Planning Event Medical Cover

Two documents matter in the UK and neither is law. The Purple Guide to Health, Safety and Welfare at Events, produced by the Event Industry Forum with Health and Safety Executive input, is the recognised benchmark for events generally. The Guide to Safety at Sports Grounds, known as the Green Guide, does the equivalent job at sports grounds with spectator accommodation, where compliance may form part of the ground's safety certificate.

Safety Advisory Groups are widely misunderstood, including by people who attend them. They are convened by the local authority, they usually include the police, fire service and ambulance service, and they are advisory and non-statutory. A Safety Advisory Group cannot approve, refuse or prohibit an event; that power sits with the licensing authority and with the statutory bodies. Not every event goes near one, and the ones that do are the ones presenting significant public safety risk. What early engagement buys you is not permission. It is the chance to hear objections while they can still be answered.

The instrument itself is the medical needs assessment, sometimes called a medical risk assessment, and it is worth being precise about who does what. Management commissions it. It is carried out by a competent person or medical provider, which at a sports ground might be a medical coordinator or an event doctor, and it is carried out in consultation: with the local authority where a safety certificate is in force, with the medical and first aid providers, with the statutory ambulance service, and with any Care Quality Commission registered ambulance provider. The legal duty stays with the organiser throughout, and the assessment then informs the medical plan.

The Purple Guide's tiers run from one, the smallest and simplest, to five, the largest and most complex mass gatherings. Headcount is only one input. The crowd's profile, the alcohol and drugs, the weather, the duration, camping, the terrain and the sport itself all move it.

Walk it. A plan written from a site map is a plan that has not met the fence.

The questions worth answering are ordinary and they are the ones that fail. How does a response team reach the far side of the arena when the crowd is between them and it, and does that route still exist when the crowd is moving? Where can an ambulance actually drive, and who opens the gate? What happens to your access route when the headline act finishes? Which parts of the site are cut off by terrain, water, a railway line or a single bridge?

Then the things the map will not show you. A crowd on grass in August behaves differently from the same crowd on gravel in November. A camping event is a twenty-four-hour operation. A licensed bar changes your case mix more than the sport does.

Site your resources by response time rather than by convenience, which means a defibrillator and a responder within reach of every part of the crowd rather than clustered where the office happened to be.

The medical centre earns its place by treating well on site. The Purple Guide is explicit that a purpose of on-site provision is to minimise the effects of the event on statutory healthcare services, and that is the aim worth holding. It is an aim rather than a target: conveyance numbers alone say nothing about whether an event was well run, and nothing here should ever discourage a transfer that a patient needs.

So the centre needs to be somewhere people can find and reach, signposted, accessible to a wheelchair and a stretcher, with an ambulance able to reach its door and leave again without crossing the crowd. It needs room to treat more than one person at once, somewhere private, and somewhere to sit the walking wounded who are the bulk of the work. It needs light, power, water and a way to keep medicines at a sensible temperature.

There is a clear medical lead, with a command structure and lines of responsibility proportionate to what the assessment found. At a sports ground with a standing arrangement that may be a formally appointed medical coordinator; at a small event it may simply be a named person who is unambiguously in charge. What matters is that nobody has to work out who is leading while something is happening.

The transport question is settled before the event, not during it, and it is settled with the ambulance service rather than announced to them.

Engage early. What gets pre-agreed is the transfer arrangement, the escalation route, the pre-alert and the rendezvous point. What does not get pre-agreed is the receiving hospital for any given patient: that depends on the patient and follows ambulance service and regional pathways, exactly as it does at a club. Find out how far the ambulance service is prepared to be your transport plan, because assuming it is one is how an event ends up holding a patient it cannot move.

Then plan for the day it goes wrong. A casualty surge plan and a major incident escalation route belong in the medical plan from the start, because the moment you need them is the moment nobody has time to invent them. Major incident planning and the individual handover decision each have their own topic in this subcategory.

• •The Purple Guide to Health, Safety and Welfare at Events, from the Event Industry Forum with Health and Safety Executive input, is the recognised UK benchmark for event medical provision and sets the five-tier system and the aim of minimising the event's impact on statutory healthcare services.
• •The Guide to Safety at Sports Grounds, the Green Guide, gives the equivalent expectations at sports grounds with spectator accommodation, and compliance may form part of a ground's safety certificate.
• •The Sports Grounds Safety Authority sets out the medical needs assessment: commissioned by management, carried out by a competent person or medical provider, in consultation with the local authority, medical providers, the statutory ambulance service and registered ambulance providers, and informing the medical plan.
• •Health and Safety Executive guidance describes Safety Advisory Groups as advisory and non-statutory bodies convened by local authorities, without power to approve or prohibit an event.

• •An event is a population, not a patient, and much of the work is in spectators and staff.
• •The Purple Guide covers events generally; the Green Guide covers sports grounds with spectators.
• •Neither is law, and a Safety Advisory Group advises rather than approves or refuses.
• •Management commissions the medical needs assessment; a competent person carries it out.
• •It is done in consultation with the ambulance service, and it informs the medical plan.
• •Pre-agree the transfer, escalation and pre-alert; the receiving hospital stays patient-dependent.