Emergency medicine experts play a large role in working across the spectrum of issues to be addressed and building effective partnerships. I’ve been the senior medical advisor for the Super Bowl since 1988. Our current medical team includes five emergency physicians, each of whom have deep expertise and are nationally known: Jim Ellis, MD, FACEP, Alex Isakov, MD, MPH, Eric Ossmann, MD, Matt Bitner, MD, and myself. Our two other colleagues, John Ritter, NREMT-P, an EMT, and Ed Klima, a firefighter and emergency manager, also have deep expertise in the public safety, emergency management, and EMS environments. At a high level, our scope of activities include coordination of overall health and safety, with particular focus on:
Disaster Preparedness and Planning
As noted, with multiple jurisdictions impacted, it is imperative to facilitate a joint and integrated approach to multiple contingencies. This year, while security became heightened in the wake of the Paris and San Bernardino terrorist actions, planning had to also include environmental issues such as El Niño and earthquakes, technological/infrastructure issues such as power failure or structural collapse, and biologic issues such as outbreaks or food contamination. Our team facilitates communications, problem-solving, development of all hazard-response plans, staging and predeployment of required assets, and training across various stakeholders. A joint command post operates 24-7 for more than a week.
For regular season games, teams normally come in the day before a game and leave after. For the Super Bowl, the teams arrive a week before the game. We set up systems of care for teams, including at their hotels, at practice facilities, and on game day. We meet with the team medical staff and trainers upon arrival to review these plans with them. In addition to key contact information, each team is given multiple GPS units with preloaded destinations to facilitate travel to offices, clinics, hospitals, and imaging centers. Each stadium has an Emergency Action Plan (EAP) that is shared with team medical staff and reviewed again with both teams on the field on game day. Team medical staff have a separate radio channel to communicate among themselves, with the ability to switch to the NFL medical channel if needed. On the field, there are medical teams on each side that consist of multiple specialties and EMS as well as X-ray and oxygen techs. Separate ambulances are dedicated to the field. Thom Mayer, MD, another well-respected emergency physician and the medical director for the NFL Players Association, meets with our group to review plans in detail and participates in on-field review of resources and the EAP meeting. Over the years, the planning and availability of resources for players have improved dramatically.
“NFL Family” Care
Putting on a weeklong event like this literally takes a cast of thousands. When adding associated broadcast, logistics and media partners, and executives and staff from various teams and NFL operational personnel who arrive during the run-up to the game, the overall group may be as large as 3,500. We term that the “NFL Family.” We work with local health systems to facilitate access and care as well as collaboration. Convenience care clinics are placed at the stadium and in the headquarters hotel, and additional contact numbers are added to health system call centers so that staff who become ill or injured can more easily navigate the local system. Of course, our emergency physicians are on call and responsive 24-7 for both the staff and the health systems. Over the years, we have had to deal with the same issues emergency physicians have to routinely handle (eg, strokes, infections, viral outbreaks, trauma, allergic reactions, and myocardial infarctions), albeit sometimes in a more challenging environment. Our team focuses on rapid communications both within our group and with the health systems to ensure critical handoffs and follow-through for patients. These same systems are available to the medical team physicians for managing the team executives, staff, and family.
The focus on health and safety for the stadium area starts long before game day. The load-in and build-out of the stadium and surrounding area start as much as a month before the game and convert the area into an industrial zone. Multidisciplinary tabletop exercises are reviewed to identify issues and address potential gaps in response. During the week of the game, our group is on-site for halftime and pregame rehearsals and works with risk managers to identify and address any concerns, such as stage movement, staff routes, and angled ramps. For the game, additional medical/EMS staff resources and staff are added within the secured perimeter; temporary first-aid stations are added if needed, especially if security requirements impede normal response routes; and the level of care is raised to include on-site physicians in order to decrease the need for transports and spare ambulances. To improve response to a blast event, tourniquet training and supplies are integrated into the medical plans. Rest areas are added so that people who are dehydrated, fatigued, or feeling ill can be cared for in a comfortable setting and return to the event if they improve. Over the years, great strides have been made to accommodate those needing self-care (eg, injections, stoma care), privacy for breastfeeding, and disability-related services. Communications and coordination are key, so radios, ring-down phones, and command centers are integrated to minimize notification and response time.
Each large-scale event, like Game Day or the NFL Experience, has a health and safety plan crafted among security, medical, public safety, operations, and others. We have found this to be key as different disciplines often have different perspectives. For example, while security focuses on restricted access, medical looks for unfettered access for rapid response. By working together and building a solid plan to train all staff, one can maximize the effectiveness of both individuals and systems. Each frontline staff member should be able to recognize a security, operations, or medical problem and then know who to call, what to report, and what to do until help arrives. On-site command posts facilitate this mindset and approach. From the health and safety perspective, injuries and illnesses are reported and monitored, problem-solving is performed within the multidisciplinary group, and changes are made to the events on the fly. For smaller events, site surveys, review of existing plans for any gaps and recommendations, and facilitated planning occur.