[Special Feature: Tokyo 2020 and Keio University] Tokyo 2020 Games and Keio University Hospital ── Reflecting on the Dispatch of Medical Staff to the Olympic Stadium

2021/12/16

The Tokyo 2020 Olympic and Paralympic Games (Tokyo 2020 Games) were held this summer after a one-year postponement and without spectators due to the impact of the COVID-19 pandemic that shook the world.

It is still fresh in our memories that the fifth wave of the COVID-19 pandemic hit Japan during the gap between the Olympic Closing Ceremony on August 8 and the Paralympic Opening Ceremony on August 24, with the capital city of Tokyo recording its highest number of infections to date. In this article, I would like to report on the medical response provided by Keio University Hospital, the closest medical institution to the main venue, the Olympic Stadium (New National Stadium), including the preparation process.

After a request for cooperation was made by the Organizing Committee to Keio University Hospital in 2017, a preparation committee was established at the Shinanomachi Campus. Initially, there was no impact from COVID-19, so in the summer of 2019, we selected and held orientations for staff to be dispatched to the venue. From that autumn, various training sessions based on pre-hospital response were conducted by emergency physicians.

The basic policy this time was "self-contained medical provision within the venue," referring to the medical response carried out during the 2012 London Olympics. Inspections and field training in London had been completed before the COVID-19 pandemic. Subsequently, we prepared appropriate infection control measures, including so-called COVID-19 responses, and maintained a state of readiness so that we could act whenever the decision to hold the Tokyo 2020 Games was made.

Medical response during events at large-scale sports venues (Event Medicine) ideally aims to provide self-contained medical care within the venue, keeping the following points in mind:

(1) Handle all emergency patient responses based on an established chain of command during planned large-scale events.

(2) Build a system capable of responding to emergencies such as Mass Casualty Incidents (MCI).

(3) Avoid placing a burden on medical institutions surrounding the venue.

In principle, medical professionals (doctors and/or nurses) within the venue judge the necessity and urgency of medical needs, and cases that can be resolved within the venue are handled there. However, for life-saving responses, prompt coordination and transport to the nearest medical institution are crucial. This leads to improved survival and social reintegration rates.

We developed an original Keio version adapted for the Olympic Stadium by emergency physicians who received training in London, referring to "ICEM: Immediate Care in Emergency Medicine" practiced at Wembley National Stadium, one of the main venues of the London Olympics. This allowed us to provide services through a highly organized medical team as a professional group, including first responders (citizen volunteers), following a designated chain of command. The implementation of emergency medical response based on ICEM received high praise from the medical management of the Organizing Committee.

As in previous games, 10 Olympic hospitals (Tokyo venues) and 4 collaborative hospitals (outside Tokyo venues) were responsible for the medical care of athletes and the Olympic Family (International Federations, Tokyo 2020 Organizing Committee, International Olympic Committee officials, etc.). Keio University Hospital collaborated with these hospital groups and primarily played the role of a Specified Collaborative Hospital in charge of venue medical care. Specifically, we were responsible for the following tasks at the Olympic Stadium. Note that "within the venue" included the Olympic Stadium, the athletics practice track (formerly Jingu Soft Baseball Ground), facilities for venue officials (formerly Jingu Second Stadium), and the entire site including the Meiji Memorial Picture Gallery area, which was surrounded by a perimeter. This placed a considerable burden on staff under the scorching sun.

(1) Dispatch of Venue Medical Officers (VMO) and Medical Volunteer Staff

In the Tokyo 2020 Games, a Venue Medical Officer (VMO) was appointed as the medical head separately from the venue operations manager, and medical rooms for athletes and spectators were operated under their command. At the Olympic Stadium, I was appointed as the VMO. From July 18 to September 5 (a total of 26 days including rehearsals), Keio University Hospital dispatched 17 volunteer doctors (151 shifts) and 20 nurses (38 shifts), providing medical response in the venue medical rooms for a total of 189 shifts.

This medical response was implemented based on the Keio version of ICEM mentioned above. There were a total of 44 cases of illness or injury (including 10 foreigners), the majority of which were heatstroke and trauma. However, there were also several cases of suspected COVID-19 and ophthalmological issues. Some were transported by ambulance to Keio University Hospital, ensuring appropriate medical coordination.

(2) Actual Venue Medical Operations

We were in charge of and operated the medical rooms within the venue, which were registered as clinics in Tokyo. Originally, the capacity was expected to be 68,000 people, but the event was held without spectators. However, the venue operation staff and others always numbered in the thousands, and during the opening and closing ceremonies, the scale reached approximately 30,000 people due to ceremony staff and performers. Therefore, we set up a maximum of four medical rooms, including those for the VIP area. Medical response for athletes within the venue was handled by the Athlete Medical Supervisor (AMSV) in the athlete medical room according to the rules of the International Federations, but a system was in place to collaborate with the venue medical team under the command of the VMO in case of emergencies.

(3) Medical Services for International Media and Games Officials (Including International Dignitaries)

A VIP response area was established, primarily for the opening and closing ceremonies. Attendance by many dignitaries, including Games officials and state guests, was expected. We prepared medical care for them and a backup reception system at Keio University Hospital to be ready for any emergencies.

Initial forecasts estimated the number of spectators during the Tokyo 2020 Games at approximately 10 million. Since the current population of Tokyo is about 13 million, it was assumed that the staying population in Tokyo during the event would nearly double. Meanwhile, Keio University Hospital prepared as a whole hospital on the premise of providing all regular medical services, including emergency medical response, during the Games. During the period when many emergency physicians were dispatched to the venue, doctors from various clinical departments were dispatched to the Emergency and Trauma Center to maintain the medical system. Although the decision to hold the event without spectators avoided a massive influx of visitors and a significant increase in Tokyo's population, the importance of responding to heatstroke and emerging/re-emerging infectious diseases, including COVID-19, remained unchanged for a summer event.

Furthermore, as a response to natural disasters, we considered lightning strikes due to sudden weather changes and large-scale earthquakes. Additionally, as the risk has increased rapidly in recent years, we addressed counter-terrorism measures, including responses to blast injuries and chemical/biological weapons. As a medical facility near the venue, we also prepared relevant manuals, strengthened security, and conducted counter-terrorism disaster drills just before the event with the cooperation of relevant departments within the hospital to be able to respond to emergencies such as terrorist attacks or mass casualty incidents.

With the unexpected rapid subsiding of the fifth wave of the COVID-19 pandemic, I believe everyone feels a sense of relief along with a certain kind of anxiety. While there are various opinions and thoughts from different perspectives regarding the merits of holding the Tokyo 2020 Games, I will refrain from discussing those merits in this article.

Since we were first approached by the Organizing Committee, we have been involved in this medical response for four years, including interruptions caused by the COVID-19 crisis. From the beginning, we have consistently believed that as professionals in medical sciences, particularly in emergency and disaster medicine, we should ensure that national events are conducted safely even under the once-in-a-century COVID-19 pandemic, and that they should not have a major negative impact afterward.

If the national government, the Tokyo Metropolitan Government, the International Olympic Committee, and the Organizing Committee decided to hold the event, medical institutions—especially a university hospital, which is a Special Function Hospital responsible for advanced medical care—should fulfill their social responsibility. We worked hard from a professional standpoint to complete that mission. While we believe we have achieved certain results at this stage, our medical response will likely be objectively verified in the future, including the construction of a legacy for the Paris Olympics.

Furthermore, the dispatch of medical staff and the development and strengthening of the medical system at Keio University Hospital this time served as an opportunity to further strengthen the emergency medical system, which is the cornerstone of our hospital's advanced acute care, and to solidify crisis management and safety measures. These points are precisely what can be called the legacy for Keio University Hospital.

I would like to take this opportunity to express my sincere gratitude to all those involved for their cooperation and support in the medical response to the Tokyo 2020 Games, and with that, I conclude this article.