Olympic Lessons Learned from London Ambulance Service

 

 
 
 

Jason Killens, MStJ, JP | From the March 2013 Issue | Thursday, February 14, 2013


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EMS Today: How London Ambulance Service Responds to Planned Events & the Unexpected

Jason Killens explained how the LAS continually improves its response to major events.
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Planning for the London 2012 Olympic and Paralympic Games began on the day it was announced that London would host the Games. That day was July 6, 2005, and as Trafalgar Square and towns and cities around the United Kingdom erupted with joy when the words “the Games of the 30th Olympiad in 2012 are awarded to the city of London” rang out around the world from Singapore.

Those of us in London Ambulance Service (LAS) operations had a different reaction. We took a deep breath and said to ourselves that we had a massive task to deliver on. But the following day, London was thrown into chaos as suicide bombers targeted the underground subway system at the height of the morning rush hour. Fifty-two people lost their lives in what was the first multi-sited and simultaneous use of suicide bombers as a weapon of terror in the UK. The London Ambulance Service would later be subject to intense scrutiny of its response to the bombings but would draw lessons from that day that enhanced our capability across the Olympic and Paralympic period.

Observational Learning
A planning team of six was established in 2007. It was tasked with working full-time across many partner organizations to scope and understand the scale and complexity of the Games. We worked with existing agencies and were able to use relationships that had been developed over many years to aid planning. Equally there were many new organizations that we needed to develop relationships with. One of these was the London Organising Committee of the Olympic Games (LOCOG). Specifically with LOCOG, a full-time senior operational manager from LAS was seconded into the organization to aid planning and share experiences.

Although London Ambulance Service has experience in planning for sporting and cultural events on a massive scale, its administrators had never planned for multiple venues working simultaneously across the city over a protracted period whilst the eyes of the world were on us. We learned from previous host cities about the nature, type and number of patients who may be seen. We also learned some of the more operational issues around accreditation and the “post Games effect.”

Members of the planning team, which sought to learn lessons from previous host cities, travelled to Beijing for the 2008 Olympic and Paralympic Games as well as other major sporting events. The single biggest lesson learned from other host cities and those that had hosted such events as the Pan American and Commonwealth Games was this, “Don’t leave planning until the Games are upon you and resource the planning team to be able to respond to the demands placed upon it.”

Rigorous Testing
Our planning team worked full-time for five years to prepare LAS to respond to the increased call volume received during the Games. In the six to 12 months leading up to the games they gained support from the Games Time Command Team of senior officers on a half-time basis. These additional officers bought the total planning team to 12 from 2011–2012.

Testing for the Games began years before the opening ceremony and involved command post, table top and live play exercises. The program culminated with three sets of live sporting events in Olympic venues across the city. We were clear from the outset that each of these test events across each venue would see the actual Games Time Command Team together with the paramedics and EMTs who would be deployed throughout the venues. This enabled those who would actually provide prehospital care at the venues during the Games to become acquainted with new venues while establishing relationships others, such as LOCOG venue managers.

During the final set of tests events in May 2012, two months before the opening ceremony, we deployed paramedics and EMTs from around the country into the venues. The Olympic Deployment Centre (ODC) was opened and our Olympic Event Control Room (OECR) managed deployments and responses to emergency calls.

Central Operations
The ODC was an empty warehouse in East London on a back street industrial park. It was located immediately across the Thames River from the Millennium Dome—now renamed the O2 Arena. We had a vision for the ODC. We wanted to transform it into a flagship, albeit a temporary one, for the Games. It would be open 24 hours a day, and be the center for EMS response. All ambulance service staff being deployed to Games venues and cultural events would be mustered, briefed, fed and deployed from the ODC. The building was a shell and after a bit of cleaning we installed temporary catering facilities along with showers, toilets, lockers, briefing rooms, a canteen, internet café plus a vehicle preparation and equipping area. The ODC became a working super-station for the Olympics and was one of the key success stories of the Games for us.

Our dedicated OECR, which was built in 2008, was open 24 hours a day during the Games. It was where we managed deployments and responses in each of the four Games delivery zones. The 36 position control room links via our CAD system to our main control room, while having the benefit of access to a network of closed-circuit TV cameras across the city.

We considered how we would deliver existing service requirements, such as response time performance standards and clinical quality, while deploying hundreds of paramedics and EMTs to sporting venues and cultural events. It was clear that even with restrictions on planned workforce abstractions, which included a deferral of all training across the summer of 2012, we would need an additional short-term boost to the workforce. There are eleven National Health Services ambulance services across England. We are the biggest and busiest handling over 1.6 million emergency calls per year. Each of the other English ambulance services agreed to send pre-planned aid to London for the Olympics and Paralympics, boosting our dedicated Games specific workforce to 500 paramedics and EMTs. Outside of the Games for business as usual we have a paramedic and EMT workforce of 3,000.

Each ambulance service around England works slightly differently. Because each has different policies and procedures, it was necessary to provide training to each member of the Games cohort. Over four days, a training team from London visited each ambulance service in England to provide training to staff. The training package was completed in London when paramedics and EMTs began to arrive in late July for the Games.

Paramedics, EMTs and Emergency Medical Dispatchers (EMDs) from around England arrived in London over three days. Each day, those arriving received an initial briefing and their personal issue LAS baseball cap, among other items of Games specific personal issue equipment.

The planning team didn’t only have to negotiate and agree how we would deliver services across the Games and its multiple venues. We also had to make sure we complied with the bid commitments, the requirements of the individual sport federations and LOCOG. We also had to arrange accommodation, feeding and transport for 200 staff from outside London.

Let the Games Begin
We began the briefings for the staff working in the Olympic Stadium with a degree of anticipation on the day of the opening ceremony. It was too late if we had forgotten something. We would have to adapt, flex and improvise. Our past five years of planning was predicated on this and had provided a framework for delivery that could be adjusted to meet operational requirements on the day.

Our Games Time Delivery Strategy provided a firm foundation for this flexibility. It complimented existing event and mass gathering doctrines in London. As the opening ceremony began and Queen Elizabeth jumped from a helicopter over the Olympic Stadium in a spoof, James Bond-style sequence, we all sat glued to the television and watched. It was at that point I knew this was going to be something special.

I had been involved in the planning and delivery of many large events in London over the past 10 years. These included the Live8 concert, G8 and G20 summits, New Year’s Eve celebrations, Notting Hill Carnival, London Marathon, state visits of the Pope and other famouse people, the royal wedding and the Queen’s Diamond Jubilee. But this was different. It was something else.

Day one of the Games followed, and our plans were working well. Although there were issues with some of the logistics, they were insignificant in comparison to the scale and complexity of the operation. Deployments of EMTs and paramedics on foot, in ambulances, on motorbikes and pedal cycles were underway. We had people in venues, at cultural events and standing by at transport hubs.

Our Olympic Information Unit (OIU) was in full swing. It operated 24-hours-a-day and provided strategic briefings on activity, incidents and relevant issues to key internal and external stakeholders. This unit worked to compliment the control room and was at the center of our EMS response during the Games.

Game-Day(s) Response
Reserves were planned for each day of the Games, depending on the perceived risk. Our assessment of risk was based on known events, the competition schedule, the weather forecast and other intelligence. The reserves consisted of ambulances and special assets. The special assets allowed us to be prepared to respond to such specific types of threats as chemical, biological, radiological and nuclear events. They included special equipment supply and mobile control vehicles, plus teams of staff able to provide urban search and rescue, high-angle rescue and swift-water rescue.

As each day of the Olympics passed, we saw increased demand but weren’t as busy as we had expected. Overall activity across London during the Games rose by about 10%. We saw some traffic congestion when the Games lanes went live, but the road network and public transport network delivered, and Londoners, visitors and spectators alike were able to travel without incident. The same was true for us with limited disruption to emergency response—perhaps as a result of the detailed route and access planning undertaken.

Equally as important to the provision of EMS at Games venues was the service we provided to the rest of London. We termed this “maintaining service delivery” (MSD), or core business. We had planned this to provide the same emergency service to Londoners in non-Olympic boroughs while delivering world-class responses and care at Olympic venues. A senior colleague oversaw the planning and delivery of MSD. We reconfigured many aspects of routine service delivery to release capacity to support Olympic or core delivery. The basis of this planning was our existing business continuity arrangements. This approach meant that staff members were already familiar with how we would do things when challenged, and it meant that we were less likely to see confusion. Existing plans formed the basis of our MSD and Olympic planning, keeping our delivery as close to what we normally do as possible and not inventing something new for the Games —both of which reduced the potential for error.

Spectators were the largest patient group during the Olympic and Paralympic Games, closely followed by those making up venue workforce. Although no major or multi casualty incidents happened over the 30 days of sport, a number of incidents happened in which critically ill patients presented with cardiac arrests, ST-elevation myocardial infarctions and convulsions in venues. Our teams worked alongside the volunteer workforce of LOCOG and LOCOG Medical (a separate team within the organizing committee that provided first aiders, nurses and, in some cases, doctors in first aid rooms) to provide initial treatment before conveying them to emergency departments (EDs).

Summary
LOCOG Medical managed thousands of patient contacts across all the Games venues without our intervention. A polyclinic in the athlete’s village had extensive diagnostic options, including X-ray and magnetic resonance imaging for athletes and the Olympic family. These helped limit the number of patients who needed transport to the ED.

Although the delivery was seamless, there were “behind the scenes” moments in the final stages of planning that made us think. We received additional requests for ambulance cover at training venues that hadn’t been planned for on short notice. In addition, the torch relay attracted bigger crowds than initially planned for. Some of the planning assumptions and agreements changed on short notice for various reasons. This meant we had to adjust our plans while also solving human resource issues that you would expect to see among a workforce of around 500 across a six-week period.

As part of the National Health Service (NHS) ambulance service Games cohort, more than 500 staff were deployed across 18 venues and 30 days of sport in London. In doing so, they delivered in excess of 165,000 hours of standby and care, responded to nearly 1,500 Games-related incidents and conveyed 800 patients to emergency departments across the capital.

After such an influx, it wasn’t easy to return to business as usual. Officials with previous host cities had advised us that there would be a feeling of “what next” once the Games concluded. When I first heard this, I thought the opposite would be the case. I expected feeling relieved of overwhelming emotion as well as from the exhaustion of the long days. I do have to say that although this was the case, it’s also true that there is a “post Games” come down. We had just been part of a fantastic summer of sport with a brilliant medal tally from Team Great Britain and Paralympics Great Britain that, of course, helped the euphoria. But we did feel a real sense of uncertainty about what to do next. We had spent five years planning for it, lived it for the past six months and been part of it for the past 30 days. And now it was over.

Overwhelmingly the experience was truly great. There was an immense sense of pride in achievement and participation on the part of every EMT, paramedic EMD, officer and ambulance service employee who helped deliver prehospital care at the Games. The Games and cultural events were a truly once-in-a-lifetime experience. We were privileged to be part of that experience, to provide prehospital care during the Games and to be able to say we were part of something that inspired a generation.

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EMS Today: How London Ambulance Service Responds to Planned Events & the Unexpected


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Related Topics: Major Incidents, Special Operations, special events ems planning, London ambulance service, London ambulance Olympics preplanning, Jems Features

 

Jason Killens, MStJ, JP

Jason Killens, MStJ, JP, is deputy director of operations at the London Ambulance Service NHS Trust and was the gold commander for the Olympic and Paralympic Games 2012.

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