Relationship Of Functional Areas

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Optimally, a central location should be designated for stationing the directors of the following functions: medical emergencies, event management, logistics, facility maintenance, public relations, security and law enforcement, ushers, and event performers or athletes. If not within the immediate area, the fire-rescue, public health, and public transportation and parking directors must be easily and reliably accessible by telephone and/or radio. From the medical care perspective, the leadership's close physical proximity is especially important if on-site care is provided, since such an arrangement allows for efficient information exchange and problem solving among the directors whose functional areas are integral to medical care delivery. A less reliable alternative involves intravenue radio links among the directors of these functional areas.

Internally, event management has to mediate issues at the interface of one functional area with another. Externally, event management represents the window with a view to outside resources, a vital function in the management of MCIs. Whenever depletion of operational resources is threatened, logistics personnel must immediately access and deliver additional equipment and supplies as patient demand dictates. The medical director and logistics supervisor must prospectively determine a threshold level for each essential supply item below which resupply is undertaken. The facility maintenance department has a major public health role in providing and maintaining an adequate potable water supply, sanitary facilities, and the venue electrical system vital to operating the public address system, air conditioning and ventilation, and lighting. Public relations plays a crucial role in directing crowd control and informing the event population of preventive public health measures as well as the location of medical care. Security and/or law enforcement personnel serve the entire spectrum of illness and injury prevention. Their primary preventative role includes pedestrian safety through the regulation of the interface of vehicular and pedestrian traffic, clearance of emergency vehicle access routes and pedestrian entrances and exits of the venue, and surveillance for and investigation of terrorist threats. The discovery of the ill or injured by direct sight or television surveillance, subsequent dispatch of medical care providers, and clearance of the path through crowds to patients represents the secondary preventative role of security and law enforcement personnel. They play a part in definitive care (tertiary prevention) when administering CPR or using automatic external defibrillators (AEDs). Similarly, ushers play a crucial role in the direct-sight discovery of victims and must know how to inform the predesignated personnel responsible for dispatching medical response teams. As with security and law enforcement personnel, their ubiquitous positioning makes ushers invaluable in the delivery of response-time-sensitive CPR. Finally, the event performers, whether they are athletes, politicians, musicians, or animals, represent a separate and distinct population requiring medical care specifically geared to their performance. The care of event performers is best provided by personnel most familiar with the performers' specific health care needs. When affordable, a separate medical care system and separate resources should be provided to ensure that care for performers does not interfere with care for spectators and vice versa.

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