Coordinating EMS at the Boy Scout National Jamboree
Ed's Note: Volunteers are needed for the 2013 Jamboree. Contact Jay Reeves at firstname.lastname@example.org, or visit https://summit.scouting.org/en/Jamboree2013/Pages/Staff.aspx.
Every four years a city of 40,000 people appears practically overnight, lasts for two weeks and then disappears almost as fast.
Since 1937 the Boy Scouts of America (BSA) has held its National Jamboree, bringing together tens of thousands of scouts from across the United States, and dozens of countries around the world. This city does not appear by magic. It takes years of planning and preparation by scouting professionals, volunteers and local partners to ensure everything is in place to support the residents of this city.
The entire infrastructure that a small city needs to function must be put in place. Food, water, sanitation, programs, IS (information services), media, banking, public safety and medical services, along with dozens of other supporting functions, must all be ready when the scouts arrive. While past Jamborees usually have had medical clinics staffed by volunteer doctors and nurses, and a supporting portable hospital from the military, EMS did not exist or had only a modest role. Local ambulances were only used if someone needed to be transported off-site. During the 2005 Jamboree several serious emergencies occurred, which validated the need for a coordinated EMS response at future events. The BSA decided to include an EMS component at the 2010 Jamboree along with the local ambulances on site. BSA volunteer EMTs and paramedics staffed five Gator ambulances and several bike teams to provide EMS services and transport patients to the medical clinics. Following the success of these EMS teams in 2010, the 2013 Jamboree medical leadership decided to expand the roll of EMS at this summer’s event.
Previous Jamborees have been held at temporary locations with infrastructures that had to be set up before the event and torn down afterward. Every Jamboree since 1981 has been held at Fort A.P. Hill in Virginia. BSA is moving the 2013 Jamboree to a new, permanent location outside Beckley, WV. The move allows for the installation of infrastructure that can be used again at future Jamborees. The new permanent location includes 10,600 acres of wilderness bordering the New River Gorge National Park. This majestic, remote area, which BSA calls “The Bechtel Summit Reserve,” is filled with steep hills and valleys. Many exciting programs are being provided for the attendees, including some that could be considered high-risk. These include BMX biking, skateboarding, scuba, shooting sports, miles of zip lines, white water rafting, rock climbing and 37 miles of professionally-designed mountain bike trails. Along with the normal variety of medical problems found in a city of 40,000 residents are the additional challenges of rough terrain, response distances and venomous snakes. Construction crews at the site have already observed and disposed of hundreds of rattlesnakes, with at least one reportedly over six feet in length.
Due to the ruggedness of the new site, EMS providers have to rethink how they will respond to emergencies. This past summer a four day “shakedown” was held at the Summit. It included approximately 2,000 scouts and allowed BSA to test some of the programs and support operations planned for Jamboree 2013. Along with everyone else, medical and EMS teams discovered many challenges they will need to overcome for the big event.
BSA Medical/EMS has recruited a core group of medical and EMS professionals with years of experience in their fields, in addition to being experienced scouters. These volunteers include a core group of several EMS physicians and paramedics from around the country who developed the EMS system at the Jamboree, which is now called “Summit EMS.” Creating an EMS system from scratch is a challenge. To create one to support 40,000 people, with few resources or people, for two weeks and then shut down seems almost crazy. The EMS core group identified challenges and is working on its plan. Their ultimate goal is to develop an EMS system which operates at the highest standards and in concert with the excellent existing local West Virginia EMS system.
Being able to access the EMS system from anywhere on the property is a priority. Cell phone coverage is sporadic, with limited tower sites in the area and rough terrain breaking up what signal is available. AT&T has promised to increased cell tower sites to provide better coverage and accommodate the 40,000 people expected on site. BSA is also working to develop a radio system, but it is not expected to be in place by next summer. A portable radio system run by the BSA organization Order of the Arrow (OA) is expected to be used for routine operations. A Summit Operations Center (SOC) will be established to coordinate all 9-1-1 calls originating on the property. The EMS Operations Center (EMSOC) will also be located in the SOC to oversee Summit EMS operations. All emergency services (EMS, fire, security) will dispatch and coordinate their units from the SOC using the West Virginia Statewide Interoperable Radio Network (SIRN) and OA radio systems. With this in place, anyone can use a cell phone or contact a staff member with a radio to access the 9-1-1 system.
One thing the BSA does not have is EMS equipment for responding to calls. In the past, medical equipment has been borrowed from EMS agencies and that may be necessary again for this Jamboree. During the shakedown, EMS was set up with equipment borrowed from local vendors, the local fire department (Mount Hope), the West Virginia National Guard (WVaNG), Jan-Care Ambulance service and ZOLL Medical, along with the equipment medics brought with them. BSA is expected to purchase some vehicles and medical equipment, but acquiring all the equipment needed for the two week operation is not practical. A systematic approach utilizing all resources will be key for getting equipment together for Summit EMS.
Finding the staff to fill all the positions is another challenge. BSA is a volunteer organization. Experienced, trained personnel are needed to walk in and work as a team with other EMS professionals from around the country. 9-1-1 call takers, dispatchers, EMTs, paramedics, supply and logistics staff, managers, QA, training and even mechanics will be necessary to make this system a success. So far about 65% of the necessary personnel are accounted for and fortunately a system is in place that will allow all volunteers to obtain medical license reciprocity to operate in West Virginia.
A response and staging plan is ready to be put in place following the National Incident Management System (NIMS) concept. The Jamboree area is separated into regions, each with its own management and resources. Each region will be supported with an array of vehicles: ALS-equipped Gator response units, WVaNG field litter ambulances (FLA) and local Jan-Care ambulances. Summit EMS will also staff basic aid stations for minor issues to prevent cluttering the medical stations or tying up response units. The mountain bike areas will be supported by first responders who are also trained mountain bikers. They will be backed up by four ALS ATVs with All-Terrain Res-Q Trailers, which will remove patients off the trail and down to a waiting Gator or FLA. Depending on patient condition, the patient will go to an on-site medical station, ALS ambulance on site or a waiting Medevac helicopter.
The Jamboree medical section has a lot of physicians, PAs, NPs and nurses to staff the medical facilities, which will operate much like civilian urgent care centers. Almost every medical specialty will be present, with many of them experts in their field. However, while incredible knowledge will be on hand, the available equipment will be limited. Medical station capabilities will drive EMS protocol for where patients are transported by Summit EMS. The Summit EMS physicians will help in this process by providing medical control to assist with field treatment and transportation destination. Jan-Care Ambulance will have several ALS units positioned at strategic locations for off-site transports, but the closest trauma center is nearly a 60-minute drive from the Summit. To handle critical patients, HealthNet Aeromedical Services will have a dedicated aircraft sitting on the Jamboree grounds, backed by WVaNG Blackhawk Medical aircraft with hoist capability.
Documentation and quality control is also under development. Electronic patient care reports (ePCRs) are now standard, but we anticipate writing paper reports for this event. Having 100-plus personnel documenting the same way could be a challenge. All the medics attending will come from various services with different styles of reporting, yet we will need to ensure PCRs are accounted for and complete, along with the proper patient care delivered.
Many of us have organized or worked on large short-term events, such as major football games, concerts, etc., but this is a different kind of challenge. We are procuring equipment for the event and anticipate 100-plus professional medics will come together to work like a seasoned team. The core EMS group putting this together is confident teamwork won’t be a problem. EMS personnel are caring professionals, providing the best medical care possible. BSA members are part of the scouting movement, filled with highly moral folks who follow the Scout Oath and Law. With all of this in place how could we fail?
Andre Toups is a shift commander with East Baton Rouge EMS in Louisiana and a nationally registered paramedic for over 30 years. He has previous experience at Jamborees and was selected to the Executive Core Team for establishing EMS at the 2013 BSA National Jamboree.