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EMS Consequence Management: Special Events and Mass Gatherings



At a recent EMS conference, I attended Ryan Mayfield's presentation on Quality Management, which is one of my many responsibilities with the department that has employed me for the past 21 years. Since then, Ryan and I have been networking about quality management tools and strategies. The other day he asked, "Out of curiosity, Jim, what does an EMS consequence manager do? I have never heard that title before." After I explained the working definition of the title, he said, "That is not nearly as exciting as I was hoping. I had a vision of you standing over the crews with a big stick."

So, what is EMS consequence management? Through emergency preparedness efforts, consequence management involves coordinating EMS resources to respond and mitigate consequences or potential consequences of any incident related to public health, safety and property.

Creating an EMS consequence management role within our department satisfies emergency preparedness efforts related to prehospital response and care. It also facilitates the coordination of EMS efforts and resources to strengthen the link to other disciplines within the healthcare community and other agencies responsible for disaster response.

This function also coordinates federal homeland security target capabilities related to the medical element of disaster response with grant management duties like the Metropolitan Medical Response System (MMRS) and other Urban Area Security Initiative (UASI) funding related to triage, treatment, transport, mass surge and fatality management. In short order, it's an emergency and disaster preparedness role taken on by EMS.

Special Events

Mass casualty incidents and use of the Incident Command System (ICS) are helpful in planning special and large-scale events (mass gatherings). The use of these tools in non-emergent but important events will make this element of the National Incident Management System (NIMS) second nature in disaster situations. Adopting ICS in planning special events and mass gatherings will also make you competent in ICS, not just compliant as we discussed in an earlier article, "The Elephant in the Room." One must be dynamic and flexible with planning. Frequent use of the incident management system will also allow you to adjust more easily to changes in a special event or a disaster, as both are often fluid by nature.

Spring is the time of year when we in public service are involved in covering and protecting the public and VIPs visiting our cities and towns during special events and mass gatherings like festivals, parades and picnics with high-profile politicians campaigning for re-election. It is our responsibility to plan for these events appropriately, which does not mean the day before the event. Your EMS agency must take an active role in the planning and coordination to ensure that adequate medical coverage is provided to both the VIPs and the masses. Don't rely on others to speak for you. As the primary 9-1-1 responder, your service has a seat at the meetings. Take it, plan for it and be a visible part of it. Remember, EMS is just as relevant as other public service entities in planning these events, which are people-driven and subject to injury and illness. Insist on being in on the preparations, because, at the end of the day, you will end up at the party whether you received an invitation or not.

In the organization where I am employed, EMS works very close with the Secret Service, the state department, and other disciplines and agencies with regard to VIP visits and special events. Memphis is the birthplace of the blues and rock and roll, and is a sacred place on the map for civil rights, and we never know when our community will be visited by a high-profile celebrity, religious leader or political figure. In the past, EMS was just an afterthought. A knee-jerk reaction the day before or the day of an event sent our service spinning to develop a plan and ensure that we had adequate coverage. It wasn't until we inserted ourselves actively in the planning and use of formal planning tools like ICS and resource management that we were effective in our mission of public safety.

We are on the brink of major campaign efforts for 2012's preliminary and primary elections. If you haven't dedicated someone to the effort of special events, mass gatherings or emergency planning for EMS, now is the time to begin. The political candidates will require your attention and good planning to make a safe stop in your town, so be prepared.

Mass Gatherings

It's spring, and your community will inevitably be having annual festivals, parades, concerts, block parties, marathons and other civic functions. As with special events, it is important for you to be at the table during planning efforts rather than receiving a phone call from another agency to see if you are going to have an ambulance on stand-by. You are the medical experts on health care resources and linkages. No one knows better than your service how many ambulances, personnel, first-aid stations, cooling stations, and patient care and safety measures will be needed. In my organization, the current administration relies heavily on our fire-based EMS system's EMS Consequence Management Office to coordinate the efforts for special events and mass gatherings where EMS crews and special event vehicles and resources are frequently utilized. These large-scale events require a robust prehospital presence. Again, the Incident Command System element of the medical branch and its associated forms are a great way to plan and coordinate efforts for these events. It allows everyone involved to be on the same page. In addition, there are several electronic estimation tools available that can assist you in projecting the EMS coverage needed for outdoor and in-door events based on weather, attendance, and if alcohol is allowed on the premises.

Liability rests with your service, as healthcare professionals are aware of the risks associated with large crowds, temperature extremes, and consumption of alcohol or drugs at mass gatherings. Adequate and appropriate supplies, equipment and personnel are a must. The use of interoperable communications, electronic information-sharing with hospitals, and instituting mass surge capabilities when necessary have a large EMS element, and responsibility should taken seriously by your service.

EMS coordination with other healthcare agencies during special events and mass gatherings will strengthen collaborative efforts and be directly connected to your disaster preparedness in the time of need during either natural or manmade disasters. Taking an active role with events like these is an exercise in emergency preparedness for your service's response to incidents like tornados, earthquakes, floods and acts of terrorism.


My boss often opens or closes meetings by saying, "Decisions are made by those who show up. Thanks for taking time to be here." Have a seat and be part of the decision. Don't just wait for the call that says, "Hey, we need an ambulance." It's much more than that.

J. Harold "Jim" Logan, BS, EMT-P/IC, is a 27-year veteran of private and fire-based EMS and serves as a lieutenant firefighter/paramedic for the Memphis Fire Department in an EMS administration capacity, specializing in EMS consequence management, quality improvement, and education. He is a nationally known author for several trade journals. He is an EMS instructor coordinator and fire instructor for the Memphis Fire Department and the state of Tennessee. He holds a bachelor's degree in health and safety. For more than a decade, he has also served as a rescue/medical specialist and a medical coordinator for FEMA's Tennessee Task Force One Urban Search and Rescue Team. Contact him at



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