivable when means of public transport are involved. In the context of stadiums it is indispensable to form of a graphical structure plan where a given mass event is supposed to be organized and it should include: a) signs: access and exits for the public, evacuation exits, access roads for emergency vehicles; b) signs: medical aid points, water points for fire fighting purposes, information points; c) signs: location of fire hydrants, valves, water connections, gas, electricity, other elements affecting the safety of users of the facility or site; d) information about the location/distribution of : Police, people at mass events and their possible distribution according to appointed sectors and the distribution of food and beverage outlets and toilets. Medical assistance will therefore be focused on sudden events which may occur not only on the way to places of sporting events but also during them To direct rescue operations at the stage of fans reaching their destinations, traditional rescue forces and operational measures will be dispatched within the National System of Emergency Medicine including: a) ground emergency medical services; b) air emergency medical services; c) Fire Fighting units of State Fire Brigade providing Qualified First Aid on the basis of the legacy of the Act on State Emergency Medical Services. The coordination of rescue operations at this stage usually focuses on medical dispatcher and other relevant dispatchers and entities of rescue departments in situations when the use of an adequate number of forces and means to coordinate is beyond the capabilities of the Coordinator Medical Emergency Physician on duty in the Regional Crisis Management Centre. 385

4 It seems that in this respect there will be no need for a substantial increase in the number of medical rescue teams but more emphasis should be put on proper coordination of rescue operations including the use of special procedures described in the regulations of the Polish Medical Air Rescue which state that more than one rescue helicopter can be used. In order to use the potential offered by a team of the Polish Medical Air Rescue, it is necessary to start constructing an adequate number of twenty-four hour heliports especially near specialized centres and hospitals with a wide diagnostic and therapeutic base. The expected result would be the creation of at least five twenty-four hour emergency landing sites for helicopters in each province. Another important element in the medical coverage of mass sporting events is an adequate preparation of hospitals, so that they could take care of a significant number of victims if necessary. Firstly, due to a temporary increase in the number of people on the spot, and, secondly, in the event of an incident with a massive turnout. In both cases proper coordination is required to provide necessary and adequate medical care in accordance with the maxim "do not move the disaster to the hospital. In the hospital area the Hospital Emergency Trauma Centres should be put on alert. Preparation of these units must be preceded by a thorough analysis of the demand for their services, and supported by a preliminary diagnosis of the number of people present at a specified time in the area adequately covered by the Hospital Emergency Department or Trauma Centre. Other hospital departments, branches of Trauma Departments in particular, should also be put on alert. An analysis of the number of people expected to be present in a given area can help to determine how many doctors and medical staff should be on duty then. In this context, it is also crucial to provide hospitals with appropriate supplies of blood units and other medical materials. While planning medical coverage, the capability to transport people with injuries from burns to specialised burn treatment centres should also be taken into consideration. In this respect it will be necessary to work out specific procedures describing how to treat such patients including the type of medical transport to be used depending on the time and distance of such transportation. The information on beds available in burn treatment centres in the country is available on the website of the Polish Medical Air Rescue, which is continuously updated. According to the prevailing operational capacity, the Polish Medical Air Rescue can be involved in coordinating the patient's medical transport to the nearest burn treatment centre. Medical coverage of football matches will depend on the number of people present at stadiums. After obtaining such information, it is important to determine the actual number of physicians (doctors, paramedics, nurses) who will provide medical coverage of the event. The number of ambulances available so as to ensure the efficient evacuation of the injured to hospital is also to be taken into account. 386

5 In this context it is necessary to work out an operational plan of medical support teams, and to adopt the principles of radio communication and evacuation routes from sectors directly to hospitals or medical points of medical segregation. It is also necessary to work out medical evacuation routes from stadium sectors. The possibility of medical evacuation using rescue helicopters should also be taken into consideration. It is then necessary to lay out emergency landing sites for rescue helicopters in the immediate vicinity of the stadium. It should be strongly emphasized that evacuation problems cannot be overestimated. Today, "in 41% cases of accident victims in Poland hospital treatment begins after more than three hours" 8. A rule stating that medical coverage of football matches must be based on additional emergency medical services but not on the teams included in the provincial plan of the operational system should be ordained. The latter may provide support but cannot form the basis of security because they must fulfil tasks imposed by a plan. Therefore, it is necessary to agree with disposers of medical rescue teams that additional teams are appointed to take adequate security measures during the event if necessary. The need to provide medical services with a radio communication system should not be forgotten. To guarantee broad-based organization, it is advisable to appoint a special coordinator of medical rescue teams who, together with a medical dispatcher, can make immediate decisions arising from the current progress of events. The protection of sporting events requires laying out places at stadiums for skilled medical staff and volunteers who know the rules of qualified first aid. Providing them with appropriate equipment contributes to the professional medical coverage of such events and rapid response when needed. From the medical coverage point of view the most dangerous issue refers to heavy losses among the participants of sporting events as well as to the number of people waiting for medical assistance that would be far beyond the capabilities of their organizers. Considering the studies conducted by the author, it can be concluded that the organization of medical protection of mass sporting events should be reduced in particular to: a) identification of needs of materials and medical equipment; b) description of requests to supply authorities with the scope mentioned above; c) identification of possibilities for the use of medical field infrastructure facilities; d) definition of the balance of needs indispensable for providing full medical coverage organizing medical aid and sanitary and epidemiological supervision. 8 J. Jakubaszko, A. Ryś, Ratownictwo medyczne w Polsce. Ustawa o Państwowym Ratownictwie Medycznym, wyd. Zdrowie i Zarządzanie, Kraków 2002, p

6 Projects cited above will be implemented through: a) the execution of policies adopted towards preparing the efficient operation of facilities and specialized services, including in particular: a review and an update of working plans conceived for a given sporting event; b) the preparation of forces and means particularly involved in: checking the update of supplies of medicinal products and medical devices (including the transfer of any changes to the appropriate institutions); c) the establishment of cooperation with governors and local government bodies in the sphere of provisions made for participants of mass sporting events. The need "in the field of security and accompanying overwhelming risks makes us feel a particular need for integration and use of all efforts to create security for all entities, that modern states and societies have. One of such entities that support with its activities governmental and autonomous institutions and prepare citizens to organize themselves for the safety are non-governmental organizations" 9. This is, however, only a signal resulting from the formula adopted. The issues of law and education are indispensable for maintaining the security of medical coverage of sporting events mentioned above. Indeed, "getting to the scene (...) even in optimally organized and functioning system requires a certain time. Typically, during the event in its location there can be found other people. It is essential that they can administer first aid until medical emergency services arrive. Thus arises the need to take action for broad public education (...)" 10. The arguments voiced here can be best summed up by the following quotation from Andrzej Zawadzki s article "but no - even perfect - legal act will not bring awaited effect if people who are to create this system, and later to act in it do not get involved in this work" 11. The present study was based on the current legal system in force that regulates emergency medical operations for the sake of people being in life-threatening conditions. This state of affairs is a consequence of the structure of public health system functioning in our country. Medical coverage problem requires a broader examination and thus thorough legal analyses and extensive consultations with other entities. PhD Robert Gałązkowski, Polish Medical Air Rescue. PhD Robert Socha, College of Health and Safety Management in Katowice A. Skrabacz, Współpraca organizacji pozarządowych z formacjami nadzorowanymi przez ministra właściwego do spraw wewnętrznych [w:] Współpraca struktur organizacyjnych resortu spraw wewnętrznych i administracji z pozostałymi elementami systemu obronnego państwa, red. nauk. E. Nowak i B. Wiśniewski, MSWiA, Warszawa 2006, p. 56. Ustawa o Państwowym Ratownictwie Medycznym. Komentarz, (red.) S. Paździoch i P. Guła, ABC, Warszawa 2008, p. 64. A. Zawadzki, Słowo wstępne [w:] R. Gałązkowski, Ratownictwo medyczne w Polsce. Komentarz do ustawy z dnia 8 września 2006 o Państwowym Ratownictwie Medycznym, MSWiA, Warszawa 2007, p