The medical care plan should address the entire flow of patients' care from the occurrence of the medical problem to definitive care. Ushers, volunteers, and security personnel should be equipped with adequate communications devices and trained to relay information concerning any individual in need of medical care. Those without communications devices should be informed of the location of the nearest security officer or device for contacting the command center. Training should include the ability to communicate the appropriate information in a clear, concise format. These individuals must also act as first responders in providing a path to the patient and, when necessary, providing bystander CPR.
The command center or dispatch center is responsible for coordinating the response to a medical incident. Provision of a clear, concise chief complaint to the center is vital to coordinating an appropriate response. The command center should provide all the necessary medical and security resources, including maintenance personnel to address plumbing and electrical mishaps. The command center is also responsible for the flexibility of personnel duties and the positioning of the response teams within the facility to provide the best response time.
Once a response team has been dispatched, they should respond and initiate patient care. This is best accomplished by the rapid extrication of the patient from the crowd to the nearest space (e.g., a tunnel or open entryway) isolated by security personnel. At this point, treatment can be initiated by protocol or with on-line medical direction. The amount of treatment provided at this time depends on the medical condition of the patient and the layout of the facility. Transport to a designated treatment site or ambulance should occur as soon as possible so that a specialist can provide care at the highest level appropriate to definitive treatment. Ideally, direct supervision by the medical director should be available. Staffing of the treatment facility can be variable, including nurses, physician assistants, emergency medical technicians, paramedics, Red Cross volunteers, medical students, or first responders.
Transportation from the event should be by the most efficient mode possible considering all factors. If no access roads are available, helicopter transport may be the most appropriate option. A medical care plan should integrate the local EMS system to allow for increased transport capabilities to external hospitals if needed. EMS units, in normal service within the community, can be dispatched to the designated sites of medical incidents at the facility or can replace a unit that is already transporting a patient to the hospital.
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