Talladega EMS: Behind the Scenes at NASCAR’s Most Fabled Superspeedway

Imagine hundreds of acres of open fields of grass and trees. Rising up among these acres, overshadowed only by distant mountains, is a giant 2.5-mile loop of racetrack with corners banked up to 33 degrees. Welcome to Talladega Superspeedway. Twice a year this otherwise-quiet part of rural Lincoln, AL, fills with cars driving at speeds approaching 200 mph and as many as 130,000 workers and spectators who come to help create and watch the excitement.

On race weekends Talladega Superspeedway is one of NASCAR’s most formidable tracks. The men and women who participate in the races often fill the headlines; however, in the background is an ever-ready group of hundreds of dedicated medical and rescue professionals committed to keeping drivers and fans safe.

In the early 1980s medical care throughout NASCAR and all of auto racing was scattered at best. Then Bobby Lewis, MD, DMD, offered to help guide the development of a medical system to manage injuries during racing events. Lewis, who still leads the Talladega medical team today, began revolutionizing racetrack care by inviting trained nurses and emergency medicine physicians to help him set up temporary “hospitals” for each event. Novelly for the time, he also invited EMS providers to participate.

In those early days, tracks relied on volunteers and saw variabilities in their training, time availability, equipment, ambulances and preparedness. Over time track leadership saw that as racing speeds increased, there was a great need for improving their standards. With Dale Earnhardt’s 2001 death helping speed the standardization of racetrack care throughout NASCAR, the sport grew from its tragedy; Talladega became the model for prehospital and emergency care throughout the system. Fast-forward to 2017, and the Talladega medical team is now the trendsetting model system for all NASCAR races.

Planning

Setting up an EMS system for 130,000–150,000 people that only needs to exist for a single week twice a year takes an incredible amount of planning and coordination. With regular NASCAR races throughout the United States, it is reasonable to ask why there isn’t a traveling EMS system on the circuit. Unfortunately, between the 100-plus races and variations of regulations and licensing rules between the states, this is for all practical purposes impossible. Thus the leaders of the Talladega EMS system (like all NASCAR tracks) begin their logistics and planning for their next race immediately after the last race is finished. While this article is focused on the emergency medical services aspect of race-day operations, these same leaders plan and coordinate the logistics for nearly 200 extrication, fire and high-angle rescue providers present as well.

Medical crew recruitment is arguably the easiest part of the planning. The track’s leadership can hire through word of mouth because its staff are among the most dedicated in EMS and return for years on end to staff every event. One reason: There is no room for error when dealing with the speeds seen and number of people present. Absolute professionalism is a must!

EMS providers for the Talladega system come from throughout the region and country. While many track-dedicated paramedics work at Talladega, most of the spectator-dedicated teams come from regional EMS systems. For perspective, on race day there are more than 60 EMS workers, a dedicated air medical resource and 26 ambulances present. Eleven ambulances are dedicated to the racetrack (one every quarter mile), and 15 ambulances and quick-response vehicles attend to the spectators. During this time all EMS providers are employed by the racetrack.

In preparation for race events, all of the EMS, fire and safety personnel undergo extensive training. Talladega personnel have led the development of standardized online training used across NASCAR that guides consistent care and patient management throughout the circuit. In addition to this standardized training, all providers receive track-specific training relating to local safety procedures and communication, extrication, fire management, mass-casualty response plans and driver injury patterns. Of note, though: Driver injuries are not common due to the multiple safety features designed into today’s race cars. Training for EMS providers dedicated to the racetrack is heavily focused on extrication, driver helmet removal and airway management.

Once the online training is completed, all personnel report to the track for a full weekend of hands-on training where the focus is not only your job but also the full understanding of what everyone else around you is doing. When responding to track incidents, your “scene” has cars passing you at 70 mph. Thus as part of this training, everyone participates in a full mock extrication, which at Talladega is further complicated by the track’s steep turns. Its 33-degree banks are too steep to walk up, so two dedicated high-angle rescue teams train to stand ready at each end of the track and are prepared to drop extrication and medical teams into cars should extrication on the top of a corner be necessary.

There is no logistical reason for track officials to keep a fleet of 26 emergency response vehicles that are used fewer than 14 days a year. Thus, while the track owns its own quick-response vehicles, officials lease fully stocked ambulances from a large EMS system. By leasing a fleet of identical ambulances, track leaders ensure that all ambulances are stocked with the same basic equipment.

Once on site these ambulances are further outfitted with Philips MRx monitors, which Philips provides free to the track for race week. Track officials reached out to Philips for help standardizing their cardiac monitors not only for their EMS system, but also for their local hospital. Building on a lean vision of standardization, Lewis and track officials wanted to be able to make transitions as streamlined and rapid as possible in their system. Standardizing their monitoring equipment reduced handoff times as well as waste. In addition, it allows all EMS providers to use any vehicle throughout the fleet and have the same equipment each time. Southeastern Emergency Equipment provides educators from its education and clinical services team to deliver cardiac monitor competency training for all healthcare providers throughout the system.

Since all the EMS staff are employed by the racetrack, Lewis and his team implemented standardized EMS protocols utilized by all on-site staff and established legal authority for the physicians of the infield care center to provide online medical control.

Throughout race weekend patient transport coordination requires special consideration. At a race event there may be as many as 40,000 people on the track’s infield, and there are only two tunnels that travel beneath the track to allow people in and out. Thus, protocols define which spectator-patients are taken directly off-site (from the grandstands) to a regional emergency department, which patients may be transported to a first-aid station (RN- and physician-staffed) and which patients must be transported to the infield care center. During race weekend patient care is seamlessly orchestrated in four distinct environments.

The Infield Care Center

On race weekend patient care is focused around the infield care center. Strategically located just inside the racetrack, this carefully constructed emergency department is designed to optimize patient care and flow. Despite being more than 15 years old, it is still considered state-of-the-art. Throughout race week the infield care center is staffed 24/7 by registered nurses and emergency medicine-trained physicians; peak staffing on race day involves three physicians on duty. Three physicians are required, as one is prepared to respond via a dedicated ambulance for certain track collisions.

A poor assumption is that the care center treats an abundance of alcohol-related incidents. Staff will tell you that NASCAR’s now-standardized care centers are the primary care locations for everyone involved on the traveling race teams, and their staff treat more medical emergencies than traumatic injuries. Inside providers are prepared to manage medical emergencies ranging from stroke and STEMI to anaphylaxis and the flu. Two full trauma resuscitation bays are also ready to stabilize any major traumas; however, when major traumatic injuries occur, the care center staff need an average of only six minutes to assess and transfer the patient to the awaiting air-medical transport resource staged just outside their back doors.

Track Teams

Every quarter mile around the just-over-2.5-mile track, an ambulance stands ready, along with dedicated rescue and fire teams. During races all emergency providers sit in their vehicles ready to respond. Whenever a track caution (debris, accident or disabled vehicle) occurs, standard procedure requires every track response vehicle to activate its emergency lights. Nobody responds until directed by officials perched in a command center high above the track. The command center can see the entire track and is in the optimal position to dispatch the closest response team. Should you see these teams on the track, you’ll note that all EMS providers are wearing blue jumpsuits; fire teams are in black and white; wrecker teams are in orange; and the track physicians wear red. All team members also wear noise-canceling headsets to allow them to communicate over the noise of the race field. Track teams follow carefully coordinated response plans to every track collision, and the EMS providers immediately communicate with one of the care-center physicians as they arrive and assess drivers. The defined protocols for physician scene response are confidential.

Infield and Campgrounds

As up to 40,000 people fill the track’s infield and more than 100,000 set up to camp in the fields surrounding Talladega Superspeedway, emergencies are inevitable. An on-site command center fields emergency requests and dispatches dedicated ambulances strategically placed throughout the infield and campgrounds surrounding the track. These EMS teams follow the standardized track protocols to provide patient care and transport to either the infield care center or a regional hospital. The infield care center is the primary transport destination for most patients, as this optimizes ambulance turnaround time and limits the impact on local emergency departments. Crews will transport directly to regional hospitals when patients are suspected to require hospitalization.

Grandstand EMS

The grandstands at Talladega Superspeedway are nearly a mile long and hold more than 80,000 spectators when filled to capacity. Rapidly responding among 80,000 spectators has its unique challenges, which are happily met by crews who use a fleet of quick-response vehicles and mini-transport units to access the ill and injured in the stands.

Like most of the EMS crews at Talladega, those who make up the grandstand team return each year. Ask its crews why, and they’ll tell you it’s the camaraderie. Twice a year these dedicated providers arrive from all over Alabama and work and live together for a week. One of the newest team members was once a grandstand EMS patient as a child, injured when a piece of race car flew into the stands, cutting her face open. Forever impressed by the care given by her EMS and infield care center providers, she was inspired to pursue a career in EMS and now annually returns.

Like the track-dedicated providers, the grandstand EMS team must remain vigilant. With every collision along the grandstands, the providers must walk the grandstands scanning for injuries that may have occurred from debris. While these are rare, the crews have little room for error, as the consequences of missing an injury could be great.

Conclusion

The leaders and EMS crew members of Talladega Superspeedway have set the standard for coordinated emergency medical response systems throughout NASCAR and are a model for developing segmented medical response within an integrated system. From planning through implementation, it is clear their teams have tirelessly worked to improve their system following each race weekend. Watch for them in late spring 2017 as they stand ready at their next event.

Editor’s note: EMS World would like to thank Southeastern Emergency Equipment, which made the author’s travel to Talladega Superspeedway possible. Southeastern Emergency Equipment has a history of advocating for and supporting the positive publicity of progressive EMS systems.

Kevin T. Collopy, BA, FP-C, CCEMT-P, NRP, CMTE, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the clinical outcomes manager for AirLink/VitaLink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at ktcollopy@gmail.com.