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Colossal Response: EMS at Bristol Motor Speedway

Safety in “the Last Great Colosseum”—Bristol, Tenn., Motor Speedway (BMS)—is the result of preparation, precision, and professionalism. 

As racing crews, facility staff, and security personnel begin their days, EMS personnel and ambulances entering the complex undergo initial vetting by state officials and bomb dogs. Their morning briefing explains basic processes of the day, zone assignments, and radio procedures. Bristol hosts two NASCAR Sprint Cup events per year; this increases the city’s population from just under 27,000 to make it the third-largest city in the state during those weekends.

The speedway is one of the highest-capacity racing venues in the United States and sixth-largest motor racing venue in the world, with a seating capacity of 162,000.1 Event and support staff easily bring the numbers to around 200,000 in and around the complex during a sold-out event. 

Years of experience and professionalism have brought emergency services at the complex to a high level. Anyone watching the operation would conclude the emergency personnel here have been doing it all their lives. They would be mostly right. Providers come from volunteer and paid departments, with varied levels of licensure and certifications. More than half of responders on site have worked the races at BMS for at least a decade. The commitment regional providers give the venue shows in continued coverage. 

Command and Control

If one had to summarize what makes BMS work, it would be command and control. It’s not just a way to get a handle on the medical traffic, it’s a way of life. 

The early days had NASCAR officials directing all ambulance traffic. Much has now changed. The facility updated the racing surface and infield and added seating, luxury suites, and skyboxes.

The public safety community expanded along with it and underwent a major restructuring after September 11, 2001, when the threat of terrorism became a major concern. The command suite in the main tower became very crowded, requiring relocation of command.

The MACC (multi-agency command center) became an integral part of the operation in its own right. The MACC allows all law enforcement (city, county, state, and federal), emergency management (county and state), fire, military, homeland security, and medical coordinators to work together in one place. Multiple onsite dispatch systems coordinate each discipline along and across jurisdictional lines as they work together to accomplish their missions. 

Medical call volumes during major events at BMS have varied from the single digits to hundreds. Many of these are handled by field crews, with less than 50% requiring transport to an on-site care center. Typically less than 5% require transport to a hospital.

For transport planning, the most important person in the room is the city traffic engineer. Gridlock is no longer the problem it once was. Through measures like pedestrian holds, contraflow, and coordinating information with Tennessee and Virginia transportation officials, the city traffic engineer holds the key to roadblocks, median blocks, and allowing emergency vehicles to navigate these obstacles and other important traffic considerations.

From an outsider’s perspective it is a madhouse, yet everything works out. How is it achieved? Incident command.

The expansion of BMS required EMS coordinators to seek resource support from the surrounding EMS community in Tennessee, Virginia, North Carolina, and Kentucky. EMS providers alone number 50–100 on any given major event weekend, with 20–25 ambulances on the property and staged strategically. Most local agencies are unable to support the event with large numbers due to local call volumes during speedway events, as not all who come to the area are at the track. 

Using the Incident Command System (ICS), the solution was to divide and conquer: The campus is divided into sectors based on the track’s features. The infield is its own sector out of necessity, with dedicated responders, an infield care center, and a trauma bay under the supervision of NASCAR officials.

An experienced supervisor/paramedic commands field crews in each sector and coordinates response and transport as needed. The responders work out of fan care centers staffed with nurses and a physician or practitioner. Fan care centers are on-site clinics that handle minor medical problems. Those with complex medical conditions are transferred to a local hospital by ground or air, depending on acuity and traffic conditions.

One predominant issue at these events is noise. When cars are on the track, it’s impossible to understand more than 20 teams sharing one frequency. Each sector is assigned its own radio channel, with two extras for command and logistics use. Sector officers control 3–7 teams of responders and coordinate their activity with race control. The layout of the stands lends itself to the implementation of a spotter for EMS crews based in one of the suite sections.

Race Command

Tracking of crews within sectors is accomplished by the sector officers, while tracking units on calls takes place within EMS dispatch at “race command.” Two EMS dispatchers monitor three channels each to keep up with unit traffic, in addition to a track radio used to communicate with speedway staff such as ushers, tram attendants, and others who know to contact EMS on the dedicated frequency. EMS dispatchers routinely interact with their law enforcement counterparts who dispatch in the same room for all personnel assigned to the event. 

State legislation allows out-of-state EMS providers to work mass gatherings under certain conditions. This issue was raised in the late 1990s due to the need for out-of-state help in coverage of the event. EMS agencies in northeast Tennessee are mostly primary 9-1-1 services that are normally staffed at or near capacity for routine business. The manpower and equipment for surge capacity within the region are minimal without significant reimbursement for overtime and equipment costs. 

Ballad Health, the predominant medical provider in northeast Tennessee and southwest Virginia, has contracted with Bristol Motor Speedway to provide medical care. Ballad supports the infield care center where drivers and crews are taken for immediate care, as well as the fan care centers located strategically in the grandstands and dragstrip pit area. It also provides aeromedical service with its flagship aircraft, Ballad One, and hires support staff to coordinate, dispatch, and support emergency medical operations on site.

Coordinated communications are maintained with an on-site medical control physician and trauma surgeon in the infield care center. All potential aeromedical flights are cleared through medical control before an aircraft is used. Though NASCAR requires the aeromedical aircraft stationed at the helipad be dedicated to the drivers when cars are on the track, Ballad has a secondary aircraft just off site, and other air services can be called as needed. Multiple landing zones have been identified in addition to the helipad.

New Threats

The size and scope of the mission has been given new meaning and complexity since Sept. 11, 2001. Ballad extended its reach to find enough EMS coverage to plan more intentionally for a targeted event. While Tennessee and Virginia services were the norm in the ’70s and ’80s, EMS providers now also come from Kentucky and North Carolina.

Mass gatherings continue to be planned as scheduled emergencies. The concentration of so many people and increased media attention require us to look and plan as potential targets for terrorism.

Attendee demographics determine how we prepare for routine care on scale, using historic numbers. The weather is one consideration—sometimes it’s cool and hypothermia is an issue, while the August event requires overheating considerations. 

Considerations for the fan experience are paramount in most decisions. The goal of the medical staff is to provide care that returns the attendees to normal to enjoy the event whenever possible. Providing an easy means to access EMS and using readily identifiable landmarks can assist them in relaying their position.

The on-site medical control within the trauma bays of the infield care center is consulted directly from care centers or race control as needed. On occasion traffic necessitates patients with low acuity be flown to the local hospital. City and county emergency services work closely in assisting BMS event staff and handle most off-site calls. Constant communication with local 9-1-1 dispatch within the venue also facilitates the first response to patients that may be closer to on-site units until local units arrive and assume care.

Constant State of Readiness

Should the unthinkable happen, there are plans and contingency assets in place around the perimeter of the complex. Mass-casualty supply caches, AmbuBuses, and identified landing zones supplement the on-site equipment. Mass-casualty supplies are stockpiled in trailers off the property. Supplies and equipment from federal, state, and other agencies are kept both out of sight and off site and shall hopefully never be needed. 

The state regional medical communications center monitors and tracks EMS and hospital availability using the state’s Health Resource Tracking System, an IT platform for monitoring bed, equipment, and supply assets across the state. Maintaining a state of readiness is just another planning tool that helps everything keep rolling smoothly and keeps us cocked, just in case something happens that requires us to “pull the trigger” for an event.

More on mass gatherings: Providing care at Bonnaroo. 


1. World Atlas. Largest Motor Racing Venues in the World,

John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office.


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