1 Aaron Frazeur -Emergency Medical Services at Ruoff Music Center
Aaron Frazeur (he/him/his) is a second-year student majoring in Psychology from Fishers Indiana. The selection below is part of his discourse community paper for his reading, writing, and inquiry class freshman year. Professor Kelly Blewett notes, “Aaron’s paper ‘Emergency Medical Services at Ruoff Music Center’ does a fantastic job of exploring how community members get the job done, in spite of being understaffed and loaded down by paperwork. I appreciate his strong examples, informative interview, clear organization, and overall thoroughness.”
Emergency Medical Services at Ruoff Music Center
Emergency Medical Services (EMS) is a very broad and diverse discourse community. Within EMS there exists smaller communities such as the different types of EMS services, 911, interfacility transport and special events. Those themselves can be broken down to different discourse communities, sometimes even down to an individual ambulance, due to the different lexis and expertise for example. This paper could go on for a long time about each individual community but instead will focus on the EMS crews at Ruoff Music Center, how they fit John Swales’ characteristics of a discourse community but also get their job done despite roadblocks such as being understaffed and large amounts of paperwork.
The Venue
Ruoff Music Center, usually shortened to Ruoff, is a concert venue in Noblesville Indiana, just under 30 miles away from downtown Indianapolis on the Northeast side. It has gone by a few different names and has had a few changes and additions since its opening in 1989, but one thing has remained constant and that’s its ability to draw a crowd. Sitting on 228 acres, Ruoff as it’s simply referred to, has enough space for roughly 25,000 concert goers during oversold shows. There are over 6,000 seats in the pavilion which is a covered area, and room for roughly 18,000 in a grassy area that is known simply as the lawn. There are 3 covered decks in the lawn that offer a more controlled environment and easier access to food and alcohol. There are also numerous places to get drinks and food throughout the venue. There are three separate parking lots and three separate public access gates each on their own side of the venue. This large area with a dense population mixed with alcohol and occasionally drugs make for an interesting challenge for the EMS crews working at Ruoff and requires them to be on top of their game every show.
The EMS Staff
Emergency Medical Technician – Basic (EMT-B) or normally shortened to just EMT, is one of the 4 nationally recognized EMS certification levels the others being: emergency medical responder (EMR), advanced emergency medical technician (AEMT or EMT-A), and paramedic or just simply medic (National Registry of Emergency Medical Technicians [NREMT], 2023). EMT-B sits between EMR and EMT-A in level of certification. To obtain any level of certification a person must attend and pass the class and exam for that certification level. In my experience most people start out at EMT and then will attend a paramedic class; however, some people, usually those in more rural departments will get an EMR certification due to training cost and time. Everyone including EMRs are trained how to do cardiopulmonary resuscitation (CPR), use and automated external defibrillator (AED) and perform basic first aid (NREMT, 2023). In Indiana EMTs get training on airway management, administering oxygen, more in-depth first aid and trauma care and also helping deliver a baby; while paramedics receive that plus learning how to start intravenous (IV) and intraosseous (IO) lines, administer drugs, as well as more medical knowledge in general (Indiana Department of Homeland Security [IDHS], 2022). These courses to obtain these certifications create a base of knowledge for all EMS providers at Ruoff, however knowledge does not equal experience especially at a place like Ruoff due to the large numbers of patients and the wide variety of medical emergencies they present. Also, one of the biggest parts of the job, documenting patient care, is not really something that is covered in these courses, and it can present problems. This is an issue that will be explained more when talking about the paperwork at Ruoff.
Speaking of experienced providers, they are vital to the safety and wellbeing of the guests at Ruoff Music Center due to their experience and knowledge at the venue. However, similarly
to other branches of EMS, a high turnover of personnel can sometimes make that a challenge. A study done by the American Ambulance Association with Newton 360 found EMS turnover rates for both EMTs and paramedics was as high as 36% in 2022 (Moore, 2022). Despite the appeal of working a concert, the EMS staff at Ruoff have had shows that were understaffed. While our ability to provide patient care was not diminished, it placed a high workload on those of us present, and over time this higher workload can cause people to leave, creating this revolving door of personnel.
The EMTs make up most of the EMS staff at Ruoff with there usually being a minimum of 8 every show and at busier shows up to 16 or more. There is also at least one paramedic at every show with up to 4 or more being present at busier shows. While there is no legal ratio to my knowledge for EMS staff to guests, we base our staffing off of estimated numbers of guests, how previous shows went for returning artists or how things have been at other shows if the artist is new. During the show EMTs in crews of 2 are stationed out in the venue with usually a crew being stationed in the lawn and one in the pavilion. More crews are added during larger shows but at small shows, about 7,500 or less, that’s what we usually have in the venue. The other EMTs and the paramedics are in the medical trailer where patients are brought back to be treated and transported if need be. This is also where most of the paperwork for the venue is done.
The Interview
To understand more about the paperwork and Ruoff as a whole I talked to Hanna, one of my coworkers who has been an EMT for 4 years and has worked at Ruoff Music Center for 3 years. When asked to briefly describe working at Ruoff during the concert season she said, “Ruoff is a controlled mad house” (H. Arthur, personal communication, April 5, 2023). At times this can be considered an understatement, she added “usually we are all tired and worn out after
running around, some shows the crowds are rough and sometimes the ones you expect to be rough aren’t” (H. Arthur, personal communication, April 5, 2023). The reverse also holds true especially for last year at Stevie Nicks, which was a show we expected to be relatively easy, but we were so busy most of us that worked the show don’t remember anything about it, except that we were so busy. I asked her about paperwork and how that usually works, and she responded, “on what could be considered a slow night paperwork is usually pretty simple and easy to get done, on a busy night like with any country or pop show, paperwork isn’t really a top priority sometimes because we can be overloaded with people” (H. Arthur, personal communication, April 5, 2023). I also asked her if the experience level of a provider had any impact on the paperwork and she said, “people who have done the paperwork before and have a good handle on it can get it done in about 5 to 10 minutes, whereas someone new it can take them up to 20 minutes and sometimes we don’t have that extra time to spare” (H. Arthur, personal communication, April 5, 2023). Which brings up one of the biggest hurdles to the goals of the EMS staff at Ruoff; paperwork taking too much time and getting in the way of patient care.
The Goals
The goals for the EMS staff at Ruoff are simple and are largely shared with the other sections of EMS. The primary goal for EMS as a whole is the quick and accurate assessment, treatment, and transport of the patient. This is especially true at Ruoff during those busy shows where there are sometimes upwards of 10 patients with only 4 or 5 providers. During these times this goal can be hindered by the paperwork that must be completed for each patient, which will be explored more in the next paragraph. Another goal that is more applicable to special event EMS staff and Ruoff, is to make sure guests enjoy their time at the concert. These fans have paid decent money to see an artist perform and we all want them to enjoy their time there and have a
good experience. However, another goal which goes along with the primary goal can sometimes supersede the goal of guests having a good time, that goal is the safety and health of both guests and staff. The greatest example of this conflict is when a guest becomes too drunk to where they are throwing up and can no longer control themselves. Barring any other medical issue or if they’re at a dangerous level of intoxication, we eject these guests from the venue and have a friend or family take them home. Unfortunately, that guest’s experience or that of those with them might not be great but the safety and health of everyone else comes before that. These goals are simple and at times they conflict, but the thing to remember is that the patient comes first regardless of the situation.
The Paperwork
John Swales listed six characteristics for a discourse community: common goals, shared lexis, mechanisms of communication, ability for feedback, specific genres, and different levels of expertise. So far, I’ve talked about the levels of expertise and the common goals and have hinted at the paperwork or the genre. Below in figure 1 is a picture of one of the pieces of paperwork that has to be filled out during patient contact. Out of all the forms filled out in the trailer, this one is most important because we keep track of what is wrong with the patient and where, their vitals and also the interventions or what we’ve done to help the patient. A less important part of the form but still helpful is the location where the patient got injured or sick. Keeping track of the locations, especially for injuries, helps us and the venue know if an area is causing problems, such as a lighting issue or if there’s a tripping hazard. This form is one of three that need to be filled out if a patient gets transported. For those patients not transported, we’ll look at figure 2.
Fig. 1
Figure 2 shows a signature of release or SOR. A signature of release is completed when a patient is assessed and or treated and does not wish to be transported by ambulance to the hospital. Every line on the form needs to be filled except for the parts about medical control, save for dangerous situations like a patient refusing after a major injury or administration of medications. Whereas the form in figure 1 not all the boxes need to be filled out, but the more that are filled out the easier the narrative at the bottom will be to fill out.
Fig. 2
During ideal conditions in the trailer, one EMT or medic will be assessing the patient and taking vitals while another EMT writes down the patient information as well as the findings of the assessment. While these forms are relatively easy and straightforward, another form that is on a limited number of iPad’s usually two, sometimes three if we’re lucky, is not easy or straightforward. This form is for the company that runs Ruoff which is, Live Nation. This other form has similar information requirements such as patient contact information, where the event
occurred, vitals and a spot for the narrative, but it also has numerous other boxes for things like what kind of shoes was the patient wearing or what and when a patient last ate. This information is rarely relevant and takes more time to input and is where the 20-minute number Hanna gave for newer people when doing paperwork. Additionally doing this type of paperwork isn’t covered in the classes to become an EMT and teaching new people can be very time consuming. There are the paper forms that need to be completed plus the electronic form for the venue and while with one or two patients this isn’t a problem, there’s rarely just one or two patients in the medical trailer. This problem of what should be getting your full attention, the paperwork or patient, starts to exist. Either you can focus more on the patient and not have all the information to record the patient contact and possibly inform the hospital if they’re transported or focus on the paperwork and potentially miss something with the patient. Many less experienced EMTs will usually struggle to juggle these two things, and I did when I was new and occasionally still do.
This conflict of paperwork ultimately led to us only completing our paper forms for numerous shows, which in turn caused us to spend hours taking that information and putting it into the iPad reports. Up until the end of the season, those of us that would come in early would sit there and input reports before the show started to just try and catch up. To better address this issue, we have worked on creating an EMS specific tab within the Live Nation app so that only relevant information is required in the report. This form will hopefully also meet the requirements from our company as well. That way a singular standardized form can be used and cut down on the juggling of different forms and iPads. Additionally, more iPads have been acquired so more people can work on reports and not create a backlog for us to try and fix. It won’t solve all of our problems, but it’s a step in the right direction.