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Extending the Emergency Department to the Arena

March 23, 2011
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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?

Fontanetta: The advantage to having the same system we use in the emergency department was that our staff did not need training. The whole key was putting the right tools in the right place. I think, often, when you are dealing with these remote situations, people don't think about creating the right environment. Without the right tools in place, it is difficult to provide the right kind of care.

HCI: What has the feedback been from the CMMC clinicians who work in the Arena? From the patients?

Fontanetta: The clinicians love it. They have everything they need to do their job and they get to go out and work in a fun, festive environment. It's something a little different. As for the patients, we have a patient satisfaction rate around 95 percent. The response has just been marvelous-they've told us they've had a great experience. We're happy to hear it.

“We've had patients with respiratory distress, congestive heart failure, and allergic reactions. Our set up means the hospital is ready and waiting for them by the time they arrived.”

HCI: Can you give me a real-world example of care at the Arena?

Fontanetta: We've had many situations where we've been able to treat patients and then allow them to go back and watch the game. For example, we had an excited child who fell as he was walking into the Arena and lacerated his forehead. As you can imagine, his concern wasn't the big cut on his forehead, but missing the game. The laceration was too big to treat on site. But thanks to the coordination between the emergency department and the arena, everything was set up and waiting for him at CMMC. We were able to stitch him up and get him back to the Arena by the second half of the game.

We've also had a handful of life-threatening emergencies. We had a patient with a brain hemorrhage who was appropriately identified and then transported to the hospital. We've had patients with respiratory distress, congestive heart failure, and allergic reactions. Our set up means the hospital is ready and waiting for them by the time they arrived. And, of course, there have been all manner of other smaller problems we've been able to handle on-site. We've done a lot of good work there and we're proud of it.

HCI: What has the feedback been from the Red Bull Arena staff?

Fontanetta: They are very happy. It was their aim to provide the same level of care and concern at the Arena that you could find at our emergency department. We've been able to do just that.

HCI: What are some of the bottom-line results that Red Bull Arena and CMMC have experienced thanks to this relationship?

Fontanetta: Beyond expedited, quality care to the Arena's visitors, we've helped Red Bull Arena with their risk management. We help them identify potential risks and keep on top of possible issues, reducing potential liability. For us, it's a great service we can provide to our community. And it's also a way for 27,000 game spectators to associate the name Clara Maass with high-quality medical care and community involvement.

HCI: What advice would you offer others trying to establish similar set-ups with local venues?

Fontanetta: To do this kind of job right, you need the right support. First off, make sure you have the right providers in place to give the right care. This isn't a place where you should send residents. You want trained emergency providers who are used to dealing with an unpredictable environment. Second, make sure you have the right cooperation from that venue. Red Bull Arena has been marvelous-they have the attitude that they are willing to do what it takes to maintain the comfort and safety of their spectators. You want that. You need that. Finally, don't underestimate the technology. Our EMR, our VPN, having all the right equipment in the Arena treatment room to handle everything from a sprained ankle to a full cardiac arrest-we have that. You shouldn't settle for anything less than the tools you need to do your job right.

Healthcare Informatics 2011 April;28(4):21-22

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