Super Ready: How a Regional Approach to Super Bowl EMS Paid Off

Nestled between the cities of Philadelphia and New York lies the state of New Jersey—home to 9 million residents and some of the most vulnerable chemical facilities in the country. A two-mile stretch from Newark Liberty International Airport to Port Elizabeth (adjacent to New York City) has been designated by terrorism analysts as the most dangerous two miles in America. On this tract of land are chemical facilities, refineries, rail yards and lines, an international airport and the third-largest port in the country—in all more than 100 potential targets. Some are more hazardous than others. In a 2006 interview with CNN, former New Jersey Homeland Security Director Richard Canas said, “Just one chlorine gas plant, if attacked, could bring lethal harm to more than 12 million people in a 14-mile radius.”

Within this area also reside major universities, vital transportation links and one of the region’s largest sports and entertainment complexes, the Meadowlands Sports Complex, which houses MetLife Stadium in East Rutherford, NJ, where Super Bowl XLVIII was held.

Then you have New York City. Industry experts continue to point out its risk for additional terror attacks. Between New Jersey and New York City, you also have the nation’s most densely populated region.

Aside from terror attacks, risks and threats, we’ve had a couple of other recent noteworthy events:

• The 2009 crash of US Airways Flight 1549, the “Miracle on the Hudson,” where all 155 occupants were rescued (the first 58 to New Jersey, the other 97 to New York City);
• Tropical Storm Irene in 2011, the seventh-costliest disaster in United States history;
• Hurricane Sandy in 2012 (more commonly referred to as Superstorm Sandy), which struck the region with historical force and yielded $65 billion in damage—the second-costliest disaster.

So with all the threats, risks, vulnerabilities and events aforementioned, when New Jersey won its bid for the 2014 Super Bowl, we had to be super ready.

How did we do it? Planning, training, exercising and relationships.

Planning

During large-scale events, the potential exists for mass-casualty incidents. Therefore it is important for all EMS professionals to actively engage in emergency preparedness planning. Super Bowl XLVIII was not only one of the world’s largest and highest-profile special events, it was also held in a unique venue that spanned dozens of local jurisdictions, counties and two states. As a result of this challenge, EMS leaders from New Jersey and New York City decided to take a regional approach to preparedness, coordination and response.

To organize and prepare for this event, the New Jersey EMS Task Force, along with several partner agencies, organized, coordinated and scheduled several regional EMS planning meetings, training sessions, exercises and follow-up briefings to ensure appropriate response activities.

Through a strategic planning process involving all stakeholders, we organized a regional EMS planning initiative. EMS preparedness for this event not only included the Super Bowl game, but also the immense number of activities occurring in the week prior—both NFL-sanctioned and non-sanctioned events, private events, public gatherings/parties, etc. In addition to these, we included in preparedness efforts areas of critical infrastructure directly and indirectly related to the Super Bowl (train stations, ports, bridges, tunnels, airports, stadiums, practice facilities, hotels, parks, etc.), not to mention Super Bowl Boulevard in Manhattan, which saw 1.5 million visitors.

The operational elements contained in the Super Bowl XLVIII EMS plan required a heightened level of security awareness for all responders. Additionally, the plan was designed to maximize resources while ensuring the safety of all EMS professionals.

The planning team included the New Jersey EMS Task Force (NJEMSTF), under the auspices of the New Jersey Department of Health (NJDOH); the New Jersey Sports and Exhibition Authority (NJSEA) EMS, the host EMS agency of SB XLVIII; the Fire Department of New York EMS; the jurisdictional New Jersey Office of Emergency Management county EMS coordinators; local EMS agencies; hospitals; and other partners such as the New Jersey State Police (the lead agency for the venue), the Port Authority of New York and New Jersey, New Jersey Transit and the FBI.

The planning timeline was focused on Super Bowl week, which included the game and its associated activities that began on Monday, January 27, and culminated a week later.

The following areas of operation received the most attention:

• MetLife Stadium, the Izod Center and Meadowlands Racetrack (old and new sites), and the Quest Diagnostics Training Center in East Rutherford (respectively the homes of Super Bowl XLVIII, major events and a practice facility);
• Atlantic Health Training Center in Florham Park, NJ (practice facility);
• Hyatt and Westin Hotels, Jersey City (where teams/families stayed)
• Prudential Center, Newark (media day);
• High Point Solutions Stadium in New Brunswick, NJ (backup practice facility);
• Super Bowl Boulevard in Manhattan (major SB XLVIII event);
• Newark Liberty International Airport (major air transportation hub);
• Secaucus Junction rail station in Secaucus, NJ (major rail transportation hub);
• Liberty State Park, Jersey City (opening ceremonies).

Other smaller venues and locations received preparedness guidelines and a template for EMS planning.

To accomplish the monumental feat of writing a regional plan, each agency/stakeholder participated in three distinct daylong summits, where items for inclusion in the plan were discussed, such as:

• Current and anticipated SB activities;
• Plans for routine EMS operations;
• Plans for MCI EMS operations with incident objectives for the first 90 minutes, broken down in 15-minute increments;
• Authority (BLS, ALS) for each jurisdiction;
• Local, county and state EMS resource availability;
• Pre-identified mutual aid;
• Pre-identified incident facilities, such as casualty collection points, triage/treatment/transportation areas, staging and heli-spot operations, etc. (see sidebar);
• Continuity of operations;
• Safety;
• Regional and local MCI communications;
• Demobilization;
• New Jersey CHEMPACK/FDNY EMS WMD truck deployment;
• Patient tracking;
• Hospital capabilities;
• Multiagency coordination;
• Other items.

In addition, an extension of our planning team included those who had previously experienced Super Bowls within their jurisdictions. This included Cedric Palmisano, special events planning coordinator at New Orleans EMS, and Andrew Bowes, chief of planning and special events for Indianapolis EMS. These individuals joined our planning meetings via conference call and provided valuable lessons learned and best practices that we incorporated into our strategies.

During the final planning meeting, the EMS agencies presented their plan to the entire working group. Once everything was approved, GIS information, maps, recent aerial photography and other photos and visuals were added to enhance the plan.

After the final planning meeting, and as expected, the plan was groomed and modified as appropriate due to the continuous refinements being made by the NFL and Super Bowl Host Committee. The final product consisted of a 500-page detailed plan that encompassed all aspects of EMS operations for the entire region. The plan was broken down into jurisdictional areas, with appendices for general areas of operation and support functions.

Training and Exercises

Training EMS agencies is paramount to ensuring all responders are prepared for potential threats to public safety. New Jersey provided targeted training based upon past intelligence in preparation for Super Bowls. The targeted areas for training included some unique topics, such as human trafficking, tourniquet use, the Mark I nerve-agent antidote kit and basic drug recognition. Each training was done in cooperation with the New Jersey Division of Criminal Justice, the FBI and the New Jersey State Police. In addition, specialized EMS management training (e.g., ambulance strike team leader, staging area manager) was offered to members of EMS community who were to, or could potentially, support operations during SB week.

Exercising plans will validate their strategies and allow for lessons learned so any shortfalls can be mitigated. For SB XLVIII, exercises to test the plans in place began early in the process.

From January–March 2011, the Federal Emergency Management Agency organized large-scale tabletops, functional and full-scale exercises simulating a “dirty bomb” explosion at MetLife Stadium. Because of the regional approach we were using, this exercise included interstate mutual aid from FDNY EMS.

In addition, unique strategies were implemented, such as the use of a large air medical operation. As a matter of fact, this exercise consisted of the largest involvement of New Jersey medevac operations ever tested. We used a total of 11 aircraft that included state, private and military helicopters. Find a clip here.

In the year leading up to the Super Bowl, through a partnership with New Jersey Transit, several weeklong full-scale simulation exercises were conducted at TEEX (the Texas A&M Engineering Extension Service) in College Station, TX. The Joint Crisis Incident Management/Incident Command Post training program simulated a disaster at the Secaucus rail station, where responders developed and enhanced the skills needed to manage complex multijurisdictional events.

During the months and weeks leading to the SB, smaller jurisdictional tabletop exercises were held in both states. With the assistance of FEMA and others, four events were scheduled where the final draft plans were discussed and participants were given scenarios dealing with various MCI-type operations such as CBRNE events, utility disruptions and civil unrest.

A little over a year prior to the SB, MetLife Stadium and the New Jersey EMS community had the opportunity for a “dry run” of sorts. In August 2012, the stadium hosted the 12th Siyum HaShas of Daf Yomi. This religious event celebrated the most recent conclusion of Daf Yomi, the page-a-day program where Jews worldwide study one Talmud page per day, completing all 2,711 pages in 7½ years. More than 95,000 people attended this event, including more than 1,000 leading rabbis and other international dignitaries.

Prior to the Super Bowl, this event and its associated venues received the most security and preparedness attention due to the nature of the event and the fact it’s a potential target for terror groups acting against those of the Jewish faith. NJSEA EMS and the state EMS community supported this event with more than 50 pieces of apparatus and 400 EMTs and paramedics. It was a good experience and proved that taking a regional approach to preparedness was the best solution.

Relationships

H. Mickey McCabe, the Hudson County OEM EMS coordinator, could not have said it any better: “In New Jersey and New York, EMS is a turnkey operation when it comes to disaster preparedness…and it’s because we all know each other.”

Getting to know your EMS neighbors, mutual aid partners and other stakeholders is critical before an event takes place. Meeting, planning, training and exercising with each other provides a level of comfort and trust—especially when using a regional approach. According to Tom Rose, the Bergen County OEM EMS coordinator, “We typically don’t use ‘sir’ or ranks such as ‘captain’ or ‘chief’ when we address each other. We are on a first-name basis…which shows the trust, dedication and respect we have for each other.”

Once relationships are formed, they need to be maintained. It’s best to meet on a regular basis to discuss any issues at hand. It could be as simple as having a cup of coffee at the diner, lunch at the deli, or socializing after hours.

Super Bowl Week

At each of the jurisdictions, Super Bowl EMS plans were enacted for routine operations, and MCI-contingency procedures were ready should an untoward event take place.

Opening ceremonies took place at Liberty State Park in Jersey City. A concert with fireworks along with the governor of New Jersey and mayor of New York opened festivities. Temperatures with wind-chills were in the single digits. Jersey City EMS and the Hudson County OEM EMS Bureau were prepared.

Media day was located at Prudential Center in Newark—this was a major media event that featured members of both participating teams. Thousands of media/news agencies from around the world interviewed players and coaches. University Hospital EMS and the Essex County OEM EMS group were prepared.

At Newark Liberty International Airport, additional EMS resources were allocated to support the airport’s busiest week in its history. According to airport officials, air and passenger traffic were 40% higher than the previous busiest week of the year, Thanksgiving.

Super Bowl Boulevard in Manhattan was a temporary theme park operated by the NFL during the week of the Super Bowl that was a combination of fan attractions and special events. These included interactive activities that allowed fans to throw a touchdown, catch a pass and kick a field goal; display of the Vince Lombardi Trophy; nightly concerts; football clinics and competitions; NFL-themed exhibits; autographs; theaters; shops; and a 60-foot-tall, 180-foot-long, eight-lane toboggan run. FDNY EMS was prepared and allocated several specialized resources and personnel at strategic locations along the 13 blocks on Broadway. A million and a half visitors came to Super Bowl Boulevard—nothing FDNY EMS isn’t used to. The event went as planned, with a total of 14 patient contacts.

Other operations included the strategic allocation and positioning of EMS resources at the Atlantic Health Training Facility, in the Hotel District in Jersey City, and in other jurisdictions in both states in which Super Bowl-related events were being held.

To coordinate all the related activities across the two states and dozens of jurisdictions, an EMS multiagency coordination system (MACS) was established. A MACS provides the basic architecture for facilitating the allocation of resources, incident prioritization, situation assessment, coordination and integration of multiple agencies for large-scale incidents and emergencies. With Super Bowl taking place over an entire region and week, it was best to approach this type of coordination with a MACS. A MACS group will coordinate the basic functions along with the support of EMS agency representatives to make administrative-level decisions on policy or resource allocation issues.

“An event of the magnitude of the Super Bowl involving two states, many municipalities and jurisdictions required cooperation and collaboration to ensure an incident occurring in one venue did not adversely impact the resources and operations of other venues,” said Fred Villani, FDNY EMS. “Information sharing is critical across jurisdictional and municipal boundaries to ensure a common operational picture and situational awareness for decision makers and all involved.”

The MACS interacted with a public safety compound (PSC) established specifically for this event adjacent to the stadium. The PSC was staffed by a multidisciplinary group consisting of law enforcement, homeland security, federal partners, fire, EMS, NFL representatives, utilities and transportation.

Communications

A comprehensive multiagency, multidiscipline communications plan involving more than 50 frequencies had to be established for Super Bowl preparedness. For EMS operations, we used a bistate communications pathway utilizing both UHF and 800 radio frequencies through console patches. This process allowed the seamless interoperable communications of all public safety agencies involved throughout the region. It required extensive coordination of all stakeholders to ensure optimal utilization of available frequencies. Frequencies had to be established for routine local operations, MCI regional operations, EMS staging, air medical operations, etc. According to Joe Burlew, coordinator of the regional emergency medical communication system where the EMS MACS was colocated, “Cooperation among local, county, state, federal and private partners was outstanding, and years of planning and partnerships paid off.”

Game-Day Operations

The culmination of game day felt like a wedding. Everyone was excited, nervous and hoping everything went as planned. For the EMS professionals and others intimately involved in planning this event, it was no surprise that preparations were sufficient. Although there were bumps in the road, in the end the goal was reached. NJSEA EMS Director Fran Guthrie said, “Preparing for the Super Bowl was one of the most challenging yet most fulfilling events we have ever participated in.”

“NJSEA EMS has been the lead EMS agency at large-scale events held at the Meadowlands Sports Complex since the complex’s inception in 1977,” Guthrie said. “The management team has existed for just as long and owes its success to being able to bring what we need to the table. The regional approach worked in this case and has worked in the past. EMS at the Meadowlands Sports Complex evolves and grows to meet the needs of our events.

“Super Bowl XLVIII demanded we bring all the outside resources we could to the table. It was like having company in your home every day for a year. Some days you didn’t want to answer the doorbell, but you put on the smile and entertained everyone’s input, ideas and questions equally. We knew we needed our New Jersey/New York EMS communities’ assistance and resources to make this event work. After a year of monthly meetings, drafting and redrafting of an Incident Action Plan for NJSEA’s approach to SB XLVIII and working closely with all the stakeholders, we knew we were ready for anything thrown at us.

“SB XLVIII challenged this agency because of its security needs. The NFL secures the stadiums by having hardened perimeters inside and outside. We had six facilities on our property that required medical coverage, including the stadium itself. Three of the facilities were outside the hardened perimeter, thus creating a need for two separate medical operations, outside and inside. Most Super Bowl venues have the luxury of utilizing the municipality’s EMS for any needs outside the hardened perimeter. SB XLVIII required NJSEA EMS to provide coverage for the inside and outside. We developed an exterior operation to encompass the parking lots, roadways, new Meadowlands Racetrack, Quest training center and the train station utilizing ambulances, paramedics and off-road ambulances/vehicles to move patients. Hackensack University Medical Center offered their mobile satellite emergency department (a New Jersey EMS Task Force asset) to be placed outside the hardened perimeter to see patients and assist in minimizing the need to transport off site to local emergency rooms.

“SB XLVIII also challenged this agency logistically due to the need to staff four locations, including the stadium, simultaneously. Utilizing our full staff for this event, we were able to develop a plan to relocate staff from other facilities to the stadium for kickoff. We were able to handle the full operation without any additional staff.

“On game-day morning I knew everyone operating in an EMS capacity personally and by name, which is very comforting. All EMS operational staff (physicians, RNs, paramedics and EMTs) were briefed prior to going on post. All resources were in place and accounted for. All medical operations went as planned.”

Find summary of game-day patient contacts in Table 1.

Summary

The Super Bowl and its associated activities represent one of the largest special events in the world. SB XLVIII was geographically unique because the NFL’s and Super Bowl Host Committee’s activities, venues and events encompassed two states and fell across numerous jurisdictions within six counties (Bergen, Hudson, Morris, Essex, Middlesex, and Manhattan). This Super Bowl was the first to do this. EMS was one of the largest operational components during this event.

In addition to the official events, there were numerous high-, medium- and low-profile privately held happenings that coincided with SB XLVIII week. Those private functions encompassed communities from all across the New York/New Jersey metropolitan area. Without the EMS planning preparedness that commenced almost two years prior, this event would not have not been as successful as it was. This planning process proved preparedness pays off!

Last and most important, it is the people and relationships that make any planning initiative and event a success. Sit down and have a cup a coffee with your colleagues, partners and neighbors in and out of state to discuss your planning initiatives. Do it early—it will make your efforts that less painful should an event of this magnitude come to a city near you!

Terry Clancy, PhD, NREMT-P, currently serves in the New Jersey Department of Health’s Office of Emergency Medical Services. She has more than 20 years of experience in EMS, public health and healthcare initiatives at the local, county and state levels. She is a licensed New Jersey health officer and holds a bachelor’s degree in healthcare administration, a Master of Arts in health education and a PhD in public health.

Henry P. Cortacans, MAS, CEM, NREMT-P, is state planner for the New Jersey EMS Task Force. He holds a master’s degree in emergency management and safety administration and terrorism and securities studies, and is a certified emergency manager through the International Association of Emergency Managers. He is responsible for the development and implementation of statewide EMS emergency operation plans, and provides administrative and operational support to the organization.