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

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, which shook the entire world.

It is still fresh in our memories that the fifth wave of the COVID-19 pandemic hit Japan during the interval between the Olympic Closing Ceremony on August 8 and the Paralympic Opening Ceremony on August 24, with the capital city of Tokyo recording record-high numbers of infections daily. 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 (Japan National Stadium), including the preparation process.

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

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

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

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

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

(3) Avoiding 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.

Referencing "ICEM: Immediate Care in Emergency Medicine" practiced at Wembley National Stadium, one of the main venues of the London Olympics, emergency physicians who received training in London developed a Keio original version adapted for the Olympic Stadium and introduced it to the venue's medical response. This allowed us to provide services through a highly organized medical team of specialists, including first responders (citizen volunteers), following a designated chain of command. The implementation of this emergency medical response based on ICEM received high praise from the medical directors of the Organizing Committee.

As in previous Games, the treatment of athletes and the Olympic Family (International Federations, Tokyo 2020 Organizing Committee, International Olympic Committee officials, etc.) was handled by 10 Olympic Hospitals (Tokyo venues) and 4 Collaborative Hospitals (outside Tokyo). Keio University Hospital collaborated with these hospital groups and primarily played the role of a Designated Collaborative Hospital in charge of venue medical care. Specifically, we were responsible for the following operations at the Olympic Stadium. Note that "within the venue" included the Olympic Stadium, the athletics practice track (formerly Jingu Gaien Soft-Ball Ground), facilities for venue officials (formerly Jingu No. 2 Stadium), and the entire site including the Jingu Gaien Meiji Memorial Picture Gallery area, known as the perimeter; the workload was considerable 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 medical volunteer doctors (151 shifts) and 20 nurses (38 shifts), performing medical responses in the venue medical rooms for a total of 189 shifts.

The medical response was carried out based on the aforementioned Keio version of ICEM. There were a total of 44 cases of illness or injury (including 10 foreigners). While heatstroke and trauma cases accounted for the majority, 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 with the Tokyo Metropolitan Government. Originally, the capacity was expected to be 68,000 people, but it became a spectator-free event. 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 cast members. Therefore, we set up a maximum of four medical rooms, including those for the VIP areas. Medical response for athletes within the venue was handled by the Athlete Medical Supervisor (AMSV) in the athlete medical room according to International Federation rules, but a system was in place to coordinate with the venue medical team under the VMO's command in case of emergencies.

(3) Medical Services for International Media and Games Officials (including international dignitaries)

VIP areas were established primarily for the opening and closing ceremonies. Attendance by many dignitaries, including Games officials and those of state-guest rank, was expected. We prepared medical care and a backup reception system at Keio University Hospital to handle these individuals and 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 to provide all regular medical services, including emergency medical response, during the Games. For the period when many emergency physicians were dispatched to the venue, doctors from various clinical departments were sent 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 people, the importance of responding to heatstroke and emerging/re-emerging infectious diseases, including COVID-19, remained unchanged for a summer event.

Response to natural disasters, such as lightning strikes from sudden weather changes and large-scale earthquakes, was also considered. Furthermore, as the risk has rapidly increased 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 ensure we could 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 mixed with a certain degree 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 the hiatus caused by the pandemic. From the beginning, we have consistently believed that as professionals in medicine, particularly 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 do not leave 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, we felt we should fulfill our social responsibility as a medical institution—specifically as a Keio University Hospital, which is an Advanced Treatment Hospital responsible for highly advanced medical care. We worked hard from a professional standpoint to complete that mission. While we believe we have achieved certain results, our medical response will likely be objectively verified in the future, including the establishment 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 served as an opportunity to further bolster our emergency medical system, which is the cornerstone of our hospital's acute care, and to strengthen 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 heartfelt gratitude to all those involved for their cooperation and support in the medical response to the Tokyo 2020 Games, and with this, I conclude this article.