Close the Gap in Your Security Program
Ensuring Patron Safety Must Involve Seamless Emergency Medical Response

By Dr. Ricardo Martinez

Ricardo Martinez, M.D., FACEP

The strong focus on security at public venues is necessary and long overdue, but represents only part of a total solution. To be truly prepared, venues also must consider emergency medical response.

Traditionally emergency medical response at venues has been focused on first aid and managed by security, safety or operations personnel.

Each of these disciplines has seen tremendous advances, making it difficult to keep abreast of the rapid changes, emerging standards and trends in the emergency medical response field. As a result, each has become isolated, rather than integrated into a seamless system.

These groups speak different languages and have different, sometimes opposite, goals. For example, security looks at the world in terms of restricted access and hard lines of jurisdiction. In contrast, emergency responders think in terms of unrestricted access and circles of time. Now, more than ever, what is needed is a truly integrated operations system that links these disciplines together.

The best approach is a team approach that focuses first on the big picture and then works down to specifics. Vital to this team approach is true understanding of roles and responsibilities of three major disciplines — venue operations, security, and emergency response — a clear vision of how the venue interfaces with the community that it serves.

A sound approach links operations, security and medical services into an integrated end-to-end system incorporating planning, prevention, response and recovery.

Planning. Begin with the end in mind. Effective planning requires identification of a broad array of stakeholders and capabilities to address issues ranging from isolated incidents to large-scale catastrophes. While this sounds simple, it is quite uncommon. Too often, planning is done by small groups acting in isolation.

Instead, everyone who has a role (including ushers, transportation managers, vendors and maintenance staff) in the success of the venue also has a role in the successful prevention, response and management of incidents.

When considering who the stakeholders are, keep in mind incidents can expand and so should the response. Some incidents require a local, regional or even national response. Planning ahead allows identification of resource needs and close integration of communications, operations and responses — both on-site and off-site.

Once stakeholders are identified, overall objectives and response standards to reflect their needs and capabilities must be established.

Prevention. While the focus now may be on security to minimize terrorist threat, the fact is major injuries and incidents will occur that have nothing to do with terrorism. Injury prevention goes beyond traditional risk-management practices to embrace injury control, a process that helps identify potential hazards, causal chains and effective countermeasures. However, one simple way to identify hazards is to work with medical responders to find out where injuries are occurring, rather than waiting for the complaint from a patron or his or her representative before reacting. An ongoing proactive process quickly helps the bottom line by decreasing potential for injury litigation, avoiding the cost of responding to unnecessary incidents and improving the patron experience.

Response. In critical situations, time is tissue. The emergency medical response is a time-driven system that seeks to deliver “the right person to the right place at the right time.” Patrons with various levels of medical needs (minor, urgent and emergent) enter the medical response system and are matched to the proper level of care such as first aid station, basic life support, advanced life support or hospital care. The chain of survival begins with notification — a fan, an usher, a concessionaire or employee. How the chain builds and how the response is deployed requires strong medical planning, trained staff and the right resources. It should include coordination of access, administration, first responders, training, medical direction, communication, first aid stations, equipment, triage, hospitals, system integration, quality assurance and transportation.

Recovery. Beyond responding to an incident, you have to contain and manage its consequences. While many incidents can be contained within an on-site response, incidents such as contamination, multiple casualties and mass evacuation may require offsite resources and mutual aid. Facility plans must interface with local, state and even national resource plans to respond to these situations.

In addition, knowing how to maintain balance between security and medical/safety response needs is essential. Prior planning, training and development of mutual aid agreements assures plans that work smoothly.

The goal is not just to respond to incidents but to recover the facility and keep operations intact, bringing depleted resources such as medics, supplies and ambulances back up to the original operations level. For large-scale events, it is important to communicate with the community because the facility may play a different role in a community response (i.e. shelter, morgue, hospital). As security professionals push the bar higher for venue safety, expanding the circle of influence and coordination reaps rewards and improves venue readiness. By bringing others together around venue prevention, planning, response and recovery issues, security professionals raise the bar even higher.

Ricardo Martinez, M.D., FACEP, a board-certified emergency physician, is the chairman and founder of Medical Sports Group.(www.medicalsportsgroup.com), a consulting firm that provides emergency planning and response for organizations such as the National Football League and Major League Baseball. He also serves as a Public Venue Security advisory board member.