Ironman Texas North American Championship: An EMS Challenge

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by Brian Gillman, EMSCI #189T-B
Cypress Creek (TX) EMS
IPMBA Conference Coordinator

It’s the beginning of 2019 and Cypress Creek EMS is in the planning stages for our 9th Ironman North American Championship. This race is held annually in the heart of The Woodlands area north of Houston in late April to late May. It requires the cooperation of several public safety agencies to protect and serve the nearly 10,000 participants, spectators and visitors who attend. As we prepare, I reflect on all the successes we have had over the years due to great cooperation and planning.

Over the years, we have staffed two medical tents with physicians, nurses, athletic trainers and the paraprofessional hospital staff necessary to staff more than 100 beds and bring first class medical care to the athletes. The local lifeguard and water rescue volunteers, supported by dive teams and water rescue teams, provide a flotilla of kayaks and paddle boards to help athletes in the water. Among all our partnering Fire and EMS agencies, we have staffed fifteen dedicated ambulances, four supervisor vehicles, ten transport carts, and upwards of twenty-five bike teams to assist the athletes, spectators and the general public along the entire 140-mile course. Our medical team will make between six hundred and a thousand medical contacts during this event.

In 2017, all the planning and preparation really served us well. That morning, all our early morning teams had deployed to support the swim portion of the event. The almost 2800 swimmers enter a local lake on the north shore, swim to the south and then enter a narrow canal that leads to a retail area in the heart of the Woodlands, where they transition to the bike segment of the race.

Approximately two hours into the race, we received a call that a swimmer was in distress in the canal not far from the swim transition area. Two advanced life support bike teams working the waterway canal were dispatched. Further information came in that the patient was located at the canal level under one of the overpasses and that a bystander had pulled the athlete from the water.

The first bike team arrived quickly and went on the scene with an adult male athlete in cardiac arrest. Advanced life support care was immediately started, additional resources were requested, and a second bike team and medical utility cart arrived on scene within the first minute of the call. An ambulance was dispatched at the same time, but was caught in traffic on the overpass above due to traffic rerouting for the race course. The patient was treated on scene and eventually transported to the hospital. Although the outcome for the patient was not what we had worked and hoped for, the response from all of the teams was remarkable. This was our first fatal incident that our race had experienced.

As we looked back on this incident and measured it against our goals for such events, we were proud of our team’s performance. At most of our events where bike teams and medical carts are deployed, it is our goal to be able to provide advanced prehospital care to a patient within ninety seconds of a call for help. Our first team arrived within thirty seconds, with advanced care initiated almost immediately. The first team was staged on the side of the canal that the patient was extracted to. They happened to be just above the patient location and navigated a trail system quickly down the canal. The initial team comprised an experienced paramedic who had been on our bike team for many years, and a relatively new EMT that had just completed his IPMBA training a few months prior.

The second team had been staged on the other side of the canal and quickly responded to the incident, adding two more seasoned paramedics to the call. The medical cart was at a staging location on the same side of the canal as the incident and two paramedics responded with additional medical and extrication equipment. The response would have been delayed if they followed paths to the lower deck, so they responded to an access point directly above the patient and carried the necessary equipment down the short, steep hill to meet up with the other crews. By this time, the streets above were congested with Saturday morning traffic that had been re-routed due to the race course and the police response to the incident.

The ambulance, from another agency, was delayed for several minutes due to traffic standstill, then had to use the path system to bring down a stretcher for transport. By the time the transporting ambulance crews arrived on location, all critical medical interventions were complete. The patient received CPR within forty-five seconds; an AED was deployed; intubation, IV access and medication administration was within minutes of arrival and continued through transfer of care to the transporting unit. The bike team deployment worked perfectly, as planned, for this type of incident. They were able to quickly access the patient and begin critical patient treatments, notify command of additional resources needed, and finally interact and transfer care to a transport unit.

The multiple agency, multi-discipline response was seamless due to solid pre-planning, strong incident command and perfect performance from all the teams on scene. All the teams were quickly back in-service and responded to dozens of calls during the next fourteen to twenty-two hours.

The average standard response time for a 911 ambulance with this level of pre-hospital care is seven to eight minutes in this general area, but here you receive treatment within seconds.

This again reinforces the benefit to the public of having public safety responders deployed on bikes and other non-conventional units in certain areas and during events such as this massive race. The four months of pre-planning by all the medical partners – fire department, EMS agencies, hospital staff, water safety crews, athletic trainers and Ironman staff – make this one of the safest events I have the privilege of working with every year.

As we conclude the planning and begin the implementation for the ninth consecutive year, I look forward to working with the amazing group of professionals.

Brian has more than 20 years’ experience as a field paramedic and Fire/EMS dispatcher with Cypress Creek EMS in Spring, Texas. He is the logistics coordinator for the CCEMS Bike Team and has been active on the team since 2005. He has been an IPMBA Instructor since 2007, a maintenance officer since 2008, and teaches 2-3 IPMBA Courses annually. He was elected to the IPMBA Board in 2014 and has held the positions of Membership and EMS Coordinator. He currently serves as Conference Coordinator. He can be reached at bgillman@pharmacal.com.

Photos courtesy Cypress Creek EMS.

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