emergency medical services2020ac.com/documents/ac/05/1/2/基調講演_dr.pam venning.pdf · medical...

Emergency Medical Services

London 2012 Olympic and Paralympic Games

Dr Pamela Venning DSC PhD RNNovember 3rd 2017

Health Bid Commitments

• Free Hospital Care during Games time

• Release of volunteers from the NHS

• Ambulance services for all venues and athlete care

LOCOG’s Medical Responsibilities

LOCOG was responsible for:

• Medical and health care planning for all client groups associated with the Games

• Coordination of delivery of medical care inside all Olympic and Paralympic venues and sites

• Ensure there is appropriate medical care outside Olympic and Paralympic venues

The aim of the service was to:

“ to provide an accessible, high quality and comprehensive medical service to all Games client groups “

3

The London Games – Some Information

Sports and Competition Venues • Athletics - Olympic Stadium

• Aquatics Centre

• Water Polo

• Cycling - Velodrome

• BMX Circuit

• Hockey Centre

• Basketball Arena

• Handball Arena

• Wheelchair Tennis

Olympic Park

• Boxing, Judo, Fencing, Taekwondo, Table Tennis,

Weightlifting, Wrestling, Boccia ExCeL

• Equestrian, Modern Pentathlon Greenwich Park

• Shooting, Paralympic Archery Royal Artillery Barracks

• Basketball (Finals), Gymnastics North Greenwich Arena

River Zone• Archery Lord’s Cricket Ground

• Triathlon Hyde Park

• Beach Volleyball Horse Guard’s Parade

• Volleyball Earl’s Court

• Marathon , Road Cycling London Streets

Central Zone

• Football

• Badminton

• Gymnastics

Wembley

• Tennis

Wimbledon

Venues outside London

Hadleigh

Farm

London

Weymouth &

Portland

Eton Dorney

Coventry

Hadleigh

Farm

Olympic Park

Competition Venues

• Olympic Stadium (80,000)

• Hockey centre (20,000)

• Basketball Arena (12,000)

• Handball Arena (7,000)

• Aquatics Centre (17,500)

• Water Polo Arena (5,000)

• VeloPark (6000)

• BMX (6000)

• Eton Manor (10,500)

Non Competition Venues

• Athlete Village

• International Broadcast Centre

• Park Common Domain

London Olympic Medical Data

27th July – 12th August

0

1000

2000

3000

4000

5000

6000

7000

8000

04 Doctor -Crowd

06 Doctor -Field of Play

09 Doctor -Sports

10 FirstResponder

11 Nurse NULL

3391

555730

7109

2019

718

NU

MB

ER O

F EN

CO

UN

TER

Encounters per Medical Provider - EMS

Planning EMS Services

A Games Planning Structure

Games Operations

Games Services

Accommodation

Catering & Food Services

Cleaning & Waste Management

Arrivals & Departures

Transport

Logistics

City Operations

Venues & Infrastructure

Venue Development & Overlay

Venue Management

Look, Way Finding and Signage

Spectator Services

Sport

Sport Competition

Sport Policy & Operations

Sports Presentation

Test Events

NOC and NPC Services

Medical

Anti-Doping

Paralympic IntegrationParalympic Planning & Delivery

BroadcastBroadcast Services

CCE

Culture

Opening and Closing Ceremonies

Torch Relay

Medal Ceremonies

Team Welcome Ceremonies

Education Programme

Youth Camp

Livesites

Animating Venue Experience

CCE Team Management

SSP

Communications and Public Affairs

Website & New Media

Editorial Services

Community Relations

Media and PR

Government Relations

Press Operations

CPA Management

Finance

Finance (Planning, Control & Payments)

Rate Card

Facilities

Executive Office

HR

HR Operations

Uniforms

Accreditation

Volunteering

Technology

Commercial

Commercial Negotiations

Merchandising

Client Services

Ticketing

Procurement

Commercial Business Management

Workforce Training

Health and Safety

Games Services Management

Risk Assurance

Brand and MarketingBrand and Marketing

Business Technology Services

Internet Technology Services

Results Technology Services

Telecommunications Services

Technology Programme Office

Technology Operational Readiness

Venue Technology Services

Planning&Programme Management

Stakeholder Relations

IKM

C3

Contact Centre

Corporate Events

Nations and Regions

Sustainability

International Relations

Sport Management & Support

Venue Department Management

VillagesVillage Management

LegalLegal

Workforce Planning

Diversity and Inclusion

HR Management

Technology Service Delivery

SecuritySecurity

Medical Services - Key milestones

Date Description

G-65 Appoint Head of Medical Services

G-60 Polyclinic design agreed

G-60 Define workforce requirements

G-60 High level draft list of equipment, consumables and pharmacy products

G-54 Commence public health planning

G-54 Commence policy and procedure development

G-40 Identify clinical experts

G-36 – G-15 Appoint first medical coordinator

G-30 Outline clinical service requirements

G-30 Identify procurement streams and commence procurement process

G-24 – G-0 Volunteer recruitment starts

G-18 Polyclinic facilities finalised

G-18 Clinical services agree prior to test events

G-12 – G-0 Volunteer training commences

G-12 Review equipment, consumables and pharmacy post test events

G-6 Final clinical services finalised post test events

G-3 Licences for pharmacies and venue drug storage

Event Literature

Multi Sport Games Time Medical Organisation

Manager

- Polyclinics, Official Hotel Services &

Technical Officials

Head of Medical Services

Medical Group Leader

Central and River Zone Venues


Olympic Park

Team Coordinator

Workforce Co-ordinator

Chief Medical Officer

Director of SportProcurement Manager


Outer London Venues

Physical Therapies

Sport Medicine

Polyclinic

Imaging

Pharmacy


Venue Medical Managers

Volunteers

Clinical experts

Medical HQ

Procurement Assistant

Workforce Assistant

International Olympic Committee Medical

Commission

EMS Imaging Pharmacy PolyclinicPhysical

TherapiesSports

Medicine

Crowd Doctor

Nurse

Medical FOP Team Member

Medical FOP Team Leader

First Responder

Team Member

First Responder

Team Leader

Sport Radiologist

Radiographer

Radiographic Team

Member

Sport Pharmacist

s

Chiropractor

Physiotherapist

Osteopath

Sports Massage

Practitioner

Sport Medicine

Doctor

Emergency

MedicineDoctor

GP

Polyclinic Nurse

Emergency Nurse

Primary Care Nurse

Dentist.

Dental Nurse

Dentist Hygienist

OptometristDispensing

Optician

Dental Lab Technician

Podiatrist

Medical Driver

Medical Admin

Medical Dispatcher

Polyclinic and VenuesPolyclinic and Venues

Aims of London 2012 EMS

• Use of Dynamic Risk Assessment methods

• Mobile Services “treat in the seat”

• Compliant with UK standards for sport and non sport events

• Unified services for all client groups

• Standardized methods

• Standardized equipment

• Integrated working within the organising committee

• Partnership working with national health and emergency services

• Reduce pressure on “business as usual” for the Health Service

Stakeholder and Partnership Working

Government Organisations

• Department of Health; central and local

• Other Government departments (Security and Policing)

• Wales, Scotland and NI

• Local Authorities

Clinical Delivery Partners

• Ambulance Services

• Designated Hospitals

• Other non designates hospitals

• Primary care organisations

Other Agencies

• Public Health England

• Medicines authorities

• Clinical professional councils

• Water and air quality specialists

Public Health Planning

17

• Major risk to the Games - planning started early

• Public Health England - Mass Gathering Unit

• Team dedicated to planning with a single point of contact for:

• Communicable diseases

• Food, air and water quality & safety issues

• Detailed policy on operations including exception reporting

• Senior PH team based in Polyclinic in Athletes village

• PH team had daily conference with UK wide leads daily and reported

back to

• Exception reporting

• PH team had a daily conference call with UK wide PH leads for sign

posting on any issues

Designated Games Hospitals

18

London

• Athlete

• Olympic/Paralympic Family

• Trauma

Regional

• One in each town/city (7)

Develop a service level agreement with each hospital

• Roles and responsibilities

Each hospital needed to enhance the following:

HOPLO - a single point of contact officer

Security Privacy

Communications Facilitated Admission

Drugs in Sport

• Operational Hand Book

Ambulance Services

• London Ambulance Service (LAS)

• Lead service for the UK

• Dedicated senior lead at Ambulance HQ

• Operational lead embedded in LOC

• Managers aligned to venue clusters

• Service level agreements with 8 services

• Operational handbook developed

• Daily calls with HoM and Ambulance HQ lead

• Mutual aid to LAS from ambulance services in England and

Wales

Medical Risk Assessment

London 2012 Olympic Games and Paralympic Games

Olympic Park

Systematic Approach to Risk Asessment

• Sport rules for Olympic and Paralympic Games

• Length of sessions

• Seating capacity for each venue

• Health and Safety Matters from Green Guide

• Ingress and egress flows (The last mile)

• Local regulations, rules and legislation

• Current licenses for existing venues

• Operations of other organising committee functions

• Polyclinic service levels

Risk assessment methods

Consequence

Insignificant Minor Moderate Major Catastrophic

Likelihood 1 2 3 4 5

Rare 1 1 2 3 4 5

Unlikely 2 2 4 6 8 10

Possible 3 3 6 9 12 15

Likely 4 4 8 12 16 20

Almost certain

5 5 10 15 20 25

Each hazard is identified in the assessment table below and the risk scored using the matrix. Any mitigating

factors and additional risk treatments are then added and a further assessment is made.

• Any risks that remain in the red or orange section (Scores between 8 and 25) after the residual risk is

completed will need to be reassessed and additional mitigation/ controls put in place to reduce the risk

further.

• Any risks that are yellow (Scores between 4 and 6) should be highlighted to ensure that all persons are

aware of the controls for that risk and if possible further controls employed.

• Risks that are green are low risk but they must still be considered by all personnel and additional

controls put in place if possible.

Potential HazardWho is

affected

Initial

Risk ScoreIssues

Further actions / Completion

Date and by who

Residual

Risk Score

C L

Ris

k

C L

Ris

k

Seating, stairwells and

angle of rake

Staff/spectat

ors

4 3 12

The upper tier is a temporary build; the design

means there is no concourse or usable lifts from

this level.

Patients have to be carried down two levels with

over 150 steps.

Medical team to develop

plans for casualty

evacuation from seats.

All casualty evacuation

from the stand will be a

four man lift.

Carry chairs with the

ability to be wheeled

down stairs will be

available.

A second team will be

available to take over

when the initial team

need to rest.

2 3 6

Audience profile

causing specific

issues.

Staff/spectat

ors 3 1 3Mixed family groups.

N/A 3 1 3

Inadequate briefing of

medical teams

Staff/Spectat

ors/Athletes

4 2 8

Risk of staff not fully understanding their roles.

Staff may not be aware of any dynamic risks

identified from the venue brief.

Ensure adequate briefing

to all medical staff before

each shift and provide

summary hand-out brief.

Ensure all medical staff

are aware of the venue

Operational Plan.

4 1 4

Olympic Stadium - Planning

Type of Medic Minimum QualificationMinimum No Required

by ‘Safety at Sports grounds’

Provided by LOCOG

Additional Athlete medical provision

Total ambulance vehicles provided

First Aiders Certificate of first aid H&S regs1981

45 40

Crowd doctor Trained & experienced in immediate care

1 4

Venue Medical Manager 2Paramedics IHCD qualified 4 4 2NHS Ambulance managers

IHCD, MIMMS, Silver commander qualified.

2 1

Communications officer MPDS qualified 1 1

Medical team RGN nurses, 2 16Sport doctors 2Total 53 54 18VehiclesParamedic units 2 2 1 3Major incident vehicle 1Control Vehicle 1Total 4 2 1 3Additional sport requirement

Athletics & Ceremonies 80,000 Capacity

Basketball

Velodrome

Bmx Arena

2 ambulances

Aquatics Centre

Water Polo

2 ambulances

Common DomainCommon DomainCommon Domain

1 ambulance 2 ambulances 1 ambulance

Handball Arena

Hockey Arena

2 ambulances

Handball Arena

Hockey Arena

Olympic Stadium

2 ambulances

3 ambulances

London Organising Committee of the

Olympic Games and Paralympic Games

Eton Dorney

Medical Plan

Version 2

November 2011

• Three types of bags• Personal (600)

• Medical (200)

• Advanced (80)

Equipment


Personal Medical Bag

Medical Bag


RSI Bag

• Additional Equipment

• Sam splint

• Kendrick splint

• EZ Intraosseous

• CAT Tourniquet

• Celox Gauze

• Scoop stretcher

• Basket stretcher

• Carry Chair


Numbers of Volunteer for Emergency Medical Services

Olympics Paralympics Both

FOP Team Leader 98 29 20

FOP Team Member 271 98 71

Crowd Doctor 92 38 28

Crowd Nurse 114 44 29

First Responder 2 412 174 128

First Responder 1 402 184 140

Total 1389 567 416

All Medical 2633 1140 734

Medical Workforce Training

Common Role

Orientation

Specific Role

Test Event Training

Common Venue

Medical Specific Venue

Daily Scenario Training

Functional Area Specific Role

Role Specific Venue Specific

Test Event - Schedule

37

Cluster OneBasketball Aug 2011

Cycling – BMX Aug 2011

Equestrian Eventing July 2011

Modern Pentathlon July 2011

Marathon & Race Walk May 2011

Tennis June 2011

Volleyball July 2011

Canoe Slalom July 2011

Cycling – Mountain Bike July 2011

Sailing Aug 2011

Triathlon Aug 2011

Rowing Aug 2011

Badminton Aug 2011

Volleyball – Beach Aug 2011

Aquatics Marathon Swim Aug 2011

Cycling – Road Aug 2011

Handball Nov 2011

Goalball Dec 2011

Cycling – Track Feb 2012

Aquatics – Diving Feb 2012

Aquatics – Swimming Mar 2012

Table Tennis Nov 2011

Boxing Nov 2011

Fencing Nov 2011

Judo Dec 2011

Taekwondo Dec 2011

Wrestling Dec 2011

Weightlifting Dec 2011

Gymnastics Jan 2012

Canoe Sprint Sep 2011

Archery Oct 2011

Cluster TwoBoccia April 2012

Aquatics – Synchro. Swim April 2012

Hockey May 2012

Wheelchair Tennis May 2012

Aquatics – Water Polo May 2012

Wheelchair Rugby May 2012

Athletics May 2012

Shooting April 2012

Paralympic Archery May 2012

Football April 2012

Cluster Three

Co-ordinated Testing

• Table top exercises • Venue based

• All functions and partners

• Games wide exercises• A day in the life of the Games

• Different scenarios often including a communicable disease

• All functions and external partners

• City wide exercises

• Nation wide exercises• External team ”injecting” events

• Lasting more than one day

• Repeated 2-3 times

Operations

ECR Coordinator

Administrate the Event

Control Room and the

other spaces within the

area

Safety OfficerPolice

Commander

Police

VGM

Fire Brigade

LOCOG Medical

Dispatcher

Managing Medical

deployment &

response with the

Stadium & Field of Play

Radio Logist

Will record in-coming

and outgoing calls

made by the Safety

Officer/VGM

Security Venue

Manager

Provides the link in to

the VSCC and venue

Ambulance

Services

Commander

Ambulance

Services

Comms Officer

CCTV

Monitor feeds from the

stadium and crowd

Management

1800mm desk

CCTV

Monitor feeds from the

stadium, crowd

Management & VSCC

1800mm Desk

EVS Group Leader

Radio sat on EVS

stewarding Chan

LOCOG Fire

Officer

Transport

Not required in

all venues

Last Mile

Not required in

all venues

Venue Communication

Manager

VE

NU

E N

OR

MA

L OP

ER

AT

ION

S A

ND

CO

MM

UN

ICA

TIO

NS

VE

NU

E C

OM

MU

NIC

AT

ION

CE

NT

RE

NO

RM

AL

SE

CU

RIT

Y O

PE

RA

TIO

NS

AN

D C

OM

MU

NIC

AT

ION

S

VE

NU

E S

EC

UR

ITY

CO

NT

RO

L C

EN

TR

EVenue Control Room

EVENT CONTROL ROOM

Hot DeskBMS Engineer

Building Systems

Manager

SCREEN SCREEN

Required spaces in all

Event Control Rooms

Not required in Olympic

Park as will be present in

the Park Operations

Centre

If space unavailable due

to venue constraints

these positions do not

need to be in the Event

Control Room

Control Room Suite

Preferably separation or

screens

Preferably separation or

screens

Communication Plan for Venue Medical Services

41

Medical Fleet Map

MEDICAL Role Call Sign Medical Channel Ops 1 Channel

MEDICAL Venue Medical Manager MEDLEAD ✔ ✔

MEDICAL Dispatcher Dispatcher ✔

MEDICAL Crowd Doctor Crowd Dr 1 ✔



MEDICAL Crowd Nurse Crowd Nurse 1 ✔



MEDICAL Sports Medicine Doctor Sport Dr 1 ✔

MEDICAL Sports Medicine Doctor Sport Dr 2 ✔

MEDICAL Physiotherapy Lead Physio Lead ✔

MEDICAL First Responder First Aid 1 ✔







MEDICAL First Responder Frst Aid 8 ✔



MEDICAL First Responder Frist Aid 11 ✔





MEDICAL FOP Team Leader FoP 1 ✔

MEDICAL FOP Team Leader FoP2 ✔

MEDICAL FOP Team Leader FoP 3 ✔

MEDICAL Ambulance Ambulance 1 ✔

MEDICAL Ambulance Ambulance 2 ✔

Games Time Medical Communication Routes

Manager

- Polyclinics, Official Hotel Services &

Technical Officials

Head of Medical Services


Central and River Zone Venues


Olympic Park

Team CoordinatorWorkforce Co-ordinator

Chief Medical Officer

Director of Sport

Procurement Manager


Outer London Venues

Physical Therapies

Sport Medicine

Polyclinic

Imaging

Pharmacy


Venue Medical Managers

Volunteers

Clinical experts

Medical HQ

Procurement Assistant

Workforce Assistant

International Olympic Committee Medical

Commission

Designated Hospitals

HOPLO

Partner organisations

DoHPublic Health England

Ambulance ServiceSenior Security Forces

Met Police

Venue ManagementTeam

Monitoring Activity

• Medical Encounter System

• All encounters logged

• Daily reports

• Daily reports from the encounter system of activity

• Syndromic surveillance reports given to Public Health for review

• Activity numbers sent to the IOC/IPC, DoH and Sport Director

• Operational reports in venue

• Intelligence from Public Health Authorities

• Exception reporting

• All partners

Conclusions

• Emergency Medical Planning is integrated in the Medical function and

this function is working closely with other OCOG departments

• Early engagement and close working arrangements with external

health care partners is essential

• Games plans are absorbed into the national major incident tried and

tested plans – reviewing any gaps

• Attention to detail in planning is key to a dynamic system that enables a

deep understanding of medical operations – Flexibility

• Investment of time, resources and commitment to training the medical

workforce is key to success of the program

• Testing and review post test is essential for refining operational

planning

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