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Chapter 14 - VIP and Executive Medicine Considerations at Mass Gathering Events
- Edited by William J. Brady, University of Virginia, Mark R. Sochor, University of Virginia, Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida, John C. Maino II, Michigan International Speedway, Brooklyn, K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
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- Book:
- Mass Gathering Medicine
- Published online:
- 11 April 2024
- Print publication:
- 18 April 2024, pp 199-209
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Summary
The involvement of dignitaries within mass gathering events can often impose several difficult levels of complexity, both during the planning phases and throughout the event itself. Whether the dignitaries are the reason for the mass gathering or they are on location as additional special attendees of the event, so-called “very important persons” (VIPs) such as celebrities, royalty, or major political figures can affect the planning and preparations for medical management contingencies as well as the operational aspects of such events [1–3]. Beyond the typical challenges of mass gathering medicine and protective security aspects, the concepts and practice of executive medicine, concierge medicine, or “protective medicine” pose unique and often unfamiliar and uncomfortable adaptations in terms of delivering medical advice and care. Medically, there is often limited access and reticence to expose the VIP to unfamiliar practitioners. Requests for medications or therapies in the absence of directly seeing the patient is more common. There is also an expectation that the medical care provider will come to see the VIP at the site and not at an off-site medical facility.
Bleeding Control Protections Within US Good Samaritan Laws
- Matthew J. Levy, Christopher M. Wend, William P. Flemming, Antoin Lazieh, Andrew J. Rosenblum, Candace M. Pineda, Douglas M. Wolfberg, Jennifer Lee Jenkins, Craig A. Goolsby, Asa M. Margolis
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- Journal:
- Prehospital and Disaster Medicine / Volume 39 / Issue 2 / April 2024
- Published online by Cambridge University Press:
- 04 April 2024, pp. 156-162
- Print publication:
- April 2024
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Introduction:
In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders.
Methods:This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage.
Results:Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states – Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri – have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it.
Conclusion:Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.
911 EMS Activations by Pregnant Patients in Maryland (USA) during the COVID-19 Pandemic
- Megan E. Hadley, Arthur J. Vaught, Asa M. Margolis, Timothy P. Chizmar, Teferra Alemayehu, Torre Halscott, J. Lee Jenkins, Matthew J. Levy
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- Journal:
- Prehospital and Disaster Medicine / Volume 36 / Issue 5 / October 2021
- Published online by Cambridge University Press:
- 14 July 2021, pp. 570-575
- Print publication:
- October 2021
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Introduction:
In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population.
Hypothesis/Problem:This study examines the impact of the pandemic on prehospital care amongst pregnant women.
Methods:A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods.
Results:There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020).
Conclusions:In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.
Comparison of Prediction Models for Use of Medical Resources at Urban Auto-racing Events
- Jose V. Nable, Asa M. Margolis, Benjamin J. Lawner, Jon Mark Hirshon, Alexander J. Perricone, Samuel M. Galvagno, Debra Lee, Michael G. Millin, Richard A. Bissell, Richard L. Alcorta
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 6 / December 2014
- Published online by Cambridge University Press:
- 26 September 2014, pp. 608-613
- Print publication:
- December 2014
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Introduction
Predicting the number of patient encounters and transports during mass gatherings can be challenging. The nature of these events necessitates that proper resources are available to meet the needs that arise. Several prediction models to assist event planners in forecasting medical utilization have been proposed in the literature.
Hypothesis/ProblemThe objective of this study was to determine the accuracy of the Arbon and Hartman models in predicting the number of patient encounters and transportations from the Baltimore Grand Prix (BGP), held in 2011 and 2012. It was hypothesized that the Arbon method, which utilizes regression model-derived equations to estimate, would be more accurate than the Hartman model, which categorizes events into only three discreet severity types.
MethodsThis retrospective analysis of the BGP utilized data collected from an electronic patient tracker system. The actual number of patients evaluated and transported at the BGP was tabulated and compared to the numbers predicted by the two studied models. Several environmental features including weather, crowd attendance, and presence of alcohol were used in the Arbon and Hartman models.
ResultsApproximately 130,000 spectators attended the first event, and approximately 131,000 attended the second. The number of patient encounters per day ranged from 19 to 57 in 2011, and the number of transports from the scene ranged from two to nine. In 2012, the number of patients ranged from 19 to 44 per day, and the number of transports to emergency departments ranged from four to nine. With the exception of one day in 2011, the Arbon model overpredicted the number of encounters. For both events, the Hartman model overpredicted the number of patient encounters. In regard to hospital transports, the Arbon model underpredicted the actual numbers whereas the Hartman model both overpredicted and underpredicted the number of transports from both events, varying by day.
ConclusionsThese findings call attention to the need for the development of a versatile and accurate model that can more accurately predict the number of patient encounters and transports associated with mass-gathering events so that medical needs can be anticipated and sufficient resources can be provided.
. ,Nable JV ,Margolis AM ,Lawner BJ ,Hirshon JM ,Perricone AJ ,Galvagno SM ,Lee D ,Millin MG ,Bissell RA .Alcorta RL Comparison of Prediction Models for Use of Medical Resources at Urban Auto-racing Events . Prehosp Disaster Med.2014 ;29 (6 ):1 -6