Olympic EMS Leader: Let the Games Begin!

The eyes of the world are on Vancouver as the 2010 Winter Olympic Games begin with the opening ceremony.

Providing emergency medical services for the estimated 5,500 athletes and the hundreds of thousands of spectators flooding the two main venues will be a daunting task, but Bob Alexander has a plan and he's ready.

Alexander is the EMS coordinator for the 2010 Winter Olympic Games for both Vancouver and the secondary site north in Whistler. He's a paramedic and supervisor for the British Columbia Ambulance Service (BCAS), the provincial government-operated emergency medical service for the entire area.

"We've got a good plan and I am confident it will work well," said Alexander, who has been in EMS for 27 years. For that quarter century, Alexander has been involved with planning and protection for many large venues, including a 1993 summit between U.S. President Bill Clinton and then-Soviet Union President Boris Yeltsin; huge bayside firework festivals attracting 300,000 people; worldwide environmental summits and conventions; and large professional hockey games.

He's also been to Beijing, China and Turin, Italy to see how EMS was provided for those Olympic games.

He learned a lot, but things will be different for the Vancouver games, Alexander said. For instance, well-equipped field hospitals are in place in Vancouver and Whistler, which will minimize the need for transport to local area hospitals and trauma centers.

The BCAS, which is completely funded by the Canadian government, will be the sole EMS provider for both venues with no need for mutual aid or outside agencies, thereby creating uniform and consistent delivery of services, and more importantly, accurate and complete reporting.

Because of the staffing requirements and resources, combined with field hospitals available to handle everything from stitches to bone settings and casts, to simple surgery, dental care and ophthalmology, Alexander can handle all the routine and anticipated calls with ease.

"The idea is not to overburden the area hospitals with all the extra calls," Alexander said. "I will be sort of a failure if we can't take care of it on site."

Obviously massive trauma or large cardiac events will be transported to the appropriate hospital quickly, Alexander said, but routine calls will be handled in-house. Doctors and nurses will be available at both sites with digital x-rays, CT scans, MRI equipment and surgical beds. Whistler will use two large, 53-foot tractor trailer units with expansion pull outs for field hospitals.

Because definitive care will be available on site, Alexander said EMS staff and response times can be reduced, and it won't be necessary to call on outside agencies for help. Ambulances can stay right on the property and won't have to travel into metro areas with patients, as with Olympic Games held in Atlanta and Salt Lake City.

Each of the events will have two ambulances with crews of two paramedics each; one crew dedicated to the athletes and one to the spectators. If one crew gets summoned to provide care, the other unit will cover both athletes and spectators until the other unit is cleared. Additionally, the paramedics will be supplemented by trained volunteers, like ski patrols and event spotters, who can help during a medical emergency.

British Columbia Ambulance Service employs about 3,500 full and part-time paramedics to provide coverage for the entire province, which is 929,730 square kilometers. Alexander said that resources allowed him to pull 350 paramedics to provide coverage for the Olympics, all of whom voluntarily signed up for the rotation of 12-hour shifts. The total number of paramedics on duty at any given time will be difficult to predict because of the variety of the events that are happening and the length of time for which they will run. Paramedics may need to stay for longer shifts - up to 18 hours for some events, Alexander said.

During the evening's opening ceremony, which will attract more than 60,000 people in the stadium alone, he'll have 110 paramedics on duty.

"We're sort of the first in, last out people," he said.

The only thing concrete regarding scheduling is that the two Olympic villages will have two paramedics and an ambulance on duty 24 hours a day for the entire length of Olympics events.

Each of the villages will have Polyclinics, which in addition to the medical staff and equipment, will have massage therapy, dentists, hot tubs and staff to fix braces and wheelchairs.

To provide ambulances for the event, Alexander was able to redistribute some of the fleet from other parts of the coverage area. BCAS also took early delivery of 60 ambulances already on order as part of the routine retirement schedule and put those in service for the Olympics. After the Olympics and the Paralympics are completed, the new ambulances will be sent out to the province to replace the units coming offline in the normal course of business.

"We are one of the biggest ambulance services in all of Canada so it gives us a lot of options," Alexander said.

Stocking all those extra ambulances was not a problem either, he said, noting BCAS has a centralized warehouse in part of a much larger government warehouse that holds medical supplies for doctors and nurses as well. All that BCAS had to do was to order more stuff early and then get it on the ambulances. Stock that's not used will be rotated back into the central supplies when the old ambulances are retired starting in April.

"It really wasn't a big problem for us," he said.

Helping out with the equipment on the ambulances was a donation from Medtronic Physio-Control, which lent BCAS 44 LifePak 15 defibrillators and a cache of LifePak 1000 AEDs, which are located throughout the venues as well. Alexander said Medtronic also has a legacy program where many of the AEDs available for the Olympics will be given to communities and organizations in Canada at the conclusion of both sets of games.

"Medtronic Physio-Control helped us out a lot," Alexander said. "They deserve a lot of credit."

And because the Winter Games are aimed at being as environmentally green as possible, with a commitment to reducing their carbon footprint, Alexander said idling the ambulances is discouraged, unless absolutely necessary. That's why each ambulance stationed at the games is fitted with engine block heaters, and AC electrical connections are available where the ambulances are stationed to make sure the temperatures in the patient care areas are comfortably maintained.

Supplementing the ambulance fleet are four air transport helicopters, two of which belong to the BCAS and two that are being contracted from Helijet International, a contractor in British Columbia that has worked well with BCAS in the past and adheres to the same quality of care and standards.

"We have twin engine aircraft with two pilots and two paramedics," Alexander said.

Alexander recognizes that having all the personnel and equipment in place is only half the battle -- training is the other half.

During the past several months, game organizers have had three major training exercises leading up to the opening ceremony. They were labeled bronze, silver and gold, and each built on the strength of the previous drill and sought to correct previous deficiencies. The last was held in October, which was a full-blown exercise with command centers established and maintained as operational for several days.

Alexander said the public safety needs of the Olympics will be run under the unified command with officials from EMS, Fire and Police as well as the event organizers, all working together to resolve any emergency issues that arise.

Fire protection is being handled by four different municipalities with the Vancouver Fire Department as lead, and police and security are being headed by the Royal Canadian Mounted Police, supplemented by other police agencies from across the country.

An urban search and rescue team is at the ready in Vancouver should a mass causality event occur, and Alexander said he will have no problem calling in the troops in the event of an unthinkable incident -- like a grandstand collapse or worse.

Alexander said his team must also be prepared for VIPs and dignitaries who will be attending the events. U.S. Vice President Joe Biden and Vladimir Putin, Prime Minister of Russia, are just a few of the dignitaries expected at the games. A contingent of officials from London are expected as well, as the 2012 games will be held in that city.

While the BCAS is well aware of the possibilities of terrorists' acts, and they are prepared, the agency is far more focused on the mundane cuts, bumps and bruises by the athletes and spectators suffering illnesses or minor injuries. The agency is used to covering big events like hockey games, as the home of the Canadian Canucks, a NHL team based in Vancouver.

They even know a bit about ski jumping and speed skating, but Olympic bobsledding is something new.

"We've never had that before," Alexander said. "You'd think the chute is all smooth ice, but it's not. The sides are like a cheese grater. ...We're expecting a lot of road rash from that event." He said it exposes his paramedics to potential confined space rescues too, with sleds that can weigh hundreds of pounds. Volunteers and spotters will be on hand to help with any bobsled wrecks, he said.

Language is not expected to be a problem. French and English are the official languages of the event, and from his experience in the days leading up to the games, that's what he's hearing spoken. Athletes who do not speak either language are most often with coaches or teammates who do speak at least one of the official languages. Alexander said he's also not worried about physicians from other countries jumping in and taking over an emergency scene, or interfering with treatments.

"They don't have licenses to practice in Canada and anything they want to do will have to be done with the physicians on staff," Alexander said.

As for call volume, Alexander said he has no idea what to expect. In past games, getting accurate numbers of patients treated has been difficult, if not impossible, given the multiple agencies involved and the challenges of correlating all the numbers.

"We're expecting to have some really good numbers from this event," he said, given that BCAS is 100 percent responsible for all EMS calls, and there will be no chasing the numbers.

Hosting the event will undoubtedly be a learning experience, and Alexander said he's very welling to help his counterparts in London in 2012, and in Rio in 2016.

"I've been involved with this since we were making a bid for it back in 2004," Alexander said. "It's been exciting, and it's certainly the biggest event I've been involved with in my career. I'm sure we'll learn a lot, and I'm willing to share whatever we learn, but I'm confident it will go off well."