16 Medical Facilities, First-Aid and Ambulances

<strong><em>General</em></strong> 16.1 Detailed requirements in regard to the provision of medical facilities, first-aid and ambulances at sporting events are contained in Chapter 23 of the Code of Practice for Safety at Sports Grounds.¹ These provisions will require adjustment for pop concerts and, in particular, concerts held on open sites. 16.2 The role of the Health Board is to: (i) maintain normal emergency medical and ambulance cover for the local resident population; (ii) provide medical, ambulance and first-aid cover for all participants; (iii) be prepared to respond to a major accident; (iv) advise on all health matters, including food hygiene, and to monitor and implement the relevant statutory regulations; and (v) provide all health services as outlined in the Major Emergency Plan. 16.3 The Health Board should be notified of the event with full details of location, artist(s), and type and number of patrons expected so that adequate medical/hospital and first-aid provision can be made. Such notification should be made at the preliminary planning stage (See Paragraphs 5.8 - 5.12). 16.4 The required health facilities on site should be agreed by the Promoter with the Health Board. This will include medical facilities such as nursing, first-aid, ambulance staff and equipment, vehicles and communications. Responsibility rests with the Promoter to ensure that adequate first-aid services are provided. 16.5 The Health Board should coordinate arrangements being made by Civil Defence and the Voluntary Aid Organisations such as the Order of Malta, Red Cross and St. John’s Ambulance. Such organisations should receive the same notice of the event as the Health Board. 16.6 The measures described elsewhere in this code will, if followed, help to prevent a serious accident. However, for Promoters to fully discharge their safety responsibilities, they should ensure that proper medical services, including first-aid and contingency medical provision, are available in case there is an incident. Such provision may be required at the venue prior to, during and after the event. 16.7 The nature of the concert will determine the extent of medical services required. A concert attracting a mainly young audience will require a wider range of medical services than a concert which attracts an older, more sedate audience. The levels of service indicated in this Chapter are for a mainly teenage audience; these levels can be reduced by up to 40% for a more sedate audience. 16.8 Plans to deal with crowd control at the site and in the surrounding areas should have regard to the necessity of ensuring that normal medical and ambulance services to the general public in the area are maintained. This may require the siting of one or two ambulances within the surrounding area before, during and after the event. 16.9 The Health Board and the Voluntary Aid Organisations should be consulted by the Event Safety Officer on the layout of the stage area, including stage and front-of-stage barriers, to ensure adequate provision is made to facilitate ease of evacuation for distressed patrons. At least one, and preferably two, fully equipped First-Aid points should be situated adjacent to the front-of-stage barrier(s) to deal with such people. <strong><em>Operational Plan</em></strong> 16.10 An Operational Plan should be prepared by the Organisation(s) providing medical and first-aid facilities at the venue indicating the names of key personnel, their area of control and the location of the ambulances. This Plan should also include a drawing of the venue which should be cross referenced to the Plan. 16.11 Medical Control is exercised by the Site Medical Officer and operational control by the Site Ambulance Officer, as designated by the Health Board. The purpose of the plan is to provide adequate patient care and evacuation elements at the venue. This will be provided through First-Aid Points, Medical Centres, and Site Ambulance Control. <strong><em>First-Aid</em></strong> 16.12 It is recommended that the first-aid system set out hereunder be operated at the venue. Properly equipped First-Aid Points should be provided at the concert site. The location and number of First-Aid Points should be provided in agreement with the Health Board and the Voluntary Aid Organisation(s). One or two of these First-Aid Points should be located adjacent to the stage and should be clearly identified on site maps. 16.13 Each First-Aid team should consist of 2 trained first-aid personnel patrolling a specific area, providing basic first-aid and reporting more serious casualties. 16.14 Fully equipped First-Aid Points, at which a number of First-Aid teams are based, should be provided. They should be clearly identified by proper signposting of sufficient size and be clearly visible. Each Point should be staffed by 4 First-Aid teams, with one team at base and 3 on patrol. Each Point should contain first-aid materials and equipment, the nature of which should be agreed with the Health Board and Site Medical Officer. This equipment should include adequate oxygen supplies. 16.15 The First-Aid Points should be provided with telephones or other method of communication with the Medical Centre, the Site Ambulance Control and outside agencies, such as hospital and other emergency services. 16.16 The number of first-aid personnel required will vary according to the type of concert, artist, crowd, and age group expected. The number required will also depend largely on the type of venue, i.e., whether in a sports ground or on an open site. 16.17 At a concert attended by a predominantly young audience the number of first-aid personnel required may be calculated on the following basis:- <table> <tbody> <tr> <td width="205"><strong>ATTENDANCE</strong></td> <td width="205"><strong>NO. OF FIRST-AID PERSONNEL</strong></td> <td width="205"></td> </tr> <tr> <td width="205"></td> <td width="205"><strong>OPEN SITES</strong></td> <td width="205"><strong>SPORTS GROUNDS</strong></td> </tr> <tr> <td width="205">5,000</td> <td width="205">25</td> <td width="205">10</td> </tr> <tr> <td width="205">10,000</td> <td width="205">45</td> <td width="205">15-20</td> </tr> <tr> <td width="205">20,000</td> <td width="205">65</td> <td width="205">20-35</td> </tr> <tr> <td width="205">30,000</td> <td width="205">80</td> <td width="205">35-50</td> </tr> <tr> <td width="205">40,000</td> <td width="205">90</td> <td width="205">70</td> </tr> <tr> <td width="205">Each Additional 10,000</td> <td width="205">10</td> <td width="205">10</td> </tr> </tbody> </table> Each group of four First-Aid teams, or less should be overseen by an experienced officer-in-charge. <strong><em>Medical Centre </em></strong> 16.18 It will be necessary to make special provision to deal with people with illnesses such as heart condition, asthma, etc.. The function of the Medical Centre is to deal with more serious casualties which are referred by the First-Aid Points. The Medical Centre should be staffed by doctor(s), nurses and Ambulance Service staff, equipped to provide Advanced Life Support and to deal with more serious casualties. The number of centres and staffing will depend on the event. Off-site medical centre(s) may be necessary. The on-site Medical Accident and Emergency Team should provide a casualty service and act as a clearing station and treatment post before transferring patients to hospital(s) in the area, if necessary. The Team should ideally include 2 doctors of Registrar status, two junior doctors and six nurses. 16.19 The Medical Centre should be large enough to contain a couch with adequate space for people to walk around. In recognised sports grounds a sink, hot and cold running water, drinking water, a work-top and sufficient room to store stretchers, blankets and pillows will be required. On open sites, alternative arrangements must be made to make provision for these facilities in agreement with the Health Board and the Site Medical Officer for the event. This may consist of sterile water or sterile normal saline and a supply of drinking water over a sink or wash-band basin. The recommended minimum size for the Medical Centre is fifteen square metres. For open sites, a marquee, mobile unit or other similar structure, could serve as a satisfactory medical centre. It must have proper access for ambulances. For major outdoor concerts a large marquee or similar structure should be provided for use as a casualty clearing area. Where the capacity of the site, calculated in accordance with this Code of Practice, exceeds 15,000 the size of accommodation should ideally be increased to at least twenty-five square metres and an additional couch should be provided. Care should be taken to ensure that the doorway is large enough to allow access for a stretcher or a wheelchair. Toilets and other facilities should be available including those suitable for the handicapped. 16.20 At any event where the number of spectators is expected to exceed 5,000 a doctor should be designated Site Medical Officer by the Promoter with the agreement of the Health Board for the day(s) of the concert. S/he should be experienced in casualty work and have expertise in cardio-pulmonary resuscitation and in the use of defibrillators. This again will depend on local circumstances and should be agreed in consultation with the Voluntary Organisation/s providing medical facilities for the event. S/he should be responsible for checking before and during the event that the necessary equipment is available. In the event of any major incident the Site Medical Officer, or an appointed deputy, will assume full responsibility for all medical and first-aid facilities on site. It is essential that provision is made for the immediate removal of serious casualties to hospital(s) on the advice of the Site Medical officer or her/his deputy. 16.21 For larger events extra doctors should be provided, as required, in agreement with the Health Board. For example, the likely number of doctors required for a major concert of over 40,000 attendance, mainly consisting of a young audience, would be four to six depending on the circumstances. The responsibility for the provision of doctors varies in different locations and, in many circumstances, doctors are provided by the Voluntary Aid Organisations but to ensure coordination between these Organisations and the Health Board full consultation should take place in the preplanning of the event. 16.22 The doctor(s) should:- (i) be at the ground at least an hour before the start of the concert; (ii) remain until half an hour after it has ended; (iii) be made aware of the location and staffing arrangements of the First-Aid Points and Medical Centre, and details of the ambulance cover; and (iv) be located in the Medical Centre and approved positions known to the Central Control Room, the Gardaí, stewards and first-aid and ambulance staff: they should be immediately contactable. 16.23 A record should be kept by the Health Board and the organisations rendering the treatment of all patients treated and details recorded should include name, address and age of the injured, nature of injury, where it happened, type of treatment, and times of admission and discharge or transfer to hospital. It is recommended that the Health Board should collate such records after the event. <strong><em>Site Ambulance Control</em></strong> 16.24 Site Ambulance Control will provide independent communications (radio and line) for all casualty functions on site and rear links to acute hospital facilities. 16.25 Arrangements should be made in agreement with the Health Board for the provision of at least one fully equipped ambulance, in accordance with the standards recommended by the National Ambulance Advisory Council, either from the Health Board or the Voluntary Aid Organisations, to be in attendance at all events with an anticipated crowd of 5,000. Ambulances should be in attendance at the event at least one hour before the event, during the event and half an hour afterwards. The need for deployment of additional ambulance(s) should be agreed with the Health Board. The suggested ambulance provision is 1 ambulance per 10,000 attending but major outdoor pop concerts with crowds approaching 40,000 or more are likely to require more detailed arrangements, especially on open sites. 16.26 For major concerts the plans will include the provision of the following equipment:- (i) mobile Control Vehicle for operational control of all Health Board operations, including casualty evacuation, emergency medical equipment, emergency power and communications; (ii) mobile Casualty Unit/Field Hospital; (iii) 2 ambulances both preferably cardiac equipped and, where possible, with 4x4 vehicle facilities; (iv) additional ambulances at locations decided by the Health Board. 16.27 The following is a general guide to the number of ambulances required for various attendances. The number will depend on location, distance to hospitals and local circumstances:- <table> <tbody> <tr> <td width="168"><strong>ATTENDANCE</strong></td> <td width="198"><strong>NUMBER OF AMBULANCES</strong></td> </tr> <tr> <td width="168">5,000-20,000</td> <td width="198">1</td> </tr> <tr> <td width="168">20,000-30,000</td> <td width="198">2</td> </tr> <tr> <td width="168">30,000-40,000</td> <td width="198">3</td> </tr> <tr> <td width="168">Each Additional 10,000</td> <td width="198">1</td> </tr> </tbody> </table> Responsibility for the provision of ambulances may rest with either the Health Board or the Voluntary Aid Organisations but in all cases the provision should be agreed with the Health Board. The agreement of the Health Board is required to the appropriate mix of statutory and voluntary services outlined in Paragraphs 16.24 - 16.27. <strong><em>Parking and Access for Emergency Vehicles</em></strong> 16.28 Special separate parking areas for emergency vehicles should be available and located so as to give them easy and quick access to the inside of the site, including the Medical Centre and First-Aid Points. They should be spacious enough to allow maneuvering as well as parking, taking into account the number of vehicles required for the capacity of the ground and the layout of the emergency areas. 16.29 In certain cases, ambulances may require a Garda escort but the traffic and emergency plans should take this factor into account in the preplanning of the event. 16.30 All Health Board staff should wear distinctive clothing and should be issued with non-transferable passes for the event. <strong><em>Reference</em></strong> 1. Code of Practice for Safety at Sports Grounds, Stationery Office, Dublin, 1996.