Imagine you鈥檙e an ambulance service director in a rural county. At the last minute, you鈥檙e responsible for staffing a 40,000-visitor-per-day event 鈥� more than your county鈥檚 entire population. In addition, it鈥檚 scheduled to last for eight consecutive weekends. This is on top of your already busy 911, nonemergent transport, and standby responsibilities.
Oh, and you only have a month to prepare. Sound daunting?
That鈥檚 the predicament Billy Rice, director of EMS for Texas鈥� St. Joseph Health, found himself in.
After using St. Joseph Health EMS for several years, organizers of the Texas Renaissance Festival decided in 2023 to switch medical providers for the event. As opening day approached, however, they concluded St. Joseph Health EMS was the only provider that could handle an event of the festival鈥檚 magnitude.
鈥淎bout a month before the festival, they realized it wouldn鈥檛 work. They called us and asked us to help,鈥� said Billy Rice. 鈥淥f course, it鈥檚 our people and our county, so we stepped up and pulled it off.鈥�
A major component involved the patient wristbands now being used across Texas, paired with the platform for tracking patients and managing events.
鈥楾HEY鈥橵E BEEN COMPLETELY TRANSFORMED鈥�
The wristbands attempt to solve a couple of chronic EMS challenges: linking patients across disparate medical records systems, such as from EMS to hospital to specialty care, and enabling patient tracking during mass-casualty incidents. The wristbands went live across the state in 2023.
First responders, EMS, or hospital staff place the wristbands, which bear unique alphanumeric codes, on patients. Caregivers use the platform to quickly scan a band鈥檚 barcode to create a new care channel for its wearer, and subsequent caregivers can also join that channel by scanning the wristband. This allows everyone involved in that patient鈥檚 care to document their activities within the platform and see what interventions have been performed and by whom. This all happens much faster than traditional MCI methods permit and helps avoid care silos and the risk of communication errors at handoff. The app allows responders to send notifications, message with other team members, share images, and make audio/video calls.
For incident commanders, Pulsara also provides the big-picture view of how many patients have been treated, who they are, what鈥檚 been done, and where they鈥檝e gone. That鈥檚 a valuable overview when running an MCI or mass gathering.
EMS organizations under Texas鈥� Brazos Valley Regional Advisory Council (RAC) 鈥� one of 22 RACs that manage EMS in the state 鈥� have been at the forefront of adopting wristbands and using Pulsara to manage major events. They implemented full use of both the wristbands and Pulsara for ambulance-to-ED communications in October 2022.
While the platform is straightforward and easy to use, there was an adjustment curve for both the EMS and hospital sides.
鈥淔or us, the first phase was just getting the paramedics to use and understand Pulsara and start building the muscle memory for it,鈥� said Rice. 鈥淲e had some pushback from the ERs 鈥� it鈥檚 change, and change is hard. But now they鈥檝e been completely transformed positively because of it.鈥�
The second phase for St. Joseph Health was to expand Pulsara to 鈥減replanned disasters鈥� 鈥� the major events that, like the Texas Renaissance Festival, will produce a certain number of sick and injured attendees even if they proceed optimally. 鈥淲e know those disasters are coming,鈥� Rice added. 鈥淲e can plan for them and build a process.鈥�
In spring 2023, St. Joseph Health EMS used the platform to provide care at Chilifest, a two-day music festival that drew over 35,000 people. Typically, it鈥檚 hard to track patients in festival situations. Providers are mainly trying to treat and release 鈥� avoid transport if possible, and just let overwrought attendees cool down, get sober or patched up, and pause long enough to feel better.
鈥淚n years past, it would be very difficult to know how many people you had in the tent, who was being treated, and their acuity level,鈥� said Rice. 鈥淲e were doing everything on paper and a few laptops. Real-time situational awareness didn鈥檛 really exist. I mean, I鈥檇 know my people were out there, I could see the trucks, and dispatch would try to keep track, but unless a supervisor came on and said he had a real problem, you鈥檇 just kind of let the event run itself. And I think that鈥檚 how most large-scale incidents in this country go.鈥�
Using Pulsara, St. Joseph Health captured information for 34 patients at Chilifest 鈥� about half of those it saw. Not bad, but leaders felt they could do better. In October, they got the chance.
FESTIVALS PRODUCE BIG NUMBERS
Familiarity and practice with Pulsara meant being called back into action on short notice at the Texas Renaissance Festival was a manageable challenge 鈥� although the massive event would require reinforcements. 鈥淚t鈥檚 like putting up another county鈥檚 worth of resources,鈥� said Rice. 鈥淚 don鈥檛 have the staff to pull that off alone.鈥�
St. Joseph Health arranged for support from medics with the Bryan Fire Department. Because that department also uses Pulsara, they were easily integrated into care scenes and command structures and worked the same way as their St. Joseph Health counterparts. Interoperability was seamless.
Around the same time, another music event occurred in Snook, just outside College Station: the Live at the Station Festival, headlined by country artist Zach Bryan. The event itself was a 鈥� but the EMS management was near-flawless. 鈥淭his,鈥� said Rice, 鈥渋s where the use of the Pulsara incident management system transformed my organization. The numbers generated that day took it to the next level.鈥�
At both Live at the Station and the Renaissance Festival, St. Joseph Health placed a dispatcher on site. Patients could access care by calling 911, walking to an EMS station, or asking emergency personnel or event staff. The dispatchers maintained high-altitude views of the cases recorded in Pulsara and functioned as liaisons with local authorities. In the past, those connections weren鈥檛 always robust 鈥� EMS providers within event grounds were often on an island and might not be called for an incident right outside the festival gates, even if they were closest. The on-site dispatcher allowed resources to be pulled back and forth.
All patients seeking help had their IDs or driver鈥檚 licenses scanned 鈥� even those with minor complaints. This provided a more complete picture of the event鈥檚 medical impact and EMS care required. 鈥淲e knew who everyone was, and that鈥檚 what was amazing about it,鈥� said Rice. 鈥淚 could have 200 people with headaches or abrasions and know every single person who walked into our medical tent.鈥�
Over October and November, with the Renaissance Festival, Live at the Station, Texas A&M football, and other events, St. Joseph Health providers became extremely proficient at using Pulsara for mass events. Their numbers were notable enough that the Texas Division of Emergency Management (TDEM) took an interest in how they did it. 鈥淲hen those numbers came up 鈥� one day it was 151; the Zach Bryan concert was 200 鈥� I think they thought they were fake,鈥� said Rice. 鈥淲e only had 12 providers on scene. I think they thought we were trialing the system.鈥�
Now TDEM is creating a regional emergency management group that will have Pulsara access when major events happen, track patients, and help drive family reunifications.
NO GOING BACK
For St. Joseph Health, the next stage of use will involve unplanned disasters. In November, a supervisor was able to singlehandedly band, scan, and process seven carbon monoxide patients when a second ambulance wasn鈥檛 nearby (though, of course, had any been critical, their treatment would have taken priority). But more likely, the organization expects, is that dispatchers will designate MCIs based on predefined criteria and alert field units.
鈥淲e鈥檒l build some kind of benchmark,鈥� Rice said, 鈥渁nd if we hit that, the dispatcher will automatically create the incident and tell each responding ambulance that an incident鈥檚 been created, so they know to stay inside the incident in Pulsara.鈥�
Exercises to this end have gone well. In one exercise, providers from eight agencies created and moved information on 112 patients to ER personnel within minutes. 鈥淚magine eight different people trying to call in radio reports to the ER,鈥� noted Rice. 鈥淭he whole system would collapse.鈥�
Elsewhere in Texas, TDEM leaders want to replicate the Brazos Valley RAC鈥檚 approach statewide, and joining the Pulsara platform to the wristband project has helped pique interest and support.
鈥淚n the early days of the wristbands, I regularly had to remind folks in the region that they unanimously voted to support this project,鈥� said Rice. 鈥淧eople didn鈥檛 understand where the wristbands were going or how it would be helpful. Once we added Pulsara, the value of the wristbands immediately sold itself because anybody who walks up to that wristband and scans it with Pulsara is now part of that patient care record.
As the success of the Pulsara platform and wristband technology resonates across Texas, it marks a significant leap in the evolution of emergency management at large-scale events. The adoption of this technology by St. Joseph Health EMS and its widespread acceptance among crews and administrators underscore a pivotal shift in how emergencies are addressed in bustling festival environments.
鈥淢y crews will not go back,鈥� said Rice. 鈥淭hey鈥檙e completely hooked. The dispatchers love it. The field staff loves it. The administration loves it. We鈥檝e never had access to this level of transparency.鈥�
Rice鈥檚 sentiment echoes a broader transformation: a move toward a future where technology and human expertise blend seamlessly to enhance safety and efficiency. The wristbands, more than just tools, symbolize a commitment to innovation and proactive care, paving the way for smarter, safer, and more connected emergency response systems.
This journey of technological integration at the Texas Renaissance Festival and beyond is a testament to the power of collaboration, adaptability, and foresight. As other regions in Texas and across the country look towards the Brazos Valley RAC鈥檚 model, the path they tread now will redefine the landscape of emergency management in the years to come.
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