Every major sporting and concert event has them and so do a lot of smaller social events. You won't see them unless you pay close attention. You won't really care that they are present unless you need them. And you won't observe them in action unless an emergency occurs.
They are the medical staff and equipment on standby until needed known collectively as event medicine.
Baptist Hospital's event medicine, part of Saint Thomas Health Services, does most of the major events in Nashville, including the Tennessee Titans, the Nashville Kats and the Nashville Predators games.
Within Baptist's health care structure, the required equipment and professional medical staff are pulled together to meet the needs of a particular happening, whether a major sporting event with tens of thousands of people or a local cookout with a few dozen.
A major event may require multiple ambulances, physicians, emergency medical technicians (EMT) and all types of equipment, while a small social event may need only one EMT.
"We offer significant [medical] care behind the scenes or on the scene," said Ronn Hollis, executive director of corporate partnerships for Saint Thomas Health Services. "Our staff has made a difference in providing care for injuries that have occurred in football, other sports or special events by being there for a quick response."
Baptist uses Federal Emergency Management Agency (FEMA) guidelines to help determine the type of clinical staff and emergency equipment needed for an event.
"Every event is different and has different needs," said Mark Buck, director of event medicine for Saint Thomas Health Services. "We want to be prepared for the type of crowd, the type of event and the situations that may pop up."
According to FEMA, 87 percent of event incidents are minor, such as the need for a Band-Aid or aspirin. About 12 percent of cases are moderate, 1.1 percent are serious, and .02 percent are critical.
The largest spectacles Baptist normally handles are the Titans games. On game day, the 70,000 people that on average gather in the Coliseum would be the sixth largest city in the state. For these games, Baptist supplies up to eight ambulances, 50 health care staff professionals, eight John Deer medical carts, and all types of necessary medical equipment. They are available to treat spectators, referees, coaching staff and players.
Four physicians are also on hand, based on specialty and having been pre-selected by the Titans on recommendations made by Baptist. Staff are located at six first-aid rooms, in the stands, on the field, and at a 24-foot mobile care unit in the parking lot.
The mobile medical carts on the field have advanced life support equipment such as oxygen, Ambu bags (manual resuscitators), cardiac defibrillators, IV fluids and backboards. They are also fully stocked with medications, splints and bandages.
All types of medical situations can occur at a game, Buck said, including broken legs, heart attacks, bruises and cuts. "A lot of people just forget and leave their medication at home," he said.
During the late summer and early fall games when the temperature is high, there is a lot of heat exhaustion. And during the winter, the problem switches to cold exposure. There is always something to be concerned about, Buck added.
The Titans event medicine team averages 300 patient contacts and six to eight transports by ambulance to a hospital per game.
The team uses high-tech communications equipment, Buck said, as well as pre-determined hand signals when a player goes down during a game. The signals are often to request specific equipment for treatment.
The team's busiest-ever event was not an NFL game, however, but a college football game where there were 18 transports within three hours, mostly because of heat in an early fall game.
Event sponsors say the show wouldn't go on without the medical team.
"I don't know what we would do without them," said Don MacLachlan, executive vice president of administration and facilities for the Tennessee Titans. "They provide the medical assistance we need, and quickly when we need them the most. They are in the stands and on the field ready to go for any developing emergency situation."
One emergency that stood out in his mind was when the Pittsburgh Steelers quarterback Tommy Maddox was injured during a play last season and lay on the field motionless.
Fearing a spinal injury, the medical event staff, working with Pittsburgh team physicians, took 18 minutes to secure the visiting player on a stretcher and cart him off the field. Though knocked out, Maddox suffered no serious injuries.
MacLachlan said Baptist is a partner working closely with the Titans in all sorts of community endeavors. Besides supplying game-day health care support, Baptist provides medical treatment for the players between games and rehabilitation therapy when needed.
In return, Titan players take time to visit patients in the hospital.
Though fans might think NFL games would require the most onsite doctors, hockey games actually have more. The Predators require five doctors, also selected by the team on recommendations by Baptist. There is one internal medicine physician, one orthopedic physician, one plastic surgeon, an ophthalmologist and a dentist.
The Titans have two orthopedic physicians and two internal medicine physicians at their games.
Doctors are selected based on the injuries likely to occur in a particular sporting event. For example, to help treat a common injury in hockey, knocked-out teeth, the Predators have a full service dental facility available at the Gaylord Entertainment Center.
"Significant injuries occur in both football and hockey and we have made a difference by being there," said Baptist's Hollis.
Sporting events are not the only happenings that employ physicians. "Rock concerts may have an internal medicine physician and a cardiologist," Hollis said.
Because event medicine has become such a big service at Baptist, it now has its own department. The department utilizes its own staff, plus it has the option of pulling medical staff from other departments at Baptist or contracting with outside entities when needed.