Emergency Medical Services London 2012 Olympic and Paralympic Games. Dr Pamela Venning DSC PhD RN November 3 rd 2017

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1 Emergency Medical Services London 2012 Olympic and Paralympic Games Dr Pamela Venning DSC PhD RN November 3 rd 2017

2 Health Bid Commitments Free Hospital Care during Games time Release of volunteers from the NHS Ambulance services for all venues and athlete care

LOCOG s Medical Responsibilities LOCOG was responsible for: Medical and health care planning for all client groups associated with the Games Coordination of delivery of medical care inside all

3 LOCOG s Medical Responsibilities LOCOG was responsible for: Medical and health care planning for all client groups associated with the Games Coordination of delivery of medical care inside all Olympic and Paralympic venues and sites Ensure there is appropriate medical care outside Olympic and Paralympic venues The aim of the service was to: to provide an accessible, high quality and comprehensive medical service to all Games client groups 3

4 The London Games Some Information

Sports and Competition Venues Athletics - Olympic Stadium Aquatics Centre Water Polo Cycling - Velodrome BMX Circuit Wembley Football Badminton Gymnastics Olympic Park Hockey Centre Basketball Arena

5 Sports and Competition Venues Athletics - Olympic Stadium Aquatics Centre Water Polo Cycling - Velodrome BMX Circuit Wembley Football Badminton Gymnastics Olympic Park Hockey Centre Basketball Arena Handball Arena Wheelchair Tennis Wimbledon Tennis Central Zone Archery Lord s Cricket Ground Triathlon Hyde Park Beach Volleyball Horse Guard s Parade Volleyball Earl s Court Marathon, Road Cycling London Streets River Zone Boxing, Judo, Fencing, Taekwondo, Table Tennis, Weightlifting, Wrestling, Boccia ExCeL Equestrian, Modern Pentathlon Greenwich Park Shooting, Paralympic Archery Royal Artillery Barracks Basketball (Finals), Gymnastics North Greenwich Arena

6 Venues outside London Coventry Eton Dorney Hadleigh Farm London Weymouth & Portland

Olympic Park Competition Venues Olympic Stadium (80,000) Hockey centre (20,000) Basketball Arena (12,000) Handball Arena (7,000) Aquatics Centre (17,500)

7 Olympic Park Competition Venues Olympic Stadium (80,000) Hockey centre (20,000) Basketball Arena (12,000) Handball Arena (7,000) Aquatics Centre (17,500) Water Polo Arena (5,000) VeloPark (6000) BMX (6000) Eton Manor (10,500) Non Competition Venues Athlete Village International Broadcast Centre Park Common Domain

5000 4000 3391 3000 2000 2019 1000 555 730 718 0 04 Doctor - Crowd

8 NUMBER OF ENCOUNTER London Olympic Medical Data 27th July 12th August Encounters per Medical Provider - EMS Doctor - Crowd 06 Doctor - Field of Play 09 Doctor - Sports 10 First Responder 11 Nurse NULL

9 Planning EMS Services

10 A Games Planning Structure Commercial Commercial Negotiations Merchandising Client Services Ticketing Procurement Commercial Business Management Technology Business Technology Services Internet Technology Services Results Technology Services Telecommunications Services Technology Programme Office Technology Service Delivery Technology Operational Readiness Venue Technology Services SSP Planning&Programme Management Sport Sport Competition Sport Policy & Operations Sports Presentation Test Events NOC and NPC Services Medical Anti-Doping Sport Management & Support Venues & Infrastructure Venue Development & Overlay Venue Management Spectator Services Look, Way Finding and Signage Venue Department Management Games Operations Games Services Accommodation Catering & Food Services Cleaning & Waste Management Arrivals & Departures Transport Logistics City Operations Games Services Management Security Security Villages Village Management Broadcast Broadcast Services Paralympic Integration Paralympic Planning & Delivery CCE Culture Opening and Closing Ceremonies Torch Relay Medal Ceremonies Team Welcome Ceremonies Education Programme Youth Camp Livesites Animating Venue Experience CCE Team Management Legal Legal HR HR Operations Uniforms Volunteering Stakeholder Relations IKM Communications and Public Affairs Website & New Media Finance Finance (Planning, Control & Payments) Accreditation Workforce Training C3 Editorial Services Risk Assurance Workforce Planning Contact Centre Community Relations Rate Card Diversity and Inclusion Corporate Events Nations and Regions Media and PR Government Relations Facilities Health and Safety HR Management Sustainability International Relations Press Operations CPA Management Brand and Marketing Brand and Marketing Executive Office

11 Medical Services - Key milestones Date Description G-65 Appoint Head of Medical Services G-60 Polyclinic design agreed G-60 Define workforce requirements G-60 High level draft list of equipment, consumables and pharmacy products G-54 Commence public health planning G-54 Commence policy and procedure development G-40 Identify clinical experts G-36 G-15 Appoint first medical coordinator G-30 Outline clinical service requirements G-30 Identify procurement streams and commence procurement process G-24 G-0 Volunteer recruitment starts G-18 Polyclinic facilities finalised G-18 Clinical services agree prior to test events G-12 G-0 Volunteer training commences G-12 Review equipment, consumables and pharmacy post test events G-6 Final clinical services finalised post test events G-3 Licences for pharmacies and venue drug storage

12 Event Literature

13 Multi Sport Games Time Medical Organisation Medical HQ International Olympic Committee Medical Commission Procurement Manager Director of Sport Procurement Assistant Head of Medical Services Chief Medical Officer Workforce Co-ordinator Workforce Assistant Team Coordinator Clinical experts Emergency Medical Services Imaging Manager - Polyclinics, Official Hotel Services & Technical Officials Medical Group Leader Central and River Zone Venues Medical Group Leader Olympic Park Medical Group Leader Outer London Venues Pharmacy Physical Therapies Polyclinic Sport Medicine Venue Medical Managers Volunteers

14 EMS Imaging Pharmacy Polyclinic Physical Therapies Sports Medicine Polyclinic and Venues Polyclinic and Venues Crowd Doctor Sport Radiologist Sport Pharmacist s GP Primary Care Nurse Chiropractor Sport Medicine Doctor Nurse Radiographer Polyclinic Nurse Physiotherapi st First Responder Team Leader First Responder Team Member Medical FOP Team Leader Radiographic Team Member Dental Nurse Dentist Hygienist Optometrist Dentist. Dental Lab Technician Dispensing Optician Osteopath Sports Massage Practitioner Medical FOP Team Member Medical Driver Podiatrist Medical Admin Medical Dispatcher Emergency Medicine Doctor Emergency Nurse

Aims of London 2012 EMS Use of Dynamic Risk Assessment methods Mobile Services treat in the seat Compliant with UK standards for sport and non sport events Unified services for all client groups

15 Aims of London 2012 EMS Use of Dynamic Risk Assessment methods Mobile Services treat in the seat Compliant with UK standards for sport and non sport events Unified services for all client groups Standardized methods Standardized equipment Integrated working within the organising committee Partnership working with national health and emergency services Reduce pressure on business as usual for the Health Service

Stakeholder and Partnership Working Government Organisations Department of Health; central and local Other Government departments (Security and Policing) Wales, Scotland and NI Local Authorities

16 Stakeholder and Partnership Working Government Organisations Department of Health; central and local Other Government departments (Security and Policing) Wales, Scotland and NI Local Authorities Clinical Delivery Partners Ambulance Services Designated Hospitals Other non designates hospitals Primary care organisations Other Agencies Public Health England Medicines authorities Clinical professional councils Water and air quality specialists

Public Health Planning Major risk to the Games - planning started early Public Health England - Mass Gathering Unit Team dedicated to planning with a single point of contact for: Communicable

17 Public Health Planning Major risk to the Games - planning started early Public Health England - Mass Gathering Unit Team dedicated to planning with a single point of contact for: Communicable diseases Food, air and water quality & safety issues Detailed policy on operations including exception reporting Senior PH team based in Polyclinic in Athletes village PH team had daily conference with UK wide leads daily and reported back to Exception reporting PH team had a daily conference call with UK wide PH leads for sign posting on any issues 17

Designated Games Hospitals London Athlete Olympic/Paralympic Family Trauma Regional One in each town/city (7) Develop a service level agreement with each hospital Roles and

18 Designated Games Hospitals London Athlete Olympic/Paralympic Family Trauma Regional One in each town/city (7) Develop a service level agreement with each hospital Roles and responsibilities Each hospital needed to enhance the following: HOPLO - a single point of contact officer Security Communications Drugs in Sport Privacy Facilitated Admission Operational Hand Book 18

Ambulance Services London Ambulance Service (LAS) Lead service for the UK Dedicated senior lead at Ambulance HQ Operational lead embedded in LOC Managers aligned to venue

19 Ambulance Services London Ambulance Service (LAS) Lead service for the UK Dedicated senior lead at Ambulance HQ Operational lead embedded in LOC Managers aligned to venue clusters Service level agreements with 8 services Operational handbook developed Daily calls with HoM and Ambulance HQ lead Mutual aid to LAS from ambulance services in England and Wales

20 Medical Risk Assessment London 2012 Olympic Games and Paralympic Games Olympic Park

Systematic Approach to Risk Asessment Sport rules for Olympic and Paralympic Games Length of sessions Seating capacity for each venue Health and Safety Matters from Green Guide Ingress

21 Systematic Approach to Risk Asessment Sport rules for Olympic and Paralympic Games Length of sessions Seating capacity for each venue Health and Safety Matters from Green Guide Ingress and egress flows (The last mile) Local regulations, rules and legislation Current licenses for existing venues Operations of other organising committee functions Polyclinic service levels

22 Risk assessment methods Consequence Insignificant Minor Moderate Major Catastrophic Likelihood Rare Unlikely Possible Likely Almost certain Each hazard is identified in the assessment table below and the risk scored using the matrix. Any mitigating factors and additional risk treatments are then added and a further assessment is made. Any risks that remain in the red or orange section (Scores between 8 and 25) after the residual risk is completed will need to be reassessed and additional mitigation/ controls put in place to reduce the risk further. Any risks that are yellow (Scores between 4 and 6) should be highlighted to ensure that all persons are aware of the controls for that risk and if possible further controls employed. Risks that are green are low risk but they must still be considered by all personnel and additional controls put in place if possible.

23 Risk Risk Potential Hazard Who is affected Initial Risk Score C L Issues Further actions / Completion Date and by who Residual Risk Score C L Medical team to develop plans for casualty evacuation from seats. Seating, stairwells and angle of rake Staff/spectat ors The upper tier is a temporary build; the design means there is no concourse or usable lifts from this level. Patients have to be carried down two levels with over 150 steps. All casualty evacuation from the stand will be a four man lift. Carry chairs with the ability to be wheeled down stairs will be available. A second team will be available to take over when the initial team need to rest Audience profile causing specific issues. Staff/spectat ors Mixed family groups. N/A Inadequate briefing of medical teams Staff/Spectat ors/athletes Risk of staff not fully understanding their roles. Staff may not be aware of any dynamic risks identified from the venue brief. Ensure adequate briefing to all medical staff before each shift and provide summary hand-out brief. Ensure all medical staff are aware of the venue Operational Plan

24 Olympic Stadium - Planning Athletics & Ceremonies 80,000 Capacity Type of Medic Minimum Qualification Minimum No Required by Safety at Sports grounds Provided by LOCOG Additional Athlete medical provision First Aiders Certificate of first aid H&S regs Crowd doctor Trained & experienced in 1 4 immediate care Venue Medical Manager 2 Paramedics IHCD qualified NHS Ambulance managers IHCD, MIMMS, Silver commander qualified. 2 1 Communications officer MPDS qualified 1 1 Total ambulance vehicles provided Medical team RGN nurses, 2 16 Sport doctors 2 Total Vehicles Paramedic units Major incident vehicle 1 Control Vehicle 1 Total Additional sport requirement

25 Bmx Arena Water Polo Basketball 2 ambulances 2 ambulances Velodrome Aquatics Centre Common Domain Common Domain Common Domain 1 ambulance 2 ambulances 1 ambulance 2 ambulances Handball Arena 3 ambulances Olympic Stadium Hockey Arena

26 London Organising Committee of the Olympic Games and Paralympic Games Eton Dorney Medical Plan Version 2 November 2011

27 Emergency Medical Services Equipment Three types of bags Personal (600) Medical (200) Advanced (80)

28 Personal Medical Bag

29 Medical Bag

30 Emergency Medical Services RSI Bag

31 Emergency Medical Services

32 Emergency Medical Services Additional Equipment Sam splint Kendrick splint EZ Intraosseous CAT Tourniquet Celox Gauze Scoop stretcher Basket stretcher Carry Chair

33 Emergency Medical Services

Numbers of Volunteer for Emergency Medical Services Olympics Paralympics Both FOP Team Leader 98 29 20 FOP Team Member 271 98 71 Crowd

35 Numbers of Volunteer for Emergency Medical Services Olympics Paralympics Both FOP Team Leader FOP Team Member Crowd Doctor Crowd Nurse First Responder First Responder Total All Medical

36 Medical Workforce Training Orientation Role Specific Common Role Test Event Training Venue Specific Common Venue Functional Area Specific Role Medical Specific Venue Specific Role Daily Scenario Training

37 Test Event - Schedule Cluster One Cluster Two Basketball Aug 2011 Handball Nov 2011 Cycling BMX Aug 2011 Goalball Dec 2011 Cycling Track Feb 2012 Equestrian Eventing July 2011 Aquatics Diving Feb 2012 Modern Pentathlon July 2011 Aquatics Swimming Mar 2012 Marathon & Race Walk May 2011 Tennis June 2011 Table Tennis Nov 2011 Volleyball July 2011 Boxing Nov 2011 Canoe Slalom July 2011 Fencing Nov 2011 Cycling Mountain Bike July 2011 Judo Dec 2011 Sailing Aug 2011 Taekwondo Dec 2011 Triathlon Aug 2011 Wrestling Dec 2011 Rowing Aug 2011 Weightlifting Dec 2011 Badminton Aug 2011 Gymnastics Jan 2012 Volleyball Beach Aug 2011 Aquatics Marathon Swim Aug 2011 Cycling Road Aug 2011 Canoe Sprint Sep 2011 Archery Oct 2011 Cluster Three Boccia April 2012 Aquatics Synchro. Swim April 2012 Hockey May 2012 Wheelchair Tennis May 2012 Aquatics Water Polo May 2012 Wheelchair Rugby May 2012 Athletics May 2012 Shooting April 2012 Paralympic Archery May 2012 Football April

Co-ordinated Testing Table top exercises Venue based All functions and partners Games wide exercises A day in the life of the Games Different scenarios often including a

38 Co-ordinated Testing Table top exercises Venue based All functions and partners Games wide exercises A day in the life of the Games Different scenarios often including a communicable disease All functions and external partners City wide exercises Nation wide exercises External team injecting events Lasting more than one day Repeated 2-3 times

39 Operations

40 Control Room Suite Preferably separation or screens SCREEN Venue Control Room EVENT CONTROL ROOM SCREEN Preferably separation or screens NORMAL SECURITY OPERATIONS AND COMMUNICATIONS VENUE SECURITY CONTROL CENTRE Security Venue Manager Provides the link in to the VSCC and venue ECR Coordinator Administrate the Event Control Room and the other spaces within the area VGM Radio Logist Will record in-coming and outgoing calls made by the Safety Officer/VGM BMS Engineer Building Systems Manager CCTV Monitor feeds from the stadium and crowd Management 1800mm desk Safety Officer EVS Group Leader Radio sat on EVS stewarding Chan Hot Desk Transport Not required in all venues CCTV Monitor feeds from the stadium, crowd Management & VSCC 1800mm Desk Police Commander Police LOCOG Fire Officer Last Mile Not required in all venues Fire Brigade Ambulance Services Commander Ambulance Services Comms Officer LOCOG Medical Dispatcher Managing Medical deployment & response with the Stadium & Field of Play Venue Communication Manager VENUE COMMUNICATION CENTRE VENUE NORMAL OPERATIONS AND COMMUNICATIONS Required spaces in all Event Control Rooms If space unavailable due to venue constraints these positions do not need to be in the Event Control Room Not required in Olympic Park as will be present in the Park Operations Centre

Communication Plan for Venue Medical Services Medical Fleet Map MEDICAL Role Call Sign Medical Channel Ops 1 Channel MEDICAL Venue Medical Manager MEDLEAD MEDICAL Dispatcher Dispatcher MEDICAL Crowd

41 Communication Plan for Venue Medical Services Medical Fleet Map MEDICAL Role Call Sign Medical Channel Ops 1 Channel MEDICAL Venue Medical Manager MEDLEAD MEDICAL Dispatcher Dispatcher MEDICAL Crowd Doctor Crowd Dr 1 MEDICAL Crowd Doctor Crowd Dr 2 MEDICAL Crowd Doctor Crowd Dr 3 MEDICAL Crowd Nurse Crowd Nurse 1 MEDICAL Crowd Nurse Crowd Nurse 2 MEDICAL Crowd Nurse Crowd Nurse 3 MEDICAL Sports Medicine Doctor Sport Dr 1 MEDICAL Sports Medicine Doctor Sport Dr 2 MEDICAL Physiotherapy Lead Physio Lead MEDICAL First Responder First Aid 1 MEDICAL First Responder First Aid 2 MEDICAL First Responder First Aid 3 MEDICAL First Responder First Aid 4 MEDICAL First Responder First Aid 5 MEDICAL First Responder First Aid 6 MEDICAL First Responder First Aid 7 MEDICAL First Responder Frst Aid 8 MEDICAL First Responder First Aid 9 MEDICAL First Responder First Aid 10 MEDICAL First Responder Frist Aid 11 MEDICAL First Responder First Aid 12 MEDICAL First Responder First Aid 13 MEDICAL First Responder First Aid 14 MEDICAL First Responder First Aid 15 MEDICAL FOP Team Leader FoP 1 MEDICAL FOP Team Leader FoP2 MEDICAL FOP Team Leader FoP 3 MEDICAL Ambulance Ambulance 1 MEDICAL Ambulance Ambulance 2 41

42 Games Time Medical Communication Routes Partner organisations DoH Public Health England Ambulance Service Senior Security Forces Met Police Director of Sport International Olympic Committee Medical Commission Medical HQ Procurement Manager Head of Medical Services Chief Medical Officer Procurement Assistant Workforce Co-ordinator Team Coordinator Clinical experts Workforce Assistant Emergency Medical Services Imaging Designated Hospitals HOPLO Manager - Polyclinics, Official Hotel Services & Technical Officials Medical Group Leader Central and River Zone Venues Medical Group Leader Olympic Park Medical Group Leader Outer London Venues Pharmacy Physical Therapies Polyclinic Sport Medicine Venue Medical Managers Volunteers Venue Management Team

Monitoring Activity Medical Encounter System All encounters logged Daily reports Daily reports from the encounter system of activity Syndromic surveillance reports given to Public

43 Monitoring Activity Medical Encounter System All encounters logged Daily reports Daily reports from the encounter system of activity Syndromic surveillance reports given to Public Health for review Activity numbers sent to the IOC/IPC, DoH and Sport Director Operational reports in venue Intelligence from Public Health Authorities Exception reporting All partners

Conclusions Emergency Medical Planning is integrated in the Medical function and this function is working closely with other OCOG departments Early engagement and close working arrangements with

44 Conclusions Emergency Medical Planning is integrated in the Medical function and this function is working closely with other OCOG departments Early engagement and close working arrangements with external health care partners is essential Games plans are absorbed into the national major incident tried and tested plans reviewing any gaps Attention to detail in planning is key to a dynamic system that enables a deep understanding of medical operations Flexibility Investment of time, resources and commitment to training the medical workforce is key to success of the program Testing and review post test is essential for refining operational planning

The London 2012 Olympic and Paralympic Games: The Medical Challenge and lessons learnt Dr Richard Budgett Chief Medical Officer LOCOG

The London 2012 Olympic and Paralympic Games: The Medical Challenge and lessons learnt Dr Richard Budgett Chief Medical Officer LOCOG 1 History of 2012 bid Olympic and Paralympic delivery Health legacy