Wednesday, Nov. 13, 2019
Cheering fans at one annual Richmond Marathon had no idea that a runner nearing the finish line was going into cardiac arrest. The runner’s heart suddenly stopped beating. That’s when the nearby VCU Health event medicine team jumped into action.
The team provided CPR and critical care on-site, reviving the runner, who was then transported to VCU Medical Center’s emergency department.
“The runner was able to walk out of the hospital because of the care [they] received,” said Rachel Middlebrook, a coordinator for emergency preparedness and event management at VCU Health.
Jeff Ferguson, M.D., was one of the emergency medicine providers at the scene. “I’m very proud of the way we responded and the outcome,” Ferguson said. “I don’t think people realize how much we are capable of doing at these types of events.”
The emergency medicine event team, similar in theory to a mobile Army surgical hospital, works major events in Richmond, including NASCAR races and professional golf tournaments. On Saturday, Ferguson and his colleagues again will be on the sideline at the VCU Health Richmond Marathon. Events that pull in thousands of spectators are fun for the public but also pose myriad risks, which is where the emergency medicine event team comes in.
“We are the boots on the ground,” Middlebrook said. “Anything that is too complex to treat on-site we will transport to VCU Medical Center or the closest facility. We definitely rely on our community partners – police, fire and EMS.”
‘We are not just handing out Band-Aids’
The team normally works out of a tent.
“We set up like a hospital at whatever event we have outside,” said Lynn Goodloe, director of emergency preparedness and event management at VCU Health. “We have a lot of capabilities. We truly have saved lives at these events. We are not just handing out Band-Aids.”
Members of VCU’s Department of Emergency Medicine and VCU Health’s emergency preparedness and event management division lead the multidisciplinary team. Their first event was a collegiate bike race in 2014, followed by the 2015 UCI Road World Championships in Richmond. Their work “snowballed from there,” Middlebrook said.
“We started working with NASCAR, Cap2Cap, the PGA tour event and Colonial Downs races,” she said.
At events, the tent is well-stocked, said Amir Louka, M.D.
“We have rolling modular carts that are stocked with everything we would use in the emergency department, from simple bandages to chest tubes,” Louka said. “We can manage quite ill patients. We have diagnostic equipment, [electrocardiogram] machines, portable monitors and portable ultrasound as well as [automated external defibrillators].”
The number of team members depends on the size of the event.
“At Colonial Downs we have a physician only and at the Richmond Marathon we have around 50 people,” Ferguson said. “We have several tents positioned at the start and finish lines, the event area and at 2-mile markers on the run, as well as the finish celebration area on Brown’s Island.”
Team members working events have to rely on their training and make decisions without the help of specialists. “We have to decide … does this person have to go to the hospital, which means sending resources away,” Louka said. “We have to have a keen sense of what does and doesn’t need immediate treatment. We have to rely on a physical exam. It’s sort of like old-school medicine.”
This is a niche area of medicine that requires special training, especially for team members working with NASCAR drivers, Ferguson said.
“NASCAR comes with its own medical standards,” Ferguson said. “They tell us what we need to provide. They have both an infield care center for drivers and an outfield care center for fans.”
Regardless of the setting, the team is prepared to act, Goodloe said.
“We have to know how to render care in those situations and provide a mechanism to get to a higher level of care, if needed,” she said.
When disaster strikes
Beyond large events, the VCU Health team responsible for emergency preparedness coordinates care for the Richmond community in emergency situations, ranging from hurricanes to particularly challenging flu seasons.
“We are heavily involved with planning, preparation and training year-round,” Goodloe said.
To maximize hospital preparedness, the team makes sure “everyone’s training is up to date and there are documents that outline emergency plans for disasters,” Middlebrook said.
“We are constantly re-evaluating those plans. We have to be prepared for any eventuality that may face us at the hospital,” she said.
As the region’s only comprehensive Level I adult, pediatric and burn trauma center, VCU Medical Center is designated to serve as a regional patient distribution center in the wake of disaster, and also acts as the regional custodian to a cache of supplies that can be deployed should there be an event that requires additional resources.
A member of the Central Virginia Healthcare Coalition, VCU Health shares knowledge with and provides training to other hospital emergency managers in the region. One of six health care coalitions in Virginia, the Central Virginia branch coordinates hospital training and shares tools for success when dealing with a wide array of potential hazards facing the community.
In the community
The marathon averages 20,000 runners and is the largest event the team covers.
“We will see some 250 to 300 patients in one 12-hour stint,” Middlebrook said. “It gets very busy, very quickly.”
The team enjoys being out in the community and serving as the face of VCU Health.
“This work is so important,” Goodloe said.
“We get such positive feedback from the people we help and the organizations we work with,” she said. “It’s all about building relationships.”
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