World Cup 2010 planning: An integration of public health and medical systems
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Public Health (2008) 122, 1020e1029
www.elsevierhealth.com/journals/pubh
Review Paper
World Cup 2010 planning: An integration of
public health and medical systems
Arthur H. Yancey IIa,*, Peter D. Fuhrib, Yogan Pillayc, Ian Greenwalda
a
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
b
Emergency Medical Services and Disaster Plan, National Department of Health, Pretoria,
Gauteng, South Africa
c
Strategic Planning, National Department of Health, Pretoria, Gauteng, South Africa
Received 17 January 2007; received in revised form 2 October 2007; accepted 21 November 2007
Available online 4 March 2008
KEYWORDS Summary Objectives: To present crucial stages of planning and the resources in-
Mass Gatherings; volved in the medical and health care that will address issues affecting the health
Special events; and safety of all participants in the 2010 World Cup.
Emergency Medical Design: Relevant literature reviews of mass gathering medical care supplemented
Systems; experience of the authors in planning for previous similar events. Attention is fo-
Injury Prevention; cused on issues wherein effective planning requires the integration of public health
Public Health Systems; practices with those of clinical emergency medical services. The tables that are in-
Surveillance Systems; cluded serve to illustrate the depth and breadth of planning as well as the organi-
Disaster Planning; zational relationships required to execute care of a universally acceptable
Multi-casualty Incident standard.
Response Planning; Conclusions: This article offers guidance in planning for the 2010 World Cup health
World Cup Soccer and emergency medical care, emphasizing the need for integration of public health
South Africa and medical practices. It depicts the span of planning envisioned, the organiza-
tional relationships crucial to it, and emphasizes the necessity of an early start.
ª 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights
reserved.
Introduction event for the health sector loom large. The WC is
expected to create opportunities for new strate-
As South Africa approaches the 2010 International gies and additional resources that strengthen the
Association of Football Federation (FIFA) World public health system, upon which the majority of
Cup (WC), the potential legacies of a successful South Africans rely for prevention and care.
* Corresponding author. Emory University School of Medicine, Department of Emergency Medicine, 49 Jesse Hill Jr. Drive, S. E,
Atlanta, GA 30303, United States. Tel.: þ1 404 616 6675; fax: þ1 404 616 0074.
E-mail address: iyancey@emory.edu (A.H. Yancey II).
0033-3506/$ - see front matter ª 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.puhe.2007.11.005World Cup 2010 planning 1021
Lasting improvements in systems of care for WC host countries (the last WC was held in
citizens and visitors alike could result from the Germany) will facilitate development of appropri-
advances in public health, public safety and ate timelines for planning.
medical care plans for the event becoming in- Following an initial review of information from
tegrated with those for local communities. The WC previous events of similar scale, a planning per-
also offers the opportunity for public and private sonnel network should be developed. It should
medical resource planners to collaborate on im- include supervisory personnel who will be respon-
proving readiness for future regional or national sible for EMS, public health, hospital administra-
health emergencies. These legacies can only en- tion and medical care in the jurisdictions chosen
hance South Africa’s image as a developing country for the matches. Venue managers and security
in Africa before the rest of the world. officials at each match venue should be recruited
These potential benefits depend upon a healthy to the group, so that it forms a comprehensive
and well-cared-for South African populace and the basis for planning.
host country’s provision of appropriate medical In terms of planning to scale, critical informa-
resources for participating athletes, officials, me- tion includes attendance and medical care statis-
dia personnel, spectators and the workers who host tics from previous WCs. A predictive model for
the event. Effective emergency medical services rates of patient presentation for care and ambu-
(EMS) system development for an event of the WC’s lance transport at mass gatherings was developed
scale requires early and comprehensive planning. in Australia,5 and compared with the use of retro-
Support for this concept is well developed and spective event data to determine the relative ef-
embodied in several comprehensive review articles fectiveness of the two models at forecasting
on mass gathering medical care1,2 and the National demand for medical care. When adequate data
Association of EMS Physicians’ (USA) planning guide were available, the retrospective reviews proved
and position statement in 2000.3,4 to be more accurate, leaving the predictive model
Event EMS operations must be closely coordi- as the default method when little or no historical
nated with the emergency preparedness plans of information exists about levels of demand at previ-
medical centres, public health and public safety ous events of similar scale.6 Expected levels and
agencies. Areas of support for these entities in- types of morbidities need to be matched with ad-
clude control of banned substances, adequate and equate, targeted, preventive and therapeutic re-
safe pharmaceuticals, forensic pathology services, sources. Information from prior mass gathering
communicable disease detection and prevention, events of the scale of the WC have shown that
environmental health, port and event security, spectators are at greater risk of heat-related ill-
emergency telecommunications, and public ad- ness, acute cardiac emergencies and respiratory
dress system-mediated prevention messages. In events, while athletes are more likely to be in-
addition to addressing these cross-cutting func- jured on the field of play.
tions, all of these sectors must be coordinated The actual demand placed on medical care
vertically, from local to provincial and, ultimately, resources in previous WCs is reflected in the number
national level, within each WC match venue as of patient encounters for medical care. Using the
well as in the communities that surround them. overall attendance figures for each previous event
The wide-ranging, disparate nature and magnitude as a baseline denominator, and the total number of
of these activities on, at least, the three opera- patient encounters as the numerator, the pro-
tional levels will require intersectoral communica- portional demand for medical care at past events
tion and coordination, before and during the can be calculated. These percentages can be
inevitable, ongoing adjustments to plans. translated into initial estimates for 2010 events
This article will elaborate on many of the tasks by extrapolating these rates to the maximum
that should be completed in preparation for the projected levels of attendance at each 2010 WC
2010 WC to ensure success. Although South Africa site. These calculations are depicted in Table 1.
has started the planning process, the following The outcome figures serve as sound estimates for
should be contributory. initial resource allocation. Present quantification
of demand for care planning is being based upon
percentages of stadium capacities: a 0.2% patient
Retrospective event research contact rate; a 0.05% transport rate; and a 2% al-
lowance for mass casualty incidents. Knowledge of
Early communication between designated South the numbers and attendant percentages of all in-
African Department of Health personnel, FIFA WC juries and illnesses that were treated on-site com-
officials and public health personnel from previous pared with those transported to off-site facilities1022 A.H. Yancey II et al.
Table l Plan for initial resource allotment. Table 3 Venue characteristics.
r Each previous event’s population attendance r Geographic boundaries of medical responsibility
(denominator) r Medical centre design
r Presentations for medical care at each previous r Seasonal weather patterns
event (numerator) r Venue spectator capacity
Percentage of attendance at each previous r Aisle space and exit capacities (relationship to
event presenting for medical care fire code specifications)
r Initial resource allotments for each 2010 event r Barriers separating spectators from the playing
Previous WC event percentages estimated field
attendance totals at each 2010 event r Accessibility for spectators with disabilities
r Each previous event’s categorical population r Accessibility of ambulatory medical personnel to
attendance (denominators) all points in the venue
Athletes r Accessibility of attendees to primary first aid
Games support posts
Staff r Emergency vehicle ingress and egress routes and
Media capacities
Host country support r Helicopter scenario e landing site(s)
Spectators
VIPs
Dignitaries
r Each previous event’s categorical patient
resources needed to minimize response times.
encounters (numerators)
Percentage of attendance in each category For these reasons, health and medical service
presenting for medical care planners should be fully involved in any plans for
r Initial resource allotments for 2010 events the rehabilitation and/or building of competition
Previous WC categorical percentages venues. Factors as ubiquitous as location-specific
estimated categorical population totals at weather patterns during the dates of the event
each 2010 WC event can have a significant impact on the demand for
EMS services, as seen during the 1996 Olympic
VIPs, very important persons; WC, World Cup.
Games in Atlanta, USA. During that event, heat ex-
posure causing illness in unacclimatised athletes,
spectators and tourists influenced the develop-
in previous WCs will assist in the estimation of 2010 ment of a stratification policy that linked escala-
WC initial allocations for on-site facilities and EMS tions in predetermined heat index ranges to
vehicles by employing the foregoing translational corresponding progressive deployment of emer-
method. This categorization is depicted in Table 2. gency preventive/care resources.7 Medical staff
sought out those most vulnerable to heat illness,
including those at the extremes of age, pregnant,
Event reconnaissance or wheelchair-bound, then encouraged active
water intake, offered cool wet towels, and adver-
Each 2010 site must be subjected to health and tised the location of misting fans.
medical reconnaissance. The distinctive venue Each venue’s infrastructure, physical assets and
characteristics illustrated in Table 3 will likely im- event activities will potentially impact the health
pact timely access to and evacuation of anyone in of attendees, so the characteristics depicted in
need of medical care, as well as the level of EMS Table 4 should be considered. Addressing these
factors prospectively will reduce the demand for,
and thus, conserve EMS resources. In preparation
for the 2004 Olympic and Para-Olympic Games in
Table 2 Disposition of presentations for medical Athens, the Greek National School of Public Health,
care. in collaboration with the Ministry of Health, imple-
r Injuries
mented a comprehensive needs assessment pro-
On-site treatment cess that prioritized potential public health
Transported off-site (hospital) threats and related them to the adequacy of public
r Illness health infrastructure to address those threats.8
On-site treatment The environmental health sector will be re-
Transported off-site sponsible for accrediting all venues utilized for
the event, including stadiums, hotels, off-siteWorld Cup 2010 planning 1023
status of their emergency departments. All public
Table 4 Intra-venue population preventive health
considerations.
and private medical facilities should have disaster
preparedness plans in place. These plans should
r Potable water supply and access address the sudden influx of casualties, including
Sufficient quantity and adequate quality contingency plans, should they have to decant
Correct positioning of taps some or all of their patients if and when their
r Toilet facilities e adequacy and access institution becomes compromised. Investigating
Sufficient quantity and adequate quality the parameters in Table 5 will contribute to this
Correct positioning of taps
planning phase.
r Food integrity inspections plans
Hygienic preparation
Waste management
r Public address system capability Surveillance systems
Quality of equipment
Training of users The health of citizens and visitors will depend
r Access to alcohol upon robust surveillance initiatives, constructed to
Service on premises vs none detect emerging patterns of injury and disease
Time period limitations on sale vs none outbreaks, local and international, in a short
Use of plastic containers
enough timeframe to enable early and effective
r Traffic ingress and egress routes
Spectator pedestrian route mapping interventions. For the 2000 Olympic Games in
Vehicle route mapping Sydney, the public health surveillance system
Security availability to minimize spectatore
vehicle contact
Vendor delivery and removal times (food, Table 5 Community medical resources.
supplies, equipment, waste, etc.)
Gate management
r Command and control
National Health Operations Centre
r Jurisdictional emergency medical services systems
surrounding venues
Extent of workforce dedicated to participation
official venues such as fan parks, and related in event care
events. Responsibilities will include food inspections Proportion of workforce available
for all catering outlets (including street vendors Proportion of time available
surrounding stadiums), potable water provision and Transport times to hospitals receiving
integrity, sanitation and waste management. This event patients
sector should link closely with the communicable Vehicle traffic pattern sensitive
disease control sector that will manage surveillance. Pedestrian traffic pattern sensitive
The realistic potential level of community med- at event ingress and egress times
ical resources that will provide crucial support for Venue mass casualty incidents
Emergency vehicle surge capacity for
the emergency care of injured or ill athletes,
patient transport
officials and spectators must be assessed carefully. Emergency vehicle surge capacity with
The jurisdictional EMS service capabilities and mutual aid provisions activated
capacities should be assessed. These services will Demand-for-care level at which a
bear responsibility for the initial care of popula- jurisdictional disaster is declared
tions outside established venues, immediately r Off-site fixed facilities (hospitals and clinics)
prior to their ingress and following their egress Specialty care (trauma, burns, opthalmology,
from events. psychiatry, obstetrics, dentistry)
Similarly, inquiry into specific capabilities and Patient decontamination capabilities (chemical,
capacities of surrounding hospitals must be con- biological, nuclear)
ducted for planning the most appropriate matches Bed capacities (staffed and non-staffed)
Blood bank capacities
of patient medical need to receiving facility
Diagnostic data collection capabilities for daily
capability. How readily hospitals can handle a surge injury and illness surveillance
in demand for care must be estimated. A bureau Bed capacities governance
for hospitals’ bed-availability status is needed to Hospital bed bureau: a website-based
ensure appropriate triage of patients. This plan- real-time status on bed availability for mass
ning should involve a web-based portal system casualty incidents
providing real-time bed-capacity status of each Patient distribution policy
designated receiving hospital and the patient-load1024 A.H. Yancey II et al.
drew clinical data from three crucial sources: the Early planning, constantly revisited, will help the
Games venues; surrounding emergency depart- country and event planners to meet this challenge.
ments; and cruise ships (docked as floating ho- The level of equipment and pharmaceutical
tels).9 The time cycle for data entry, three-times supplies available will depend, to a great degree,
daily data transfer, automated collation, analysis upon the level of financial support made available
by an Olympic Surveillance Review Team, and to the health sector. Early budgeting can lead to
briefing to the Health Olympic Coordination Centre timely procurement of equipment and supplies. It
was 24h. Three years prior to the Games, a risk as- also addresses the reality that some contracted
sessment was performed, leading to an initial list vendors of care and support resources may fold
of morbidity priorities from which public health in- prior to the WC, necessitating contingency plans
terventions and services were developed. For the for contracting with alternate vendors.
1998 WC in France, a system of sentinel disease The apportionment of stationary on-site vs
surveillance was instituted through electronic re- transport-capable resources should be based ini-
porting by physicians in communities surrounding tially on the statistics gathered from research into
the matches.10e12 Given that the event will be previous WC events. Lists of these resources and
held in mid-winter, the possibility of pandemic in- their attendant operational issues are presented in
fluenza necessitates effective internal and inter- Tables 6 and 7.
national surveillance. This holds crossover value
in detecting bioterrorism events because of similar
clinical presentations. At the venues for the 2002 Access to care
WC matches in Japan, on-site caregivers were pro-
vided with e-mail capability to transmit real-time With personnel recruitment and procurement of re-
data on patient presentations, EMS system opera- sources underway, planning can shift to devising
tions, and the status of medical equipment and pathways to, and protocols for, care. Within the event
supplies.13 Data from 10 different geographic pa- venues, two parallel systems of emergency medical
tient care areas were analysed centrally at the care should be designed: one to cover WC participants
Japanese Ministry of Health, Labour and Welfare, (e.g. athletes, officials); and one to cover spectators
including data on five environmental conditions and event workers. This arrangement achieves con-
and 12 clinical parameters. Prompt detection of tinuous, universal, medical care coverage for
isolated incidents and looming epidemics is essen-
tial to enable the EMS system to respond to victims Table 6 On-site resources.
of injury and illness in a timely manner, render ex-
pert evaluation at the scene, triage and initiate r Medical staffing
treatment, and transport patients swiftly to the Classification (doctors, emergency care
closest appropriate hospital for definitive care, personnel, nurses)
when required. Establishment of a country-wide, Training (event-specific) contents
electronic surveillance system, inaugurated for Schedules in relationship to event
Accreditation
the WC and perpetuated beyond it, would serve
Identification
as an invaluable and fitting legacy of the event. Deployment and deactivation times
r Medical equipment levels for mobile responders
Basic life support
Event-dedicated resources to meet the Intermediate life support
demand for medical care Advanced life support
r Pharmaceuticals for mobile responders
With the foregoing information, initial estimates Basic life support
can be made for levels and types of expertise, as Intermediate life support
well as quantities of medical resources, that will Advanced life support
be needed for care at WC events. Decisions about
r Stationary facilities
Strategic location(s)
actual acquisition of resources will always repre-
Supplies
sent a compromise between the ideal, determined Staffing
from the preceding research, and the possible, Medical equipment
dictated by the constraints of surrounding commu- Pharmaceuticals
nity availability of expertise and financial support. Signage (appropriate languages)
Adequate recruitment, distribution and efficient r Intravenue mobile resources (i.e. modified
utilization of human expertise will be a challenge, stretcher-bearing golf carts)
given the multi-day, multi-site nature of the event.World Cup 2010 planning 1025
Table 7 Resources for patient transport off-site. Table 8 Information to spectators through the pub-
lic address system.
r Mobile resources e capacities and availabilities
Ambulances r Planned (protocol-driven) instructional message
Restocking of supplies and pharmaceuticals Directions to fixed medical care facilities
Communication capabilities Instructions for spectators to alert event
Refuelling officials of need for medical care
Staffing patterns Provisional instructions for venue evacuation
Security r Instructions and training for non-medical
Helicopters personnel on alerting event medical system
Indications (protocols) for use Access instructions for people with disabilities
Availability in given service area Directions to fixed care facilities
Communication capabilities Frequency of messages during event
Planned (non-emergency) patient transport Wrist-band identification of children under
Protocol governing use 8 years of age on entrance to venue
Staffing
Communication capabilities
disparate resources. Medical control comprises
spectators while preventing disruption of the compe- the communications links that directly impact
tition that would be caused by delays in medical care delivery of care, from discovery of illness/injury,
of athletes. Steps should be taken to ensure co- to notification of event EMS, to dispatch of event
operation between the host country’s system of EMS services, to evaluation of the emergency(s)
athlete care and that provided by participating teams’ and, when indicated, to dispatch of jurisdictional
medical support personnel. EMS services with notification of designated hos-
Changes in, or introduction of, enabling legisla- pitals and public health. Event command refers to
tion that serves unique aspects of event medical communications links bridging all operational as-
care will also drive the need for immediate initia- pects of the events, many of which play crucial
tion of planning. Consideration should be given to supportive roles in medical care. These concepts
enabling waivers of certain licensure requirements are depicted in Table 9.
for medical practitioners who accompany teams to
South Africa. Present import and export prescripts
for pharmaceuticals and medical equipment may Dignitary and VIP care
need to be modified or waived with respect to
items that are brought into the country by each An event of the WC’s magnitude and prestige will
team’s medical support group. attract the attendance of many who, by virtue of
The crux of access to care resides in linking their position in a government or status in the
a person in need of medical attention, likely private sector, require special care provisions.
discovered by non-medical personnel, to the EMS Well-organized planning for the care of these
system designed to respond, evaluate and address subpopulations will likely benefit everyone’s care
the emergency. This crucial interface is best facili- by preventing delays in the care of these visitors as
tated by educating everyone at the events on how to well as disruptions in care for those outside these two
access the EMS system. The public address systems at categories. Table 10 addresses these considerations.
each venue will be critical in this regard, as depicted
in Table 8. They should be constructed and tested in
the pre-event phase to ensure easy audibility Mass casualty incident planning
throughout each venue. Surveillance for illness
and injury events by event personnel, both trained The attractions that draw record crowds and high-
in vigilance and supplied with efficient communica- profile attendees to WC events can make the
tions links to the EMS system, should augment the venues and surrounding areas potential targets for
use of surveillance cameras feeding into a central- soccer hooligans wishing to disrupt the event, or
ized bank of screens, monitored by event security. terrorists attempting to bring attention to a par-
Instructions for non-medical event personnel on ticular cause. The 1972 Munich Olympics massacre
alerting the medical system should be imparted and the 1996 Atlanta Olympic Park bombing are
during pre-event training. examples.14e17
A well-planned, multi-modal communications The intense emotions that often surround WC
network is vital to coordinating otherwise matches suggest that extra vigilance and care must1026 A.H. Yancey II et al.
forms of violence, resulting in even more wide-
Table 9 Event communications systems.
spread injuries and deaths than terrorist acts.
r Event command links Hooliganism involving gangs of so-called ‘fans’ at
Event management or near sports venues has been a major problem in
Medical control Europe.18 In Africa, stampedes at football matches
Facility maintenance (car parks as potential caused 266 deaths between 1991 and 2002.19 Ap-
triage areas and vehicle staging) proximately 170 of these deaths occurred during
Public relations (public address system access) a 1-month period in 2001 at three matches.
Security services (crowd control, aisle clearance,
Forty-three deaths occurred in a tragic event in
emergency vehicle ingress/egress route access)
Usher supervision (discovery of illness/injury) South Africa, with the details of both the contrib-
Resource procurement uting organizational factors and clinical care well
r Modalities documented.20 In addition, the prospect of crimi-
Landline telephones nal activity directed at individual tourists and
Mobile telephones small groups of visitors must also be taken into ac-
Radios count. This contingency may represent a significant
r Communications manager role challenge to security forces, as well as an addi-
Construct/maintain event radio/mobile tional demand on emergency care personnel and
phone/landline networks the EMS system as a whole.
Designate radio frequencies and landline To prevent such tragedies and limit the conse-
numbers
quences of any incidents that do occur, well-
Procure and distribute equipment
Maintain radio battery charges known principles of injury prevention should be
Ensure spare radios in working order instituted. As a pre-event education tool, when
Ensure the security of communications resources event surveillance suggests that predetermined,
Test of all resources, daily, prior to matches hazardous, spectator density thresholds have been
exceeded, the public address system should be
activated to direct attendees to disperse, so that
be taken to ensure crowd control before, during overcrowded conditions are relieved. These mes-
and after each WC match. Over a considerable sages must be reinforced by the strategic de-
period of time, the sport, as a whole, has repeatedly ployment of security personnel. In planning event
shown itself to be vulnerable to less-organized operations, careful consideration must be given to
protocols enabling competition suspension until
overcrowding is rectified. This ‘ground rule’ should
Table 10 Care of dignitaries and ‘very important be announced via the public address system prior
persons’ (VIPs). to and at predetermined regular intervals during
competitions. As a pre-event engineering tool, if
r Definition of dignitary fencing is used to separate spectators from the
Anyone representing a government or organiza- playing field, it should be constructed of materials
tion for whom medical care will be provided by
that are designed to collapse at pressures that
respective governmental or organizational
personnel outside the event medical care system
would otherwise cause thoracic crush and asphyx-
r Definition of VIP iation injuries. Such designs have been used suc-
Anyone designated by event management to cessfully along highways to protect motor vehicle
receive medical care provision by event occupants upon crash impact. As an enforcement
personnel outside the event system tool, security personnel should monitor venue spec-
r Considerations tator ingress. Whenever this ingress exceeds pre-
Coordination with regular medical providers to determined, safe venue capacity thresholds,
obtain pertinent patient medical history security supervisors should have the authority to
Coordination with event security and dignitary suspend the competition, at least temporarily.
protection service personnel to plan for Similarly, whenever real-time surveillance, prefer-
medical access to patient
ably video-monitoring, reveals that safe aisle space
Confidentiality guidelines
Contingent special care area designated in passage is threatened by overcrowding, designated
event planning security supervisors, in conjunction with the juris-
Special assigned medical personnel dictional health authority and event officials,
Pre-designated supplies/pharmaceuticals should have the authority to suspend competition
Contingent receiving hospital(s) designated until safe, spectator redistribution is restored.
in planning Special attention should also be given to a de-
tailed analysis of designated hospitals’ emergencyWorld Cup 2010 planning 1027
department disaster readiness. Where required,
Table 12 Incidents requiring jurisdictional
deficiencies should be addressed. This readiness resources.
will require that personnel of all medical disci-
plines be accessible immediately for mass casualty r Designation of contingent casualty clearing
incident (MCI) responses, and that extraordinary stations (mass casualty incident scene unsafe for
triage training be provided for all emergency triage)
department personnel. r Triage tags for foregoing victim categories
By their secretive nature, in the case of terror- distributed to EMS personnel prior to event
r Joint decision of event management, EMS and
ism, and their spontaneous nature, in the case of
security to call for jurisdictional resources
spectator stampedes, the timing of these disasters r One pre-designated individual to request
cannot be predicted. However, awareness of these jurisdictional (provincial, national) resources upon
and other past MCIs serves to emphasize the decision for intervention
importance of contingency planning, all of which Law enforcement official optimal
involves coordination with event security and law Secure communications link
enforcement. Forensic pathology services should r Essential information to be transmitted
be on standby in the unlikely event of mass deaths, Event aetiology (explosion, trampling, noxious
in order to support the police services as well as inhalation, shooting)
establish a victim identification programme. Some Number of casualties
of the essential elements and action plans are Injury type of casualties (burns, crush/
asphyxiation, inhalation injury)
listed in Tables 11 and 12.
Potential hazards to incoming responders
Specific resource requests
Formation of event health and medical EMS, emergency medical services.
care organizational plan
A well-indexed organizational plan will facilitate emergency care will be conducted, with what
review, reflection and coordinated adjustments to resources, and the timelines within which the re-
optimize the translation of plans into operations. sources will be positioned and operable.
Its contents may be organized by the foregoing Copies should be distributed to venue and games
framework of issues, and should reflect how management, as well as that of EMS, security,
environmental health, facilities maintenance, pub-
lic relations and ushers. Managers of these functions
Table 11 Elements of disaster preparedness. should, in turn, ensure that staff are familiar with
r Pre-event review of jurisdictional disaster plan by
relevant portions of the plan. Copies should also be
event EMS personnel distributed to chief medical and executive officers
r Hospital emergency preparedness plans of participating jurisdictional hospitals, public
r Plans for security sweep of ambulances entering health agencies, law enforcement, and disaster
venues management organizations, so that expectations
Security sweep inspections vs switching and roles are clearly understood prospectively.
patients from venue ambulance to The initial planning document should be final-
jurisdictional ambulance at fence line ized on a specific date, in anticipation of the need
r Response to incidents adequately addressed by for widespread distribution to, and review by, all
event-dedicated resources of the aforementioned supervisory staff. They will
Pre-assigned alternative roles for event EMS
be expected to provide feedback on the contents,
personnel (consistent with jurisdictional
EMS incident command system positions)
leading, in turn, to important adjustments. Time
Triage officer to implement these adjustments must be consid-
Immediate category victim treatment officer ered when determining the finalization date of the
Delayed category victim treatment officer document.
Minor (ambulatory) category victim
treatment officer
Deceased victim category supervisory official Quality management
Ambulance staging zone officer
Ambulance loading zone officer Given the high level of accountability expected at
Ambulance transport destination recorder such a world-class event, prospective planning and
preparations for medical care, ongoing monitoring
EMS, emergency medical services.
of potential emergency situations during the event,1028 A.H. Yancey II et al.
and retrospective analysis of the care performed
Table 14 Concurrent quality management.
should be addressed and documented through qual-
ity improvement (QI) management practices. For r Event surveillance for injury/illness/mass casualty
the 2000 Olympic Games in Sydney, a system of incident
monitoring for critical incidents was designed and Ambulance security sweeps upon entrance of
instituted to evaluate and continually upgrade di- vehicle to venue
saster medical readiness. Its function was based on Suspicious packages e investigation and disposal
anonymous reporting by disaster medical team Crowd density monitoring for stampede
conditions
members of any incident with the potential to
Food preparation inspections
threaten the safety of team members, patients r Community surveillance for injury/illness due to
and/or an optimal response to MCIs.21 Conclusions impact of the event
drawn were that central collation and analysis of Pre-event standardization of hospital-generated
anonymously reported potential adverse incidents diagnosis data
holds advantages for the continual improvement of Acute respiratory illness (asthma)
quality. Accurate analysis for QI depends upon con- Acute diarrhoeic illness (gastroenteritis, possi-
scientious accurate documentation of both formula- bly food-borne)
tion and execution of event plans. Tables 13e15 set Injuries (violence-, traffic-, alcohol-related)
forth medical care management tasks that are Fainting, syncope (humidity- and temperature-
grouped temporally in relationship to the occur- related)
Collection of baseline data during defined
rence of the event.
pre-event phase
In order for South African health and medical Daily data collection from surrounding hospitals
services to take their rightful place as contributors and clinics
to the legacy of this internationally esteemed Daily data collection from intravenue sources
event, a post-event summary report should be Daily collation of data according to standard
prepared. It should document the extent of diagnoses
health services and emergency care provided Daily analysis of data in search of epidemic
during the 2010 WC and the nature of care trends
rendered, and it should offer recommendations
to further improve care at future WC events. This
Table 13 Prospective quality management.
r Staff recruitment
r Orientation and training Table 15 Retrospective quality management.
Assigned geographic postings (mapped)
Coverage areas of medical responsibility r Selection of audit filters reflecting the most chal-
(mapped) lenging aspects of medical care
r Radio communications instruction and practice Reconnaissance information from previous
Communications medium familiarity World Cups
Practical scenarios for rehearsal Observations of most common conditions
Mock mass casualty incident demanding care
Cardiac arrest Observations of most critical conditions
Player injury demanding care
Dignitary/VIP asthma/allergic reaction r Review of patient care report forms based on
r Medical care documentation e patient care audit filters selected
report forms r Review of events (mass casualty incidents) of a
Perspectives magnitude requiring jurisdictional emergency
Brief encounters medical services involvement
Out-of-hospital environment Interviews of event officials
Brief documentation Joint reviews with event management and
Definition of a patient encounter jurisdictional authorities
Information confidentiality r Data summaries
Training on filling out forms Absolute numbers of medical events
Plans for collection Incidence of medical event types per
Storage for review venue population
r Event emergency medical services organizational Incidence of medical event types per
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Ethical approval
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