From personal experience, I believethat ambulances have no place on a golf course. I base this strong statement on a "man down" call I responded to at a local course. We arrived with no previous plan in place. I looked at the situation and decided to drive out on the course with the knowledge that we had a rule against off-road operation of ambulances. And although this was a difficult case with a good "field" result for our team, it also resulted in an unpleasant visit to the office, a letter in my file and a complaint from the course.
As an EMS provider, you often head into fields with wet spots, culverts, bridges and other unknowns, and EMS pre-plans for a lot of possible scenarios. But one that seems to be overlooked is the local golf course. On any given day there is a high-risk group of people playing golf. Many golfers arein their lateryearsand have a variety of ailments. Add to that slips, strains, contact with animals -- or being hit by balls or clubs or lightning -- and someone, somewhere will respond to a golf course. Today might be your day. Are you prepared?
Starting the Conversation
A lot of people who have seemingly minor injuries or illnesses find their way to the clubhouse. However, for the most part, it's safer to leave the patient where they are and get trained providers to them. Golf course staff and golfers shouldn't move patients, and it's a good idea to reinforce through public education that patients should only be moved in dire circumstances.
But getting to a patient on most golf courses, whether in a country or city setting, requires special equipment capable of off-road patient transport that either the golf course has on site or the providers bring with them.
Many course owners, managers and superintendents assume an ambulance can simply drive on a golf course. For the most part, that's an incorrect assumption. Pickups and small dump trucks might be able to drive on a golf course, but ambulances with low ground clearance might not make it out to a patient and back without damage to the course, the vehicle or both.
Of course, not everyone will agree that ambulances shouldn't be operated on golf courses.Some objections I have heard to setting up a pre-plan include the course having paved roads for carts. But where do you turn around? Others cite having never had a problem before or having too low an incident rate to be concerned with it. And from golf courses, I've heard the two worst excuses for not having a plan or equipment on site: "I call 9-1-1. It's their problem," or "It's too expensive."
There are EMS agencies and golf courses that have had long discussions and have functioning plans. However, there are also many instances where neither the course nor responders recognize the potential risks involved in the world of golfers and the places they play the game. It's rare for the management of a golf course to come to responders asking for assistance. It falls to the EMS responders to initiate contact, and you will most probably have to knock on their door.
Engage management in a friendly way. Explain that you would like to look at the course, assess your ability to get around on it and explain the off-road limitations of your equipment. See what they have on hand to handle emergencies and determine whether they have some plans in place. Check out their communication system. You might offer to brief their staff about the proper handling of emergency messages. If appropriate, offer to include their staff in CPR or AED refresher classes.
Lay of the Land
Golf courses have various levels of accessibility. Once on the terrain, you'll find anything from a course surrounded by roads and condos that only requires good directions and maps for easy access, to a course with minimal access for your equipment and no way for an ambulance to get near most of the property. No matter what you find out about the course, however, the effort to make a pre-plan is a good idea.
Review the layout of the course, and note anything that will obstruct or assist you in getting to a sick or injured person off the course. If you find the course has limited access and large areas an ambulance shouldn't try to reach, is the right equipment to get your staff to the patient, such as a utility terrain vehicle (UTV), available? Further, it's necessary for the course to provide an appropriate patient transport platform to get the patient back to your ambulance. This may be a dedicated ambulance cart or a retrofit for one of their utility vehicles. Over any long distances, it's quicker and safer toload a patient in a Stokes basket or put them on a backboard and transport them on aUTV than it is to carry them on a stretcher. It's also easier to continue treatment more effectively. You may want to consider including a landing zone in your plan for those patients whose condition is serious enough to require air evacuation.
If the course can be reached from several places by ambulance crews, communications have to be set up between the course and responders so you get to the right place the first time. You may have to transport initial responders to the patient on the course's golf carts from predetermined meeting places. As far as equipment for off-road patient transport goes, there are options. Departments that have a UTV equipped to move patients might bring it along.If your department is looking to fund a UTV, the local golf course might be a reason to do so and could possibly be a source of funding.
If you're in an area where there's no other use for a UTV-type vehicle, it's the course's responsibility to have the equipment available for you to move a patient. They can opt for a single-use "ambulance cart" or modify one of their existing side-by-side utility vehicles with a skid-mounted patient transport. The latter is considerably less expensive for them and still allows the course to use the rig, as long as the operator has communication and can be called to meet incoming EMS responders at a pre-designated place.
For a golf course not able or willing to spend huge amounts of money on equipment or modifications, a product like theMedlite by Kimtekresearch, is a viable retrofit to an existing utility unit.
Once your plan is in place, you should hold combined drills every year and keep the plan updated.
EMS should make the effort to contact the local golf course and the two should create a pre-plan not only because it's the right thing to do but also because it will ensure patient treatment isn't delayed and that property or equipment isn't damaged. Stay safe, plan ahead and hit them straight. You don't want to be playing out of bounds.
Ralph Sandersis a retired firefighter/paramedic. He can be contacted firstname.lastname@example.org.