Impact of the New Zealand 2011 Rugby World Cup on an Urban Emergency Department Mark Gardener, Tim Parke, Peter Jones

Home , 2011 Rugby World Cup, Rugby World Cup

ARTICLE

ABSTRACT AIMS: The next Rugby World Cup will take place in England commencing August 2015. This paper describes the preparation and workload relating to the previous Rugby World Cup, held in New Zealand 2011, as it affected the primary receiving hospital for the main venue. This paper describes preparation arrangements and actual workload patterns to assist planners with future similar events. METHODS: Preparations for the tournament were summarised, and data gathered from the Auckland City Hospital database were analysed for total and hourly presentation rates, short-stay observation workload, admission rate, 6-hour target compliance and type of presentation. RESULTS: Overall workload during the tournament increased by 8%, but much larger spikes in attendances per hour and short-stay workload related to the major events were experienced. Alcohol-related presentations were very much more prominent than usual. Pre-arranged additional staffing and flow arrangements allowed the department to maintain 6-hour target compliance. CONCLUSION: Major sporting events, such as the Rugby World Cup, require special arrangements to be put in place for the main local receiving Emergency Department, especially around the major events of a tournament.

he Rugby World Cup (RWC) is the 3rd were employed to mitigate the effect of largest sporting event in the world. this. Previously published papers on major TIt is next due to be held in England, sporting events were reviewed.1-3 Local commencing August 2015. The tournament workload data from the hospital database was last contested in New Zealand from were also extracted for periods around 9 September to 23 October 2011, and previous mass gathering events in the city. consisted of 48 matches across the country. There were essentially three strands to The opening game and ceremony, both planning the medical cover for the event: semi-finals and the final were played 1. Central DHB-level emergency planning in Eden Park Stadium, Auckland. The covering the possibility of mass Emergency Department serving both this casualty incident stadium and the city centre ‘Fan Zone’ was 2. St John Ambulance planning covering Auckland City Hospital (ACH), a tertiary the positioning of ambulance and first urban trauma centre. This paper describes aid assets for events and general cover some of the preparations made by the 3. Specific AED plans for increased Adult Emergency Department (AED) and general workload and identification of reports on the workload experienced likely peaks of activity. during the tournament. Although planning began over one year before the event, plans required significant Preparation alteration in the build-up to the tournament A higher than usual workload was due to the 2011 Christchurch Earthquake, anticipated for the duration of the which resulted in additional matches being tournament and a number of strategies played in Auckland and elsewhere.

NZMJ 24 July 2015, Vol 128 No 1418 ISSN 1175-8716 © NZMA 80 www.nzma.org.nz/journal ARTICLE

Figure 1: Example of ADHB RWC publicity campaign

With regard to the AED preparations, the hospital through meetings, posters, following strategies were employed: events and email staff alerts to 1. AED staffing: Medical staffing was expedite and streamline flow out of supplemented by an additional senior AED for patients requiring the inter- doctor on standby throughout the action of in-patient specialist services tournament during weekdays and by and radiology. An example of one of an additional duty senior doctor on the posters is given in Figure 1. all weekend shifts (whether or not a 4. Inter-departmental co-operation: match was being played in the city Discussions took place with the other due to anticipated workload from the three emergency departments in the ‘Fan Zone’). The approximate cost of city to manage workload in the event this staffing was estimated at $50,000. of ACH becoming overloaded, with 2. Short stay unit: It was anticipated an understanding that ambulance that there would be a larger number diversion may be employed. of intoxicated patients requiring a period of observation. The short-stay Results capacity of the department was Over the course of the tournament the doubled to eight beds and plans department saw 7,419 new patients against made to expand into the next door a seasonal comparator of 6,854, representing Admission Unit as required. Standard an 8% increase in overall AED activity. operating procedures regarding the There were, however, several dramatic triage and management of severely spikes in presentations, which presented intoxicated patients were jointly challenges in spite of the preparations. drawn up with ambulance service The first occurred during the Opening and AED medical and nursing team. Ceremony on 9 September, when larger 3. Publicity campaign: A publicity than anticipated crowds turned out in campaign was mounted within the the city centre ‘Fan Zone’ and difficulties

NZMJ 24 July 2015, Vol 128 No 1418 ISSN 1175-8716 © NZMA 81 www.nzma.org.nz/journal ARTICLE

Figure 2: Emergency Department Presentations at World Cup Opening

Figure 3: Emergency Department Presentations on World Cup Final Night

occurred with transport infrastructure numbers of patients diverted to other due to a railway incident and a significant neighouring departments. road traffic accident. During this period, These spikes in activity were matched by the department experienced a surge of spikes in short-stay observation activity, Australasian Triage Category 2 and 3 with a peak during the evening of the presentations. Total presentations peaked opening ceremony of 44 patients, repre- at 25 per hour (Figure 2), which resulted senting nearly a threefold increase on the in a large number of ambulances queuing departmental average of 15 per 24 hours. to offload. A temporary diversion was During the tournament, no increase in the put into effect for two hours to the two referral for admission rate was seen and the neighbouring emergency departments to national ED target of 95% patients admitted redistribute ambulance resources and allow or discharged within 6 hours was met the AED to move some patients through to (Figure 4). The department saw its highest the adjacent admitting unit. ever 24hr daily attendances around those The second significant spike two peaks. unsurprisingly occurred around the RWC There was also a change in the case mix Final between the home nation and France of the presenting problems, with alcohol- on Sunday 23 October. This produced a related presentations becoming much more sustained late spike in activity that lasted prominent. For patients who were coded several hours, and there were small (ie, those with a stay greater than 3 hours),

NZMJ 24 July 2015, Vol 128 No 1418 ISSN 1175-8716 © NZMA 82 www.nzma.org.nz/journal ARTICLE

Figure 4: Patient Volumes and Compliance with Emergency Department Disposition Target.

alcohol intoxication moved from the 10th events. Wellington Hospital has previously most common diagnosis (1% cases) to the reported the use of a pre-hospital 2nd most common diagnosis (4% cases). intoxication protocol for both their RWC Problems relating to alcohol excess were matches and the Wellington Sevens particularly prominent at weekends (15% tournament.4 Indeed, a similar system cases), increasing to 50% of all attendances was implemented by St John Ambulance being related to alcohol in the 4 hours in Auckland during the tournament and following the conclusion of the final. is likely to have significantly buffered attendances at the AED. Large-scale public Discussion health measures to reduce alcohol harm were put in place during the London Activity at ACH AED increased during the Olympics and they appear to have been RWC in a reasonably predictable manner, highly successful in minimising impact on with an overall increase of 8%, but with local health facilities.5 disruptive peaks in presentations and short stay workload around the times of the major We hope this report of our experiences events. The investment of time in planning may prove useful in planning future events for the event, particularly targeted additional including the upcoming RWC in England. medical resources at weekends, proved essential in managing this work, along with Conclusions additional AED short-stay capacity and the Major sporting tournaments require special hospital campaign to minimise delays to planning arrangements to the receiving admission to in-patient beds. Emergency Departments, especially around Much of the additional workload likely spikes of activity consequent on mass appears to have been caused by alcohol crowd events. A comprehensive alcohol harm consumption. Strategies to mitigate against reduction strategy should be considered alcohol-related harm would therefore seem including public health measures and to be an important part of planning for such pre-hospital care.

Competing interests: Nil Author information: Mark Gardener, Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand; Tim Parke, Adult Emergency Department, South Glasgow University Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland; Peter Jones, Adult Emergency Department, Auck- land City Hospital, Private Bag 92024, Auckland, New Zealand. Corresponding author: Tim Parke, Adult Emergency Department, South Glasgow University Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland. [email protected] URL: www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1418/6598

REFERENCES: 1. McGreevy A et.al. The 3. Moody WE, Hendry RG, Wellington, New Zealand: Effect of Sporting Events Muscatto D. Were Atten- A Sobering Experience. on Emergency Depart- dances to Accident and NZMJ 2013 Apr; 126(1372) ment Attendance Rates Emergency Departments 5. Morleo M, Jones A, O’Keefe in a District General in England and Australia M et al. The Impact of the Hospital in Northern Influenced by the Rugby 2012 London Olympic Ireland. Int J Clin Pract. World Cup Final 2003? and Paralympic Games 2010 Oct;64(11):1563-9. Eur J Emerg Med. 2007 on Alcohol-related Illness 2. Sivarajasingam V, Moore Apr;14(2):68-71. and Injury. Centre for S, Shepherd JP. Winning, 4. Swain A, Weaver A, Public Health Final Losing, and Violence. Gray A et al. Ambulance report July 2013 Injury Prevention. 2005 Triage and Treatment at Apr;11(2):69-70. Major Rugby Events in