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Enhancing Preparedness for Medical Emergencies at Mass-Gathering Sporting Events
First-hand experience with the extreme heat and humidity of the 2007 Chicago Marathon, resulting in the need to cancel the event mid-race, gave George Chiampas, DO, CAQSM, FACEP, unique knowledge in the management of a mass-gathering event in the face of adversity. Today, the Chicago Marathon—which utilizes the emergency plan called the Chicago Model that Chiampas helped establish—is recognized as a world leader in emergency preparedness and public safety. In this episode, Chiampas shares strategies for enhancing preparedness for medical emergencies at mass-gathering sporting events, from high school football games to big city marathons.
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Learn more about George Chiampas, DO
George Chiampas, DO
George Chiampas, DO, CAQSM, FACEP, assistant professor of Emergency Medicine and Orthopaedic Surgery at Northwestern Medicine, is the chief medical officer for U.S. Soccer. He also serves as medical director of the Bank of America Chicago Marathon, team physician for the Chicago Blackhawks and on FIFA’s Medical Committee as the U.S. representative and Concacaf’s Medical Committee.Learn more about George Chiampas, DO
Transcription:
Enhancing Preparedness for Medical Emergencies at Mass-Gathering Sporting Events
Melanie Cole (Host): Today we’re talking about sports event preparedness management. And my guest is Dr. George Chiampas. He’s an Assistant Professor of Emergency Medicine and Orthopedic Surgery at Northwestern Medicine. Dr. Chiampas, as I told you, I love this topic. It’s so important and so timely. Before we get into actually planning this; help us to understand if you would, the global threat environment directed at soft targets and how do you identify sport event and special event threats when it comes to medical management and what’s going to be needed.
George Chiampas, DO, CAQSM, FACEP (Guest): Well Melanie, it is a timely topic and when you see how things have changed around the world. Large scale events, the sports environment are the soft threats. Individuals or groups potentially feel like they can make a significant impact. It’s where lay people in the public find joy in sports and exercise and entertainment. And so, we have to – in the operations side make sure that we respect that and put our plans in place to do everything we can to prevent, to be able to manage the scope not only for the sporting events but for any potential external threats as well.
Host: So, what are some of the most common events associated medical conditions and injuries and incidence. I mean it’s pretty rare to get hit in the head with a hockey puck, but it happens. And all of these kinds of things you wouldn’t think would happen, but it’s your job to think of these things, yes.
Dr. Chiampas: Without question. And obviously it has to do with how large your event is because things do happen and when things happen, and you have 45,000 participants such as we do have in the Bank of America and Chicago Marathon in Chicago; we also have 1.7 million spectators. So, it truly is a coordinated effort between city-state event organizers, federal agencies to be able to manage an event like this from your most simple things where the vast majority of things may be musculoskeletal and cramping and things that you typically associate with large scale events. You are also going to have the things that are life threatening such as severe heat stroke or a cardiac incident or underlying medical conditions that rear their ugly head and when they do that in a very large scale event across 26.2 miles; you have to have the operations and the resources to be able to respond to them, to manage them and provide the best care for them.
Host: It’s so complicated and it must be not only multidisciplinary but comprehensive. Tell us what should an appropriate medical plan include.
Dr. Chiampas: Your medical plan should bring everyone to the table, and it is multidisciplined with Chicago, we have over 2000 medical staff, we coordinate with our private ambulance companies Superior Ambulance, Chicago Fire Department, police, and all the agencies that I can run a list down of all of them. But it’s about all of them being a part of the plan, having tabletop exercises in advance. All of them really being in a unified command approach under one scope to be able to address those issues.
And there is months and months of planning ahead with regards to resources, emergency action plans, staffing and then communications. So, it really is a task. It’s one that is not something that is built overnight but slowly you build those plans and to be able to scale them to the magnitude of one of the world’s biggest events in Chicago.
Host: Wow so much goes into it. So, briefly tell us about the emergency plan called the Chicago model that you helped establish. How does it work and how is it used today.
Dr. Chiampas: So, the Chicago model is something that goes back to about 2008 and it follows post 9/11 federal government implemented an incident command structure. That’s under the National Incident Management System. And what it essentially said is that anytime there’s a large scale event with greater than 1000 individuals, you should operate in the unified command approach. And that sounds very simple, but what it really entails, and the Chicago model is the perfect example of it is basically establishing a hub where all of the stakeholders that have to do with the event from public to private partnerships, all are in one room or in one location and being able to make decisions that impact the events.
So, receiving information from the event, from simple as what sort of traffic situation is, car locations, resources, information that we are getting on the streets, medical encounters and then being able to push that information back out in a unified approach as well. And it sounds simple, but it is one that from 2008 to now 2019, Chicago has without question been the ones who have published it, have operationally put it in place and now other large scale events, other marathons are following suit. It is definitely something to be seen.
Host: Really amazing Dr. Chiampas. So, tell us a little bit about some other innovative research that’s being conducted in this area at Northwestern Medicine and what you’d like other providers to know about enhancing their own preparedness for medical emergencies at mass events. Do you have some top recommendations?
Dr. Chiampas: Using a unified command approach, bringing in your fire, your police, your medical staff under one is best practice now. Secondly, from a technology perspective, we’ve looked at our data, we’ve looked at where we have injuries across the 26.2 mile course, where we see those types of injuries, also compared to weather data. So, if it’s a cold day, warm day; we can know where those surges are and so then we build our resources in advance. So, we are really - pre-event planning is something as year by year goes by in your event; you can look at your data and then build your planning accordingly. Lastly, from a technology perspective; we’ve worked with Northwestern’s Engineering school and looked at a program called SAFE which is situational awareness for events. And what we’ve been able to do is look at technology and be able to, in their unified command approach, we know that everyone in that room requires key pieces of information that allows them to operate in their own space.
And so we’ve built a dashboard that gives roughly about ten to fifteen points that have to do with our event from weather, medical conditions, with there the thousands of runners are in a dynamic fashion, street closures, first runner, last runner, elite runners and off that dashboard; all of our stakeholders in our unified command can work off of that. And that’s a large screen, multiple screens in our hub which is truly innovative and allow us to work in a really efficient way.
And then lastly, we’ve created our own electronic medical record dashboard that in real time, I could turn to our city, I can turn to our rice director and be able to provide them what conditions we’re seeing, what the chief complaints are, if there’s a trend of anything and for our public health office, for our city, those are really key piece of information for us to be able to operate on race day.
Host: Wow, as I said, so much goes into it. How do you build an effective risk management team? Before we wrap up, I’m just curious how you go about – you said that there’s so many different providers in this multidisciplinary approach; how do you find them all?
Dr. Chiampas: I think retention is built upon assuring that you have a really solid plan and that you’re sensitive to your providers of all disciplines. All of them are volunteers and so that really comes down to building great relationships, assuring for them that you have their interests in mind. I mean we’ve secured medical malpractice insurance for all of our licensed providers. That’s a big thing that I’m proud of that we put in place many, many years ago. Showing them that we are always sensitive to them, how they are getting there, making sure that they are taken care, making sure that we are communicating to them and recognizing the fact that these 2000 healthcare professionals are giving their time on a Sunday.
And I think when you do that in a very sensitive way, and operationally you have a sound plan; your retention for them year after year is really significant because you give them a day that they get to enjoy outside of their clinic, outside of their hospital and we’re very collaborative across the state, all of the hospital, clinic systems are welcome. And I think that’s how you build it. You build it based on really being best practice, sensitive to them, communicating really, really well and making sure that they have fun as well.
Host: Well thank you for that answer. Wrap it up for us Dr. Chiampas what you would like other providers to take away from this on the importance of this comprehensive approach to sports management, even preparedness and what you’d like them to know.
Dr. Chiampas: I think the final thing is emergency action plans across sports can be scalable from a high school football game or sporting event to large scale events and sometimes when we get to the large scale events, we can become overwhelmed. But the reality is that it’s just a larger magnitude, but the same principles apply. So, it is doable. It is a massive task, but it definitely requires larger resources, state, federal, city resources but at the end of the day, it is really the practitioners, the healthcare providers that come out on that day to make sure that the runners all have a tremendous experience, accomplish their goals. It is a tremendous experience and the last thing I would say is for those practitioners, healthcare providers who have never volunteered for the Chicago Marathon; we’d love to see you in October every year. We hope that you come out and by all means, please bring your skills set.
Host: What a great segment. Such an interesting topic. Thank you so much Dr. Chiampas and thank you for all the great work that you’re doing. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs; follow us on Facebook and Twitter. Until next time, I’m Melanie Cole.
Enhancing Preparedness for Medical Emergencies at Mass-Gathering Sporting Events
Melanie Cole (Host): Today we’re talking about sports event preparedness management. And my guest is Dr. George Chiampas. He’s an Assistant Professor of Emergency Medicine and Orthopedic Surgery at Northwestern Medicine. Dr. Chiampas, as I told you, I love this topic. It’s so important and so timely. Before we get into actually planning this; help us to understand if you would, the global threat environment directed at soft targets and how do you identify sport event and special event threats when it comes to medical management and what’s going to be needed.
George Chiampas, DO, CAQSM, FACEP (Guest): Well Melanie, it is a timely topic and when you see how things have changed around the world. Large scale events, the sports environment are the soft threats. Individuals or groups potentially feel like they can make a significant impact. It’s where lay people in the public find joy in sports and exercise and entertainment. And so, we have to – in the operations side make sure that we respect that and put our plans in place to do everything we can to prevent, to be able to manage the scope not only for the sporting events but for any potential external threats as well.
Host: So, what are some of the most common events associated medical conditions and injuries and incidence. I mean it’s pretty rare to get hit in the head with a hockey puck, but it happens. And all of these kinds of things you wouldn’t think would happen, but it’s your job to think of these things, yes.
Dr. Chiampas: Without question. And obviously it has to do with how large your event is because things do happen and when things happen, and you have 45,000 participants such as we do have in the Bank of America and Chicago Marathon in Chicago; we also have 1.7 million spectators. So, it truly is a coordinated effort between city-state event organizers, federal agencies to be able to manage an event like this from your most simple things where the vast majority of things may be musculoskeletal and cramping and things that you typically associate with large scale events. You are also going to have the things that are life threatening such as severe heat stroke or a cardiac incident or underlying medical conditions that rear their ugly head and when they do that in a very large scale event across 26.2 miles; you have to have the operations and the resources to be able to respond to them, to manage them and provide the best care for them.
Host: It’s so complicated and it must be not only multidisciplinary but comprehensive. Tell us what should an appropriate medical plan include.
Dr. Chiampas: Your medical plan should bring everyone to the table, and it is multidisciplined with Chicago, we have over 2000 medical staff, we coordinate with our private ambulance companies Superior Ambulance, Chicago Fire Department, police, and all the agencies that I can run a list down of all of them. But it’s about all of them being a part of the plan, having tabletop exercises in advance. All of them really being in a unified command approach under one scope to be able to address those issues.
And there is months and months of planning ahead with regards to resources, emergency action plans, staffing and then communications. So, it really is a task. It’s one that is not something that is built overnight but slowly you build those plans and to be able to scale them to the magnitude of one of the world’s biggest events in Chicago.
Host: Wow so much goes into it. So, briefly tell us about the emergency plan called the Chicago model that you helped establish. How does it work and how is it used today.
Dr. Chiampas: So, the Chicago model is something that goes back to about 2008 and it follows post 9/11 federal government implemented an incident command structure. That’s under the National Incident Management System. And what it essentially said is that anytime there’s a large scale event with greater than 1000 individuals, you should operate in the unified command approach. And that sounds very simple, but what it really entails, and the Chicago model is the perfect example of it is basically establishing a hub where all of the stakeholders that have to do with the event from public to private partnerships, all are in one room or in one location and being able to make decisions that impact the events.
So, receiving information from the event, from simple as what sort of traffic situation is, car locations, resources, information that we are getting on the streets, medical encounters and then being able to push that information back out in a unified approach as well. And it sounds simple, but it is one that from 2008 to now 2019, Chicago has without question been the ones who have published it, have operationally put it in place and now other large scale events, other marathons are following suit. It is definitely something to be seen.
Host: Really amazing Dr. Chiampas. So, tell us a little bit about some other innovative research that’s being conducted in this area at Northwestern Medicine and what you’d like other providers to know about enhancing their own preparedness for medical emergencies at mass events. Do you have some top recommendations?
Dr. Chiampas: Using a unified command approach, bringing in your fire, your police, your medical staff under one is best practice now. Secondly, from a technology perspective, we’ve looked at our data, we’ve looked at where we have injuries across the 26.2 mile course, where we see those types of injuries, also compared to weather data. So, if it’s a cold day, warm day; we can know where those surges are and so then we build our resources in advance. So, we are really - pre-event planning is something as year by year goes by in your event; you can look at your data and then build your planning accordingly. Lastly, from a technology perspective; we’ve worked with Northwestern’s Engineering school and looked at a program called SAFE which is situational awareness for events. And what we’ve been able to do is look at technology and be able to, in their unified command approach, we know that everyone in that room requires key pieces of information that allows them to operate in their own space.
And so we’ve built a dashboard that gives roughly about ten to fifteen points that have to do with our event from weather, medical conditions, with there the thousands of runners are in a dynamic fashion, street closures, first runner, last runner, elite runners and off that dashboard; all of our stakeholders in our unified command can work off of that. And that’s a large screen, multiple screens in our hub which is truly innovative and allow us to work in a really efficient way.
And then lastly, we’ve created our own electronic medical record dashboard that in real time, I could turn to our city, I can turn to our rice director and be able to provide them what conditions we’re seeing, what the chief complaints are, if there’s a trend of anything and for our public health office, for our city, those are really key piece of information for us to be able to operate on race day.
Host: Wow, as I said, so much goes into it. How do you build an effective risk management team? Before we wrap up, I’m just curious how you go about – you said that there’s so many different providers in this multidisciplinary approach; how do you find them all?
Dr. Chiampas: I think retention is built upon assuring that you have a really solid plan and that you’re sensitive to your providers of all disciplines. All of them are volunteers and so that really comes down to building great relationships, assuring for them that you have their interests in mind. I mean we’ve secured medical malpractice insurance for all of our licensed providers. That’s a big thing that I’m proud of that we put in place many, many years ago. Showing them that we are always sensitive to them, how they are getting there, making sure that they are taken care, making sure that we are communicating to them and recognizing the fact that these 2000 healthcare professionals are giving their time on a Sunday.
And I think when you do that in a very sensitive way, and operationally you have a sound plan; your retention for them year after year is really significant because you give them a day that they get to enjoy outside of their clinic, outside of their hospital and we’re very collaborative across the state, all of the hospital, clinic systems are welcome. And I think that’s how you build it. You build it based on really being best practice, sensitive to them, communicating really, really well and making sure that they have fun as well.
Host: Well thank you for that answer. Wrap it up for us Dr. Chiampas what you would like other providers to take away from this on the importance of this comprehensive approach to sports management, even preparedness and what you’d like them to know.
Dr. Chiampas: I think the final thing is emergency action plans across sports can be scalable from a high school football game or sporting event to large scale events and sometimes when we get to the large scale events, we can become overwhelmed. But the reality is that it’s just a larger magnitude, but the same principles apply. So, it is doable. It is a massive task, but it definitely requires larger resources, state, federal, city resources but at the end of the day, it is really the practitioners, the healthcare providers that come out on that day to make sure that the runners all have a tremendous experience, accomplish their goals. It is a tremendous experience and the last thing I would say is for those practitioners, healthcare providers who have never volunteered for the Chicago Marathon; we’d love to see you in October every year. We hope that you come out and by all means, please bring your skills set.
Host: What a great segment. Such an interesting topic. Thank you so much Dr. Chiampas and thank you for all the great work that you’re doing. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs; follow us on Facebook and Twitter. Until next time, I’m Melanie Cole.