Emergency medical care for spectators attending National Football League games.

OBJECTIVE: To analyze medical care facilities and resources available for spectators attending football games in the current National Football League (NFL) stadiums. METHODS: A prospective, structured questionnaire regarding facilities, transportation, medications and equipment, personnel configuration, compensation, and communications was mailed to all 28 NFL organizations. Those falling to respond were interviewed by telephone using the identical questionnaire. Data were compiled using Lotus 1-2-3. RESULTS: Data were collected from all 28 NFL organizations. Because two teams use the same stadium, results were calculated for 27 facilities (n = 27). The number of stadium first aid rooms ranges from 1 to 7, with an average of 2.4 +/- 1.3 rooms per stadium (+/- 1 SD) and these vary in size from 120 to 2,000 square feet, with a mean of 434 +/- 377 square feet. Each room is equipped with an average of 3.3 +/- 2.9 stretchers (or tables), with telephones being present in 91% and sinks in 88% of all rooms. To provide contractual EMS coverage, stadiums use standard EMS system designs, including private (n = 19), fire department-based (n = 7), municipal (city/county) (n = 5), volunteer (n = 4), and hospital (n = 3). Nine stadiums employ more than one type of provider. All stadiums have a minimum of one ambulance dedicated on-site for spectators, with a range of 1 to 7, and a mean of 2.9 +/- 1.4. Golf carts are used for intrafacility patient transportation in 17 stadiums, with a range of 1 to 6, and a mean of 2.5 +/- 1.3. Advanced Cardiac Life Support (ACLS) medications and equipment are present in all NFL stadiums and are provided by the private EMS company (n = 16), stadium (n = 10), fire EMS (n = 7), hospitals (n = 4), municipal EMS (n = 2), and the local NFL organization (n = 1). Several facilities have more than one provider of ACLS medications and equipment. The majority of stadiums dispense acetaminophen (n = 25) and aspirin (n = 24). Some dispense antacids (n = 7) and antihistamines (n = 6). The average stadium staffs 8 EMT-Bs, 7 EMT-Ps, 3 registered nurses, and 2 physicians. Nine stadiums pay a predesignated fee per game to an agency to provide emergency care to spectators. Medical personnel are compensated by an hourly rate (n = 15), a fixed rate per event (n = 9), overtime wages (n = 3), or volunteerism (n = 4). Four NFL organizations pay their medical personnel by more than one type of compensation. Courtesy seats are provided to physicians and nurses in 1 stadium and to just physicians in 8 stadiums, with a range of 2 to 6 and a mean of 3.3 +/- 1.3. All stadiums use two-way radios for the communication and coordination of medical care in the stadium. Additionally, 20 use fixed telephones in the first aid rooms, 3 use cellular telephones, and 2 incorporate a pager system to dispatch personnel within the stadium. CONCLUSION: A wide variety of system designs, facilities, and personnel configurations are used to provide emergency medical care for spectators attending NFL games. This information may be useful for assisting those individuals responsible for organizing stadium medical coverage.

Prehospital care.

To improve patient outcome and reduce time at the scene, treatment protocols for specific injuries and rapid transport should be established with individual systems. These standards should be based on such parameters as history, mechanism of injury, physiologic status of the patient on arrival, triage criteria, and predicted transport times. Ensuring airway patency and stability is a vital function that must be rapidly and carefully performed. Any patient at risk for neck or back trauma needs to be immobilized quickly using a rigid cervical collar with head immobilizer and long backboard. Initiation of IV fluids is acceptable if this skill can be accomplished within several minutes and does not significantly postpone transport. When prolonged or delayed transport times are encountered, aeromedical evacuation should be considered. Medical direction by a qualified physician with an interest in prehospital care and emergency medical services is an essential component in any successful system. The medical director should be strategically involved with protocol development, training and continuing education, and continuous quality improvement. Intensive supervised training in trauma management for EMTs and paramedics will help to reduce the amount of time spent at the scene of an accident. Emergency medical services have certainly come a long way over the past century. Indeed, more research is necessary in order to confirm, perfect, or dispute the many traditional theories that have been a part of prehospital technology. As the field of emergency medicine continues to develop and expand, so too will the specialty of prehospital medicine. Napoleon would be proud!

Academic emergency medicine in United States medical schools.

OBJECTIVE: To determine the current standing of academic units of emergency medicine in allopathic medical schools and to measure the attitudes of medical school deans toward the specialty. DESIGN: An investigator-blinded survey of the senior deans of 123 allopathic medical schools in the United States. RESULTS: Ninety-four of 123 (76%) survey instruments were completed. Fifty-six medical schools reported having academic units of emergency medicine (five divisions of the dean's office, 16 full departments, 35 divisions/sections of other departments). Twenty-five of 56 units were reported to be academically less productive when compared with other specialty academic units of similar size. When overall mission (academic plus clinical/administrative) was considered, 46 of 56 units were reported as adequately fulfilling or exceeding mission expectations. Thirty-eight schools reported not having an academic unit of emergency medicine. Only ten of the 38 reported have no institutional support or plans for academic emergency medicine. CONCLUSION: Medical school deans are generally satisfied with the clinical/administrative performance of academic emergency medicine units but are less so with academic productivity. Despite the small numbers of full departments and disparate status of established units, it is noteworthy that only ten of the 94 respondents to this survey reported no support whatsoever for academic emergency medicine.