Hospital-based healthcare provider (nurse and physician) integration into an emergency medical services–managed mass-gathering event

Martin-Gill, Christian; Brady, William J.; Barlotta, Kevin; Yoder, Anthony; Williamson, Allen; Sojka, Benjamin; Haugh, Dayton; Martin, Marcus L.; Sidebottom, Marge; Sandridge, Leonard

doi:10.1016/j.ajem.2006.07.003

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 1 , Pages 15-22, January 2007

Hospital-based healthcare provider (nurse and physician) integration into an emergency medical services–managed mass-gathering event

Christian Martin-Gill, MD
- Affiliated Residency in Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
William J. Brady, MD
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
- Charlottesville-Albemarle Rescue Squad, Charlottesville, VA 22908, USA
- Corresponding author. Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA.
Kevin Barlotta, MD
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
Anthony Yoder, EMT-P
- Charlottesville-Albemarle Rescue Squad, Charlottesville, VA 22908, USA
Allen Williamson, RN
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
Benjamin Sojka, EMT-P
- Charlottesville-Albemarle Rescue Squad, Charlottesville, VA 22908, USA
Dayton Haugh, EMT-C
- Charlottesville-Albemarle Rescue Squad, Charlottesville, VA 22908, USA
Marcus L. Martin, MD
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
Marge Sidebottom, BS
- Office of Emergency Preparedness, University of Virginia Health System, Charlottesville, VA 22908, USA
Leonard Sandridge, BS, MS
- Vice President's Office, University of Virginia, Charlottesville, VA 22908, USA

Received 12 October 2005; received in revised form 26 May 2006; accepted 2 July 2006.

Abstract

Introduction

This report describes not only the implementation of a coordinated emergency medical services–hospital–based healthcare team but also investigates the integration of nurse-physician teams at a mass gathering medical care event.

Methods

A review of resource utilization, patient encounters, and local ED census was performed during this period at a college football stadium.

Results

During this 4-year period, 1681 patients presented for medical care during 26 events with a total attendance of 1544244 (1.09 patients per thousand attendees [PT]). The majority of patient contacts were for minor complaints (1451, 87.6%), whereas 205 (12.4%) received full evaluations (focused history and physical examination most often with pulse oximetric and electrocardiographic monitoring). A total of 109 patients were transported (4.19 PT), representing 6.48% of all patients. Patient census for the event medical deployment increased from 0.44 PT in 2001 to 1.75 PT in 2004. The number and percent of patients transported also increased between 2001 (0.02 PT, 4.48%) and 2004 (0.12 PT, 6.67%). However, 118 (57.6%) patients who received full evaluations were able to be discharged by a physician, avoiding transport. Chief complaints and management of patients receiving full evaluations were consistent across this period, with altered mental status (52.7%) and chest pain (12.7%) as the most common complaints. Average ED census during this period was found to be significantly higher on event days (176.2) than nonevent days (161.2) (t = 8.04, P < .001), although this produced only a minor impact on the emergent care system.

Conclusion

This study describes one potential deployment plan for a mass gathering medical event and suggests that the incorporation of physicians into a mass gathering setting may be associated with an absolute increase in patient census and transports, while decreasing the percent of patients transported. The impact on local emergency medical services and ED resources, although not specifically investigated in this study, was likely minimal.