White Paper: How a mobile ER trailer can enhance patient care at a mass gathering

Marathons, triathlons and other active participation events need to treat nearly any patient condition without straining local EMS and hospital resources

By Matt S. Friedman MD and Connor B. Fitzpatrick

Surges happen. Whether there is country concert or an electronic dance music festival, you must be prepared to provide continuous medical care. Mobile ER Trailers are the solution; a mobile emergency room that provides immediate access to critical care.

Depending on the anticipated size, number of active participants, viewing capacity, and risk for terrorism, natural disaster or extreme weather, each mass gathering requires a unique disaster plan and event-specific risk mitigation procedures.

Typically, medical care offered at these events is provided in a large tent at the finish line and several smaller tents along the racecourse. There are unique challenges and tangible limitations when providing medical care in tents without a surge capacity capability. While this system has been in place for decades and may provide quality medical care to the majority of event participants turned patients, there may be a better way.

When a needs assessment of a predetermined MCI requires additional resources, a mobile ER trailer is an option to provide high-quality, efficient, cost-effective, and advanced medical care that is comparable to treatment offered in the closest emergency room.

Most patients can be managed in the mobile trailer throughout their emergency treatment course while a few may need transport for definitive care at a tertiary care facility. Even those patients who need transport can be sufficiently stabilized in the mobile trailer given its capability to provide aggressive and advanced medical care directly on-site. Some mobile trailers are configured to have small OR suites to offer surgical procedures ranging from appendectomies to splenectomies. The following six features methods can enhance the quality of medical care offered in the prehospital field by providing a mobile ER trailer as opposed to the current standard quo of a finish line tent or transport to a local hospital:

1. Controlled environment for emergency care

A controlled environment is a clean, comparably sterile work environment where you have the space, maneuverability and equipment to handle the worst-case scenario. If you are anticipating patient presentations aside from concussions, lacerations and other musculoskeletal injuries, there is a medical advantage to having a controlled environment such as the mobile emergency room trailer on-site.

Typically, at active participant events, patients present with a range of benign complaints to more severe conditions such as dislocated joints or critical asthma exacerbations. Procedural sedation is utilized to reduce shoulder, elbow or hip dislocations and this procedure should be done in a more controlled setting. Likewise, patients with severe asthma exacerbations should be administered continuous, intravenous steroids, magnesium, or bronchodilators...

2. Patient privacy during care

Inside a mobile trailer, there is room to treat patients in a private and humane environment. Patient assessment and treatment can be provided out of view of other participants and spectators in cordoned off private areas.

Obtaining rectal temperatures to determine who is mildly hyperthermic from those patients with end-organ toxicity resulting from severe hyperthermia is more easily performed. An EMS staff that treats patients humbly in some of their worst hours is indicative of those with mass gathering professional experience. There should be no reason to completely expose a patient in full view of other patients and participants just because they happen to be in extremis at a mass gathering. While patient exposure is paramount in many conditions, it should be done in a professional, dignified manner that the medical team is proud of when clinically defending the resuscitation at a later point.

3. Capability to treat severe illness or injury

There are improved patient outcomes with lower morbidity and mortality rates when advanced medical care is provided on-site to treat the critically ill. Whether it’s rapid cooling in severe hyperthermia to prevent multi-organ failure, early intravenous steroids and ventilatory support to reduce work of breathing and decrease hypercarbia in severe asthma exacerbations, adequate sedation to treat excited delirium secondary to psychostimulant drug-induced toxicity (PDT), or hypertonic (3%) saline administered through central intravenous access to reverse hyponatremic seizures, patients have fewer sequelae with aggressive treatment early on. Most importantly, cardiac dysrhythmias secondary to acute coronary syndrome or severe electrolyte derangements can be terminated quickly and effectively preventing the patient from sustaining cardiac arrest.

4. Supplies and point of care labs

Mobile trailers typically have well organized cache abilities offering easy access to stock supplies, providing the direction of healthcare events in the medical community...

5. Reduce burden on local emergency services

Another potentially beneficial feature of a mobile ER trailer providing care at a mass gathering is avoiding the disruption of healthcare services to the hosting community...

6. Dedicated space for medical team

Finally, mobile trailers offer the medical staff a place to congregate and escape the environmental elements as well as the opportunity to recuperate...

About the authors

Matt S. Friedman, MD, FACEP, DABEMS, is the Associate Medical Director of Prehospital Care and Director of the EMS Clerkship at Maimonides Medical Center, Brooklyn, NY...

Connor B. Fitzpatrick, AEMT, is the Executive Director at CrowdRx (A Global Medical Response Solution), applying his background in emergency management...