Music medicine.

Our lab was located in the middle of Woodstock '99--here's how we prepared for the worst and delivered our best!

The news that Woodstock '99 was coming to Rome, NY, at the very location of our newest outpatient laboratory was exciting news to many of us at Centrex Clinical Laboratories. As the operations manager for that lab, I would be responsible for providing diagnostic services at this daunting event. Some 200,000 excited fans were expected to flood the vast grounds of the Griffiss Business and Technology Park, located in Rome, on a hot weekend in July.

The services of the medical team for the festival were being billed as "music medicine," and the teamwork that this special event inspired was unforgettable.

Preparing for the event

Early in 1999, rumors were flying about that the Woodstock festival was coming to Rome. Philip Vuocolo, MD, who operates an urgent care clinic in the medical complex where our lab is located in Griffiss Business and Technology Park, requested a meeting in late April with Centrex representatives. Dr. Vuocolo was to serve as the medical team director for the festival, and the urgent care clinic would be outfitted to serve as a temporary "mini-hospital" to care for the concert-goers. The designated Woodstock clinic would be located just down the hall from us in the medical complex. The medical team would require 24-hour laboratory services, and our laboratory staff members would be considered official medical team volunteers. Centrex would be the designated lab for Woodstock '99.

Centrex, a regional facility that operates 5 laboratories and employs approximately 300 personnel, had already given me a wealth of experience as a multi-site operations manager, but Woodstock provided me with my challenge for the year.

The first meeting. At our initial meeting, Dr. Vuocolo gave an overview of what the medical services would include. Several first aid tents would be located on the festival grounds. Minor medical cases would be treated at these stations, and more serious cases would be transported by ambulance to the clinic at the medical complex. My initial concern was that we might have problems transporting blood samples collected at the tent stations to the main lab, but luckily no specimen transport would be necessary. Patients whose health status made blood work necessary would be transported to the medical complex.

Dr. Vuocolo described the kinds of tests he felt would be required. First on the list were tests relating to dehydration, because the concert would be held July 23rd through July 25th The Griffiss site, a former U.S. Air Force base, has large areas of tarmac with no shady places for relief from the sun.Dehydration was a major concern, and electrolyte profiles would be high on the roster of ordered tests. Physical injuries might warrant X-rays, and it was anticipated that serum and urine pregnancy tests would be popular requests before X-rays could be taken. Complete blood counts, urinalysis, and routine chemistries would also be frequent requests.

So far, so good-all of those tests were offered in-house at the Rome laboratory. However, last on the list of needed tests was urine drug screening. Our Rome facility does not have a New York State Department of Health permit to perform drug screens, and this was our first stumbling block. Dispatching these urine samples 18 miles to our central laboratory did not seem realistic. Local traffic was expected to be a big problem, and there were no guarantees that a courier could get in and out to deliver samples. We would have to see what could be done to provide this service on-site.

Staff coverage. Arranging staffing for Woodstock weekend was going to prove difficult. Coverage for the festival would be needed 24 hours a day, from noon on Thursday, July 22nd, through noon on Monday, July 26th. We would need medical technologists, phiebotomists, and specimen processing staff

The festival was to be held during our peak employee vacation time. I am one of 2 managers responsible for preparing a monthly master schedule for our technical staff members at 3 Centrex labs (Rome, NY; St. Luke's Hospital, New Hartford, NY; and Faxton Hospital, Utica, NY). Currently, the Rome lab is staffed with only 1 technologist on the day shift and 1 on evenings. Also, we employ only 1 phiebotomist during the day.

The problem was maintaining adequate staff coverage in the 2 labs at Faxton Hospital and St. Luke's Hospital. A big concern was that critical patients from the medical complex at Rome would end up at Faxton and St. Luke's, straining services at those sites. I remember thinking that cloning our technical staff would be the only answer.

One aspect of coverage, however, was not a problem. We have a pool of cross-trained employees who can work in more than 1 location. Cross-training at Centrex is relatively easy because all of its labs have similar analyzers; the models are geared toward a particular volume. Also, all Centrex labs are linked by the same laboratory information system, which means that the interface screens and options are all the same. That weekend we would need medical technologists to cover shifts at Rome who had never worked there before, but their training would not have to be extensive.

When the announcement was made that employees were needed in Rome to cover the lab for Woodstock weekend, I received a strong response from each division of our staff Dr. Vuocolo estimated that approximately 100 patients a day would require lab services, starting July 22. We anticipated that we would need 1 medical technologist on duty at all times, with the addition of 1 medical laboratory technician during the evening shift into the early morning. Because the medical staff would be drawing the blood samples, we were told that none of our phlebotomists would be needed. We were not comfortable with this, so we staffed with 1 phlebotomist on each shift for difficult draws and order-entry work. I also added a central processing clerk to the evening shift, anticipating this as the busiest time.

After we had decided how many, we had to decide who. Two of the regularly staffed technologists at Rome were among our first volunteers. One medical technologist from the Centrex Syracuse, NY, outpatient lab and 1 medical technologist from the Faxton Hospital lab volunteered. In addition, I recruited a medical laboratory technician from our special testing center to have a certified breath-alcohol tester on staff if needed. Two phlebotomists from St. Luke's and 1 from Syracuse completed the staffing for phlebotomy. Also, I enlisted a specimen processor from Faxton Hospital.

Arriving at the final talent line-up for the lab took approximately 2 months; schedules had to be arranged and rearranged many times to adequately cover all the sites. The technical staff members who did not routinely work in the lab at Rome were very flexible with their own schedules to facilitate training. I needed them to be as comfortable as possible at the Rome site if they were to function independently.

Urine drug screening. We had to act quickly to obtain a New York State drug-screening permit before July. After some shopping around, we selected the Rapid Drug Screen from American Bio Medica Corporation (Kinderhook, NY). Our special chemistry department at St. Luke's Hospital began correlation studies between this kit and the Axsym--we had to perform a complete validation as well as pass 2 rounds of proficiency testing. I was concerned that we would not be able to complete this work before Woodstock weekend, so we contacted the New York State Department of Health. They suggested running the urine drug screen as a health fair, using our St. Luke's permit. This would save us the time of having to perform proficiency testing, a good solution because we were hurrying to add this new category.

Inventory. We could not obtain sufficient data about the testing performed for the last Woodstock festival held at Saugerties, NY, in 1994, so we had to use our best judgment in stocking supplies. Our usual inventory on hand is a 2-weeks' stock of supplies.

We were not sure if extra supplies could be delivered that weekend because of the anticipated traffic problems. Consequently, we added an extra 3 weeks' worth of inventory and ordered 750 drug kin. The unused kits could be incorporated at other sites.

Woodstock weekend

I was lucky to get into the Griffiss Air Force Base housing on Wednesday before the concert to pick out rooms for my staff Dormitory housing that had been vacant since the base closed 5 years before would be used as living quarters. We had already decided that we would live at the site of the festival during Woodstock weekend--none of us relished fighting our way through mobs of people and cars to travel to and from home.

Because it was first come, first serve, I raced from room to room trying to find suitable spaces. Placing a name on the door reserved a room. The rooms were dirty and some had plumbing problems. I was feeling discouraged about the unsanitary conditions and brought my concerns to the administrative officers at Centrex, telling them I needed petty cash for cleaning supplies. When they heard my plan to clean the bathrooms myself, they insisted on hiring a service. This was a welcome relief for me, and my staffs clean rooms were the envy of Building 444.

Each Woodstock lab worker received a medical team ID badge that had to be worn at all times. The badges had bar codes on the back, which were scanned whenever we went to eat at our food tent. The badges also served as backstage passes and gave us a chance to get close to some of the bands that were performing. Two of the phlebotomists were allowed backstage to see the Dave Matthews Band and Metallica.

Our first patient came in soon after the clinic opened for business. It truned out to be a very hot weekend, and many of the patients treated there suffered from dehydration. We also had our share of drug overdoses and moshpit injuries, which were mainly cuts and bruises.

We were all very excited, hoping to give high-quality service and a rapid turnaround time. Specimens came at a steady pace throughout the weekend, but the busiest times were Friday and Saturday nights. One tense moment came on Thursday, when our Coulter STKS went down because of a problem with the aspirating needle. Thankfully, a service representative was able to get in to fix the problem. I didn't think he would make it through all the traffic and the security checkpoints, which were stopping cars as the first crowds arrived.

Late on Friday afternoon, Woodstock promoters were having a problem transporting medical supplies to all the first aid stations on the festival grounds. There were not enough volunteers to operate the golf carts used to deliver supplies. I ran into Dr. Vuocolo in the hail, and he asked if there was any way Centrex could help.

In response, I quickly asked 2 of my staff people to make phone calls to solicit aid from Centrex employees, friends, and families. They needed to find at least 30 volunteers to help deliver supplies. In exchange for their assistance, the volunteers would be given medical team ID badges and could enjoy the concert when they were not working. We were able to get 26 volunteers, and Michael Lang, one of the concert's promoters, autographed our medical team T-shirts with his thanks.

Successful results

We received many compliments that weekend from the doctors and nurses who worked at the medical complex. They were pleasantly surprised with the testing we offered in-house and were astounded by our turnaround time. One nurse commented that the lab at her hospital back home couldn't come dose to our turnaround time. As the operations manager, this was "music medicine" to my ears!

When we looked at the numbers, we found that we had performed testing on a total of 259 patients during the weekend (see Table 1). We also performed many individual chemistries that were not ordered as panels. Only 10 tests had to be sent to our main lab at St. Luke's Hospital, which included therapeutic drug monitoring, urine cultures, and miscellaneous chemistries.

The turnaround time for stat testing was determined for selected tests from order entry to result verification. Our standard stat turnaround time during that weekend was 1 hour from order entry to result verification (see Table 2).

In retrospect

After the concert was over and we were busy getting our lab back to normal, I thought about what I might have done differently. The inventory stock we had kept on hand was much more than we needed. We had ordered 750 drug kits and used only 49. We also overestimated on pregnancy test kits. Luckily, we were able to incorporate both of these kits at our other locations. Other than the inventory ordering, I would use our 1999 plans again for any future Woodstock events.

I conducted an informal poll of "Team Centrex" after the Woodstock '99 weekend was over. I simply asked, "Would you do it again?" and the response I received was an overwhelming "Yes!" It was an exciting opportunity for us to be part of a once-in-a-lifetime event.

Jack Zito is Operations Manager for Centrex Clinical Laboratories, Inc., Rome, NY, and Faxton Hospital, Utica, NY.

                           Test volume performed
                             at Woodstock '99
Test                        Number
Complete blood count           128
Urinalysis                      81
Basic metabolic panel           59
Urine drug screens              49
Serum/urine pregnancy           37
Electrolyte panel               33
Comprehensive panel             30
Hepatic panel                   14
Prothrombin time                 9
Partial thromboplastin time      8
Sedimentation rate               4
Mononucleosis test               1
                        Stat test turnaround times
                         Average
                       turnaround    Percent verified
Test                 time in minutes  [less than] 60
                                         minutes
Complete blood count      27.2             95.1
Comprehensive panel       28.6             90.9
Basic panel               29.1            100
Electrolyte panel         31.1             87.5
Urine drug screen         38               84.2
Urinalysis                40.7             89.7