Inside Duke Medicine

Stronger emergency presence binds Duke, community to provide campus-event care

 Victor J. Dzau, M.D., (second from right) chancellor for health affairs and CEO of DUHS, discusses the new emergency medical response plan for campus events with Ian Greenwald, M.D., (second from left), chief medical officer of DUHS' Preparedness and Response Center and assistant professor of emergency medicine; Matt Bittner, M.D., (right) assistant medical director for EMS and an Emergency Department physician; and Larry Tucker, RN, a Duke Regional Advisory Committee member who oversees the State Medical Assistance Team (SMAT).

The Sept. 18 Duke-Alabama football game showcased a new comprehensive emergency medical response plan covering all Division I football games, men’s basketball games, and other large gatherings on the Duke campus.

Duke Emergency Medicine’s Section of Pre-Hospital and Disaster Medicine and community partners including Duke EMS, a student-run organization; Durham County EMS; Duke Police; Parkwood Fire Department; Duke Life Flight; and the Duke RAC State Medical Assistance Team (SMAT) are collaborating in a highly coordinated and integrated effort to enhance the emergency medical response capabilities at large gatherings.

The system was designed to ensure that event attendees who require emergency medical attention receive the level of prompt, efficient and professional healthcare Duke Medicine strives to provide throughout its clinical settings. In the case of football games at Wallace Wade Stadium, care is provided in a series of tents set up on the concourse level.

“Whether emergency medical care is provided at a scheduled mass-gathering event in a stadium or in the hospital’s Emergency Department, the patients deserve our highest standard of care,” says Ian Greenwald, M.D., chief medical officer of DUHS’s Preparedness and Response Center and assistant professor of emergency medicine. “The environment in the stadium presents some unique challenges and these events are dynamic with lots of moving parts. Fortunately, our team, community partners and Duke Athletics’ operational staff are experienced, dedicated and work exceptionally well together.”

For the Alabama game, the system included four emergency physicians, nine nurses and three ambulances. A total of 147 patients were seen at the medical aid stations, and 14 were transported to Duke University Hospital or Durham Regional Hospital.

“The Alabama game was particularly challenging, given the size of the crowd and the heat,” says Eric Ossmann, M.D., new Medical Director for Durham County EMS and associate professor of emergency medicine at Duke. “We had developed a heat-management plan in conjunction with Duke Athletics earlier in the season. It was key to have water and cooling stations in place and ready to go. DUKE ROTC assisted in the cooling stations and with the logistics of the water stations. We will certainly build off this program for future events.”

One of the biggest advantages of the system is having physicians present who can immediately determine whether to treat patients on the spot or to transport them, Ossmann says. For example, in the recent Duke-Elon game, 47 people needed attention at the game, but only two were transported. The treatments ranged from dehydration to an allergic bee sting to an asthma attack.

"A mass gathering requires a different response from that of a person who calls 911 for medical attention,” says Jessica Thompson, who manages the Duke Preparedness and Response Center and Emergency Preparedness and Planning at DUH. “With larger events, we can anticipate an increase in medical support needs, both minor and critical. That is why we have all worked together to form a multidisciplinary partnership comprising EMS, nurses, and physicians from many local response agencies including Duke to help facilitate onsite medical care and when necessary ambulance transport. Those can be very complicated decisions, and not all conditions call for ambulance transport.”

Among the many people who made the Alabama game a safe, healthy success were Bob Weiseman in Duke Athletics, Chief John Dailey and Lt. Shannan Tiffin of Duke Police, Duke Emergency Services COD Frank Demarco, SMAT, and the Emergency Medicine Residency, which staffed the game.

“This game represented hours of preparation and planning for medical coverage and response to medical and traumatic injuries during the game,” says Mike Smith, System Director for Durham County EMS. “Large crowds, alcohol and heat are added factors at a gathering. It has thus far been a great partnership as we continue to improve our pre-hospital care and medical coverage for mass gatherings. I cannot say enough about the importance of working together as a team to accomplish a common goal.”