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Extending the Emergency Department to the Arena

March 23, 2011
by root
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Interview with John Fontanetta, M.D., FACEP, Chairman, Emergency Medicine, Clara Maass Medical Center
John Fontanetta, M.D.
John Fontanetta, M.D.

In March 2010, Clara Maass Medical Center (CMMC) began providing on-site emergency medical services for events at the then newly opened Red Bull Arena in Harrison, N. J. John Fontanetta, M.D., FACEP, who is Chairman of Emergency Medicine at CMMC, speaks about point-of-care computing and what it takes to provide top quality emergency care outside the emergency department.

Healthcare Informatics: How does your emergency set up at Red Bull Arena differ from what you might see at other arenas or stadiums?

John Fontanetta, M.D.: Most stadiums have nurses, residents from a medical residency program, or general practitioners who work in the stadium and man the medical services. They basically see patients and then triage them out. We wanted to create a service at the Red Bull Arena that essentially provided an annex of our emergency department inside the arena. We can take care of most problems right there.

HCI: What kind of equipment are you using to connect the Arena to Clara Maass?

“The advantage to having the same system we use in the emergency department was that our staff did not need training.”

Fontanetta: We aren't using any handheld equipment. We simply have a PC in the Arena's treatment room that is connected by virtual private network (VPN) to our emergency department's electronic health record system at CMMC. That allows us to directly chart the patients we see at the Arena directly into the software. This becomes very important when we need to transport a patient from the arena to the emergency department. Before the patient even arrives at CMMC, which is only 10 minutes away, all of the records are already there waiting. The transition is seamless.

HCI: Were there any challenges to implementing the technology?

Fontanetta: Surprisingly, no. We have a great information services department that took only a couple of days to get our VPN up and running. We haven't had a glitch-but there is a back-up system if the primary system fails. And I can't underestimate our electronic medical record, EDIMS. It allowed us to easily set up this additional environment. It also has very robust order sets and templates. It gives our medical team the right structure, so that even when they're out of the normal emergency department environment, every step in the care process is properly documented. That's important.

HCI: What staff is present for Arena events?

Fontanetta: For each game, we have an emergency physician, a physician's assistant, at least three paramedics, and then between 12 and 14 emergency medical technicians (EMTs). These are the people you want on hand if there is an emergency-they have the right training to handle any problem that comes their way.

HCI: That's a lot of people. How do they all work together?

Fontanetta: It's Red Bull Arena's goal, and ours, as well, to offer premier medical services to visitors. We have the emergency physician and physician's assistant in the treatment room. The paramedics and the EMTs roam throughout the stadium, helping to quickly identify patients and get them to us when needed. Before the stadium opened, we spent weeks coordinating with the paramedics and EMTs, walking around the arena and setting up systems for how to respond to different emergencies that might occur within the arena. There are a lot of challenges inherent to working in an arena. You might have to move a patient from an area that is only accessible by a steep staircase. You have to know where the elevators are. You need to know how to get a patient from this spot-any spot-to the treatment room or ambulance as quickly as possible. We spent a lot of time working those protocols out with Arena security, the EMTs and our emergency medical team before any spectator walked through the doors.

HCI: How long did it take to train up personnel?