A medical team that cannot communicate effectively is not a medical team — it is a collection of isolated responders who happen to be at the same event. At any event with more than one medical worker, formal communication systems and documentation procedures are essential to coordinated care. At larger events, medical communications become a distinct operational function requiring dedicated radio channels, written protocols, and integration with the event’s broader incident command structure.

Medical documentation is equally important. Patient records created during an event may be subpoenaed in litigation. They may be required by health authorities for epidemiological reporting. They are the only reliable record of what care was provided and what clinical decisions were made. Documentation that is incomplete, illegible, or absent is a liability problem and a patient safety problem simultaneously.

The Medical Radio Channel

At large events, there must be a separate, dedicated medical radio channel distinct from the event’s general operations channel. Using the general operations channel for medical communications creates multiple problems: medical language may inadvertently trigger audience panic if overheard through speaker systems or amplified areas; medical providers cannot communicate freely about patient conditions in language that may alarm bystanders; and routine event operations traffic competes with time-sensitive medical communications during an incident (Federal Emergency Management Agency [FEMA], 2010).

The medical radio channel should connect:

• The Medical Group Supervisor or Medical Branch Director (in ICS terms, the medical section chief)
• All ambulance crews on site
• Key medical workers including paramedics and nurses at the main medical facility
• Mobile response teams
• Designated senior first-aiders who are responsible for defined zones

A bridge or gateway to the general event command channel must exist, so that the Medical Group Supervisor can communicate with the event incident commander without requiring all medical traffic to cross to the general channel. In the National Incident Management System (NIMS) framework, this inter-channel communication is managed through the communications unit in the Logistics Section (Department of Homeland Security [DHS], 2017).

Call signs and radio protocols must be established before the event, in writing, and distributed to all radio users in the medical group. Ad hoc radio protocols developed on the day of the event produce communication failures during incidents. The communications plan for the medical group should specify: call signs for each position and each facility, the procedure for requesting ambulance response, the format for reporting patient status updates to the main medical facility, and the procedure for escalating to the event incident commander (FEMA, 2010).

Telephone and Communication Redundancy

The main medical facility must have a dedicated external telephone line that does not route through the event’s internal switchboard. During an incident requiring coordination with local hospitals, EMS dispatch, or public health authorities, the medical team cannot rely on routing their calls through an event communications hub that may be simultaneously managing multiple operational functions. A direct line with published number, held at the main medical facility and communicated to all relevant external agencies before the event opens, is a standard requirement (FEMA, 2010).

All satellite medical facilities — secondary first-aid posts — must have an internal communications link to the main medical facility, either by radio or telephone. A satellite facility that cannot communicate with the main facility is an isolated resource that cannot coordinate patient transfers or request additional resources.

For very large events or events in areas with poor cellular coverage, communication redundancy — backup radio systems, satellite phones, or mesh radio networks — should be considered. A radio system failure during a mass casualty event has the potential to be catastrophic. FEMA’s special events guidance recommends pre-event testing of all communications systems under event conditions, including an assessment of radio dead zones in the venue or on the site (FEMA, 2010).

Medical Staff Communications with the Incident Commander

Under the ICS structure, the Medical Group Supervisor reports to the Operations Section Chief or, if the event does not use a full ICS structure, directly to the event incident commander. The reporting relationship must be defined in the medical plan and understood by all relevant parties before the event. The Medical Group Supervisor is responsible for reporting to the incident commander on (DHS, 2017; FEMA, 2010):

• The total number of patients treated and the distribution by type of complaint during the event
• Patients transported off-site and their destinations
• Any emerging pattern in medical presentations that may indicate a systemic problem — a spike in heat illness, multiple alcohol poisoning cases, or several patients presenting with similar symptoms that may indicate a food safety issue
• Any resource deficiencies — personnel shortages, equipment failures, or facility limitations — that the incident commander needs to know about and may be able to address

Regular periodic reports from medical to incident command — even brief verbal summaries at pre-agreed intervals — are more effective than waiting for thresholds to be reached before reporting. An incident commander who receives a report that 47 patients have been seen in the first two hours of a 6-hour event with an unusually high proportion of heat-related illness can take corrective action (opening additional water distribution points, activating cooling areas) before the situation becomes a mass casualty event.

Patient Documentation: What Must Be Recorded

Every patient who receives treatment at an event, no matter how minor, must have a patient record. The minimum required information in each patient record includes (FEMA, 2010):

• Patient name and date of birth (or age if name cannot be obtained)
• Contact address
• Gender
• Presenting complaint — the patient’s stated reason for seeking treatment
• Clinical findings on assessment
• Diagnosis or clinical impression
• Treatment provided, including any medications administered with dosage and route
• Onward disposition of the patient: released to return to event, released to event assistance (welfare), transported by ambulance to hospital (and which hospital), refused transport against medical advice
• Signature of the treating provider or the person responsible for treatment
• Date and time of initial presentation and time of discharge

Where standard patient report forms are used by the local ambulance service and provided for the event, those forms should be used for consistency and ease of documentation. Where the appointed medical provider uses proprietary forms, those must include all required fields.

The Event Medical Log

In addition to individual patient records, an event medical log must be maintained at the main medical facility. The event log is a running chronological record of all significant actions and decisions made by the medical management team during the event. It is not a clinical record — it documents operational decisions: when additional ambulances were requested, when a patient was transported, when the Medical Group Supervisor notified the incident commander of an emerging pattern, when specific resources were deployed or repositioned (FEMA, 2010).

The event medical log is a critical document in the aftermath of any significant incident. Litigation arising from event-related injuries or deaths may occur months or years after the event. The event log, alongside individual patient records, provides the contemporaneous record of what decisions were made, when they were made, and who made them. A log that is written during the event is dramatically more useful and more legally defensible than a retrospective account prepared afterward (FEMA, 2010).

Information Sharing and Privacy

Medical records created at events are subject to privacy considerations under the Health Insurance Portability and Accountability Act (HIPAA) when the treating provider is a HIPAA-covered entity. The privacy rules governing who may see a patient’s medical record at an event are the same rules that apply in any other medical context: only those directly involved in the treatment of the patient, or those with legal authority, may be shown patient records (U.S. Department of Health and Human Services, 2020).

This has practical implications for event organizers. A security supervisor who wants to know whether a specific person received treatment cannot simply review patient records. A media representative cannot be given information about patients. Parents of adult patients cannot be given clinical information without the patient’s consent. Event organizers should ensure that all personnel — including those not directly providing medical care — understand these restrictions before the event opens.

One frequently arising scenario is when friends or relatives of a patient ask at the medical facility whether their companion has been treated or transported to hospital. Standard practice is to confirm to a person of apparent concern that their companion is receiving appropriate care, without disclosing specific clinical information. If the companion has been transported to hospital, providing the name of the receiving hospital — without clinical detail — is generally appropriate and humane (FEMA, 2010).

Post-Event Reporting

After the event, the appointed medical provider should prepare a post-event medical report that compiles: total number of patients treated by category of complaint, number of patients transported by ambulance and their receiving facilities, number and type of medications administered, equipment used, and any significant incidents or operational observations (Arbon, 2007; FEMA, 2010). This report serves multiple purposes:

• It provides the event organizer with data to improve medical planning for future events
• It provides local health authorities with epidemiological data that may be required for licensing or permit purposes
• It creates the baseline data against which future events of the same type can be measured, gradually building the historical database that dramatically improves the accuracy of medical staffing estimates

References

Arbon, P. (2007). Mass-gathering medicine: A review of the evidence and future directions for research. Prehospital and Disaster Medicine, 22(2), 131–135.

Department of Homeland Security. (2017). National Incident Management System (3rd ed.). FEMA.

Federal Emergency Management Agency. (2010). Special events contingency planning job aids manual. U.S. Department of Homeland Security.

U.S. Department of Health and Human Services. (2020). Summary of the HIPAA privacy rule. HHS Office for Civil Rights. https://www.hhs.gov/hipaa