Audio and visual communications represent the glue that joins not only the myriad medical care and surveillance components into an efficiently functioning system but also the venue health care system to the other systems vital to managing a mass gathering.

The spectator level presents the greatest challenge. The first "first responders" are always fellow performers or spectators. Upon entry to an event, they should be educated in how to communicate knowledge of an illness or injury to the venue's medical care system so that rapid assistance can be rendered. In preparation for the 1996 Olympics, health promotion brochures were mailed with ticket information. Concise information on ticket stubs accompanied by periodic public service announcements can serve the same purpose.

At the medical care system personnel level, every event official, from ushers, volunteers, security guards, and public relations personnel to the top rung of management, must be educated in and updated on the most expedient manner in which to obtain medical assistance. Because radios are expensive, for the most numerous event workers, usually ushers, alternatives such as flag systems have been devised. At the US Open tennis tournament, in New York, a flare system has been organized. All event personnel should know the venue location of the nearest official who has a radio.

Among those officials with radios, frequencies and/or "talk groups" (800 MHz trunking) can be organized to minimize interruptions and maximize effective radio traffic from incident discovery through responders to definitive care givers. At the most highly evolved events, discovery of a victim by the system usually proceeds from bystanders, ushers, or vendors to in-field security personnel to a central communications or command center where the event medical director is based. Venue surveillance cameras can augment verbal reports on the victim's location and can show the scope of the incident. The medical director can then select and radio-dispatch the nearest most appropriate responders with adequate security and/or public relations assistance. Event field providers must be able to communicate with dedicated event ambulance crews, venue medical facilities, and the medical director to coordinate the transportation of the patient from the incident site to the next most appropriate level of care. Fixed facility providers must be on line with field providers, event ambulance crews, and the medical director. The medical director must be able to communicate with all venue-dedicated ambulances, the jurisdictional 911 public safety answering point for access to the public EMS system, and those officials responsible for the jurisdictional disaster plan. In addition, medical command should have voice access to all area hospital emergency departments.

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