Having the proper event medical provider at your event is one of the most overlooked services. Everyone thinks about event security, ensuring there are adequate toilets, power, and water however events often forget or do not prioritize ensuring the health and wellbeing of their attendees.
It is important for event organizers to take a few things into consideration when planning their events, including having the appropriate medical response capabilities. Here are a few things to consider:
The Legalities
Events in Ontario fall under several local, provincial, and federal statutes, most importantly the Occupiers’ Liability Act, R.S.O. 1990, c. O.2. Most notably section 3(1) of the act states “An occupier of premises owes a duty to take such care as in all the circumstances of the case is reasonable to see that persons entering on the premises, and the property brought on the premises by those persons are reasonably safe while on the premises”.
This is a very important piece of legislation, as in most of the published cases where an event organizer was held liable for failure to provide adequate medical services on-site based on their level of risk involved this law, along with the tort of negligence.
As section 3(1) is a very broad statement, event organizers need to take into consideration all measures to ensure safety of those in attendance. This ranges from ensuring proper security and medical services on-site, proper egresses for evacuation, protective measures for wires, cords, etc., fire-safety just to name a few.
Insurance Requirements
Many insurance providers required events to have a medical services provider on-site. Regardless of if this requirement is present or not, most insurance providers have clauses in their policies requiring you to comply with all applicable laws. For instance, if you are not in compliance with the Occupiers Liability Act and litigation is initiated under this Act there is a chance your insurance provider could deny your claim or support in the litigation.
Medical Services
With approximately 20% of events in the Algoma region having any sort of medical services on-site, and approximately 12% having the “proper level of care” on-site, local event organizers are gambling with the liability risks, and more importantly the health and well-being of their attendees.
Having “someone” there as first aid or medical or relying on security guards to render first aid with a 1-day first aid course while on the surface may appear to be “checking the box” for keeping people safe, it is putting your event at a greater risk of litigation.
For example, there was an incident in February 2024 at a British Columbia martial arts competition where an individual suffered catastrophic injuries. The family of the injured party has filed a lawsuit against the event organizers, event hosts and first aid providers under the premise that the tournament did not properly protect the individual, and the first aid attendants were “grossly inadequate”.
When you look at that example and apply section 3(1) of the Occupiers Liability Act in Ontario for instance, the event organizer may land up being negligent. If the event involved contact including kicking, and the event only had a first aid trained individual on-site to respond to emergencies, that can easily be argued as inadequate. The organizers understood the risks to the attendees, and ought to have the properly trained personnel to respond to the type of emergencies that could occur. While the qualifications of the first aid providers have not been disclosed publicly yet, at minimum an event like that should have had paramedic level services to ensure proper response and immobilization to anticipated injuries. It goes without saying that due to the current legal action and the reference to “first aid providers” in the media that the event was not staffed with experienced paramedics.
Types of Providers
It is very challenging for event organizers to select the right provider for their event in Ontario. This is attributed to the fact that event medical services or event first aid providers are not subject to any oversight. Superior EMS has been advocating to the Ministry of Health and Long-Term Care for many years now that there needs to be some type of regulatory oversight on this industry, as well as specific requirements for event organizers to ensure the safety and wellbeing of the attendees.
Typically, in Ontario you will find a few levels of service. This includes:
· Event First Aid
· Event Advanced First Aid
· Event First Response
· Event Medical/Paramedicine Services
· Municipal Ambulance/Paramedic Services
· On-Site Hospital Level Care
Due to a lack of regulatory oversight in our province, the challenge is anyone essentially can use any terminology without having to comply with any policies under these headings. Now we will try and give you a basic breakdown of these services.
Event First Aid
Event first aid providers typically have the minimum level of care and training. They often are trained at a Standard First Aid level which is 2-day (13 hour) course every 3 years. Some security providers offer a “first aid” add-on, provided by their guards. In that case, it may be someone trained at the Emergency First Aid level which is a 1-day (6.5 hour) course every 3 years.
Equipment varies, but this level of provider usually is only equipped with basic first aid supplies, and in some cases an Automated External Defibrillator (AED).
The costs can vary for this level of service but are often provided by volunteer organizations keeping costs relatively low.
Event Advanced First Aid
While this term is not common you may see this in Ontario with some organizations. Advanced First Aid teams usually complete a minimum of 60 hours of advanced first aid training and participate in ongoing training within their organization.
These organizations usually have greater visibility with standardized uniforms and are often equipped with a greater supply of equipment ranging from immobilization devices, oxygen and often AED.
The cost of these services is usually a flat fee to cover their expenses, as they are typically volunteer organizations.
Event First Response
Like Advanced First Aider’s, First Responder level training ranges from 40-80 hours depending on the training provider and provides a greater scope of training and patient care capabilities. Often these first responders are volunteer groups and provide some degree of ongoing training within their organization to keep their skills current.
You will usually see these providers with standardized uniforms, and are often equipped with rescue equipment, immobilization devices, oxygen, and often an AED.
Some of these organizations will use the word “medical”, for example: “Medical First Responder”. This can be confusing to the public, as their actual level of care is not the provision of medical care.
The cost of these services is usually a flat fee to cover their expenses, as they are typically volunteer organizations.
Event Medical/Paramedicine Services
Event EMS/Paramedicine services are private companies that provide what is typically considered a “professional” level of care at the event. They employ medical professionals ranging from paramedicine practitioners*, emergency trained nurses, nurse practitioners, physicians, and other medical specialties to ensure a high level of care delivery right on-site.
You will often see these providers in professional uniforms like the municipal paramedic services, they are often equipped with ambulance style vehicles and other response type vehicles, and their equipment is vast. Most providers are equipped with diagnostic tools such as cardiac monitors, defibrillators, advanced equipment, emergency medications and more.
These services often operate under the oversight of a medical director and can perform advanced procedures right on-site ranging from advanced airway insertion to even suturing and other advanced skills that are controlled acts in the Province of Ontario.
Many of these companies voluntarily comply with the vehicle, training, and equipment standards of the Ambulance Act, ensuring that the event is getting the same level of training and equipment at their event that would be provided by the local ambulance service. In addition, many of these companies will comply voluntarily to follow the provincial Basic and Advanced Life Support Standards for the provision of patient care.
The cost of these services is certainly a lot higher than the volunteer services, as the medical staff are employees, paid competitive wages with the level of their training, and the equipment costs and insurance are significantly higher to operate.
*Paramedicine Practitioner is now used to represent a Paramedic who is employed outside of a municipal ambulance service. As of 2020, the title Paramedic is protected under the Ambulance Act and can only be used by on-duty paramedics employed with a municipal paramedic service.
Municipal Ambulance/Paramedic Services
The municipal ambulance/paramedic services are municipally funded agencies that provide ambulance services under the Ambulance Act. They employ Paramedics of Emergency Medical Attendants who are employed either by the district social service administration board (DSSAB) or a private provider contracted by the DSSAB).
These providers will be in a professional uniform and typically will be equipped with an ambulance or paramedic response unit from their respective service. These providers are equipped to the minimum equipment and training standards of the Ambulance Act and are the only service in the province that is considered an Ambulance or Ambulance Service. Their employees operate under a “base hospital program” which is the medical oversight for these services which allow them to perform controlled acts within the provincial Basic and Advanced Life Support standards.
This is likely the most expensive option for the provision of care at your event. In this situation, many of the providers are required to compensate their paramedics on an overtime basis, like when you secure off-duty police officers for your event, and there will be a standard cost for equipment, supplies, and vehicle operations.
On-Site Hospital Level Care
In very rare circumstances you may see a hospital level of care at an event. This where essentially a mini-emergency room is setup at the event, and there are emergency trained physicians, nurses, and allied professionals on-site to provide critical care right on-site.
They are often equipped to perform the same level of care you would find in an emergency room including advanced life support, minor procedures and more. This level of service is often equipped to provide patient monitoring on-site for longer periods of time, reducing the demand on local hospitals.
An example of this was in the 1990’s at the Canadian National Exhibition in Toronto. The EX operated a “polyclinic” staffed by a physician, nurses, and supported by Toronto EMS and volunteer first aid teams to provide care right on-site. While critical patients were transported to the closest hospital, this clinic was able to treat and diagnose conditions right on-site, provide prescriptions, suture, provide wound care, as well as provide keep patients on-site and monitor their conditions and discharge them without the need for a hospital visit for more minor ailments.
This is an extremely expensive level of care at a community event. While it is proven to reduce the demand on hospitals during large scale events, professional event medical services have also been proven to do the same. There are few providers in the province equipped to provide this level of care, requiring the event organizer to make a significant investment. The EX no longer has this level of care, they have moved to a combined Ambulance Service/First Responder clinic on-site.
Selecting the Right Provider
So, now that we have addressed the levels of service, event organizers now have the daunting task of selecting the right provider.
First and foremost, every event should have some level of provider on-site. You owe this to your attendees, and if the right provider is selected you will significantly reduce your liability and ensure compliance with the Occupiers Liability Act. There is not a single community event that should not have a provider on-site, as its simple, if there is a person at your event, then there is a risk of injury.
The most important thing you can do when considering the appropriate level of coverage at your event is to conduct a risk analysis. Once you have completed the risk analysis then you can truly gain a better understanding of the level of care to consider at your event. While it is always best to have the “highest” level of care, it is also important to balance the actual risks, and the cost effectiveness.
The first word of advice we can give you is, just having a “fist aid trained” person on-site will ensure compliance with the WSIB Act for workers on-site but would never be sufficient for compliance with the Occupiers Liability Act should you have an incident on-site and it go to litigation. Any good lawyer is going to immediately call into question the lack of care available on-site and present a strong case of negligence.
Now the big question is, who should you book? It falls back on your risk analysis.
For example, if you are hosting a small community BBQ where there will be some children’s activities, and only 100 people attending, the risk analysis will more than likely lean towards a volunteer first response or advanced first aid team being on-site. If you
are hosting a large gathering, with motorsport involvement, or a contact sporting event then you would likely want to consider a professional event medical service or municipal ambulance provider to be on-site.
There is also a collaborative approach to event medicine coverage. For example, if you are hosting an eco-challenge or similar type of event in the wilderness, it would be prudent to have a rescue organization on-site such as a volunteer search and rescue team who is able to conduct remote rescue operations, while having professional event medical providers or an ambulance service at the finish areas to receive any injured persons. In remote areas there is a much higher risk of death if advanced level of care is not provided, so having a professional level of care available that carries emergency medications, advanced airways, etc. will make the difference in survival.
Now, let’s say you have decided you want a professional level of service at your event (good choice!... Yes, we may be a bit bias here), who do you go with? An Event Medical/Paramedicine Service or the local Paramedic/Ambulance Service? This is where it gets tricky…. There are a few things to consider. First, Event medical providers are not regulated, so you need to carefully evaluate their actual level of care. Do not be afraid to ask the questions such as what level of training do the providers have? Do you have a medical director? What type of equipment do you carry? Do you voluntarily comply with the Ambulance Act and Patient Care Standards of the Ontario MOH?
Another thing to consider is do you require the provider to transport the patient to hospital immediately. If so, the only option is the Ambulance Service of the area. In the province of Ontario, the only provider legally able to transport an “emergency” patient to hospital is the local Ambulance. Event EMS providers will stabilize the patient on-site and call for an Ambulance to transport any emergency patient off-site. You also need to consider, if you do contract the local Ambulance service to provide coverage, they cannot stay and wait for another ambulance to arrive if they have an emergency patient, they will immediately transport off-site, which means your event is now without any coverage.
Do not forget to consider the costs and work the costs of this type of service into your budget. The small investment in having the proper level of provider on-site will simply save you money down the road if an incident occurs.
Athletic Events
Athletic events are a whole other ballgame when it comes to the provision of medical care. Its two-pronged risk: tending to the chronic injuries/health issues of athletes, and the provision of emergency care when a significant injury occurs.
When considering the chronic injuries and health issues of athletes, this is where a certified athletic therapist, physiotherapist or similarly qualified individual comes into play. They have an in-depth knowledge of musculoskeletal injuries which are the most common issues at these events and are also trained in preventative care such as athletic taping and wrapping, pre-game conditioning, and often have first responder training to assist professional EMS staff should a major injury occur.
For high-risk sports, event organizers should not rely on the athletic therapist or physiotherapist as the emergency medical provider. While they often have first responder training (approximately 40 hours), they are not trained or equipped to provide advanced emergency care. This is a common confusion when planning sporting events and has resulted in successful legal action against organizers for not having a minimum level of care on-site.
It is also important that event organizers comply with the minimum level of training required for on-site personnel as dictated by their sporting organizations. For instance, at minimum at an OHL hockey game the minimum level of service is a transporting ambulance. If you do not comply with the minimum coverage requirements, you will likely be at a high risk of liability should an incident occur.
In closing, take care with ensuring that you have proper medical services at your event, it can reduce your liability, ensure that the attendees have access to proper care on-site, help reduce hospital demand for minor injuries, and ultimately save lives!
Superior EMS is pleased to provide a no-obligation FREE consultation to evaluate the risk of your event. We have staff on-site with comprehensive university education in emergency & disaster management with expertise on event emergency planning, not only for medical coverage but all emergencies that can occur at your event.
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