Event Medical Cover Requirements in the UK: Strengthening Preparedness and Response

Abstract: This whitepaper provides an overview of first aid and event medical cover requirements in the United Kingdom. We discuss existing regulations, recommendations from the Health and Safety Executive, and lessons learned from tragic incidents.

Introduction

The provision of first aid and event medical cover at large public events in the UK is essential for ensuring the safety and well-being of attendees. The tragic Manchester Arena bombing in May 2017 highlighted the need for more robust and coordinated emergency medical services at events, both on-site and from those attending as statutory responders (such as NHS Ambulance Services).

This article aims to outline event medical cover requirements in the UK, referencing relevant guidelines and recommendations made following incidents such as the Manchester Arena bombing. It is not, however, a replacement for specific professional advice and organisers should obtain formal advice from specialist providers, or experienced consultants such as CJPI.

First Aid & Event Medical Cover Requirements in the UK

There are various requirements that event organisers and medical providers must adhere, to or consider, when planning, arranging and coordinating medical provision at events.

Health and Safety at Work Act 1974

Under the Health and Safety at Work Act 1974, organisers of events must ensure the health, safety, and welfare of everyone involved in the event, including attendees, employees, performers and contractors. To fulfil this obligation, organisers must arrange adequate medical cover, which may include trained first aiders, paramedics, nurses, doctors and the necessary emergency medical equipment to the skill level employed.

The level of medical cover required varies considerably, from basic first aid provision to complex multidisciplinary medical teams, temporary hospital facilities, emergency dental capability and even on-site imaging. What is required largely depends on the size, nature, and location of the event.

Health and Safety Executive (HSE) guidance

The Health and Safety Executive (HSE) offers guidance to organisers on providing adequate medical cover for events. This includes conducting a risk assessment to identify potential hazards and putting in place measures to mitigate them. Organisers must consider several factors, including;

• Size and type of event
• Event duration (and whether on-site camping, for example)
• Demographics of attendees
• Event location and accessibility
• Past incident data (if it is a recurring event) and specific risks

In some circumstances, such as for any large-scale events, the event organisers must consult with local NHS ambulance trusts, as well as engaging private ambulance providers or voluntary aid societies, to ensure adequate medical cover is provided. The NHS have a statutory responsibility in the case of a major incident and so for many large events, the NHS Ambulance Trust may wish for a physical presence from a strategic or operational commander at the event (typically in the event control room alongside the medical provider on-site, security provider, safety representatives and any other local statutory services such as the Police).

Depending on the event, it may also be necessary to engage either in writing or in several planned meetings with the local authority Safety Advisory Group (SAG).

The “Purple Guide”

The Purple Guide, published by the Events Industry Forum (EIF), is a comprehensive guide for event organisers. It provides guidance on various aspects of event safety, including medical cover, and is widely recognised as a key reference for event safety management in the UK.

The guide offers some examples of events, together with the recommended levels of medical cover for that category of event. This is a helpful reference document when conducting a more detailed assessment of the risk and required medical cover which also includes previous patient numbers as well as various other factors.

Joint Emergency Services Interoperability Principles (JESIP)

JESIP is unlikely to be familiar to most event organisers and potentially even some medical providers who have not held roles within the NHS, or operated at larger events. JESIP is a set of principles that encourage collaboration between emergency services during major incidents. These principles help to improve coordination and communication between different agencies, ensuring a more effective response.

While the JESIP principles are largely aimed toward the multi-agency response by statutory responders (Police, Fire, NHS Ambulance and potentially other specialist government assets), they should be considered in any event medical plan and the expectations of those working in various capacities on-site should be made clear.

These principles can often be helpful when considering the ‘business as usual’ collaboration between medical, safety and security operators at an event – particularly on principles such as joint decision-making and colocation.

Medical Provision Standards

Training, equipment and quality of event medical staff and provision is extremely broad. However, The Faculty of Pre-Hospital Care and the Royal College of Surgeons of Edinburgh published the “Pre-Hospital Emergency Medicine (PHEM) Skills Framework”, which outlines the minimum competencies and skills required for different levels of pre-hospital care providers. Event medical cover personnel should adhere to this framework to ensure appropriate training and skill sets.

It is crucial to remember; not everyone wearing green is a Paramedic and not everyone with a first aid kit is a first aider! Far too many organisers do not give sufficient consideration to what it is they are booking and whether or not it is actually being delivered by the contracted provider.

Ambulance Provision

Legally, in England, a provider of ambulance services must be regulated by the Care Quality Commission (CQC). However, there is currently no requirement for event medical providers to be regulated by the CQC, including if they operate ambulances, provided they do not transport patients off the event site. This is a controversial position both in terms of the lack of regulation and the restrictions placed on a provider who is operating ambulance vehicles on-site, but relying upon the NHS Ambulance Service to convey patients to the hospital. This is unlikely to be acceptable for most mass-gathering or large-scale events, unless a formal agreement is made with the NHS Trust and vehicles are made available to satisfy the medical plan and medical cover requirements.

Organisers should seek professional and ideally independent expert advice in relation to their medical requirements, including on the quality, equipment and qualifications of their intended medical provider – to ensure they are meeting their obligations.

Recommendations Following the Manchester Arena Bombing

The Kerslake Report, published in 2018, reviewed the emergency response to the Manchester Arena bombing and made several recommendations to improve medical cover at future events. This was followed by the comprehensive public enquiry into the atrocity by Sir John Saunders.

The principal recommendations relating to event medical provision included:

1. Enhanced communication and coordination

The Kerslake Report and the inquiry report by Sir John Saunders both highlighted the importance of effective communication and coordination between event organisers, medical providers, and emergency services. Implementing JESIP principles can help to achieve this.

2. Medical cover tailored to event risk profile

It was recommended that event organisers work more closely with medical providers to tailor medical cover to the specific risk profile of each event. This involves considering factors such as event size, location, and potential hazards, including the potential for a terrorist attack on or around the event.

The cost of medical cover and the commercial relationship between the medical provider and organiser should also be considered when organisers determine whether those risks and arrangements have been fully addressed. Due to this relationship, it is advisable to seek independent recommendations on the medical plan and requirements for medical cover from either an independent expert and/or from the local statutory NHS Ambulance Trust.

3. Regular training and exercises

Regular training and exercises for event organisers, medical providers, and emergency services are essential for maintaining preparedness and ensuring an effective response to incidents. The Kerslake Report called for joint exercises involving all relevant agencies. This includes the actions taken when planning an event and ensuring that the relevant stakeholders, suppliers and statutory authorities are involved in testing and exercising scenarios relating to the specific event.

Conclusion

Event medical cover and first aid is vital for ensuring the safety of all those involved in large-scale events in the UK and arrangements should cover the primary and urgent care of participants, together with the more significant incidents requiring emergency response.

By adhering to the legal requirements and HSE guidance, taking independent expert advice, and by considering the lessons learned from incidents such as the Manchester Arena bombing, event organisers have the tools to provide a safe and secure environment for attendees, staff, and performers.

Organisers and medical providers must take into consideration all scenarios across the range of medical requirements which may arise. A major incident response from the emergency services should not exclusively be relied upon as adequate cover for significant incidents at organised events and furthermore, the risk of terrorism for particular events should be carefully considered and the appropriate emergency, mass-casualty equipment be made available according to the deemed level of risk.

CJPI has a team of experienced event medical consultants and experienced emergency care clinicians who can assist clients in relation to event medical cover requirements, emergency medical planning, testing and oversight.