MEDICAL SUPPORT FOR MASS GATHERINGS

Large events have been defined in many ways, from the vague description of a focused gathering of people to the more specific description of an event with at least 1,000 spectators and participants who are gathered at a specific location for a defined period of time. Regardless of the definition applied, the actual medical requirements vary considerably from one event to the next. The ability to predict these medical needs allows for the provision of adequate medical support. Many factors contribute to medical need at a large event, including event type, weather (particularly heat index), the presence of alcohol and / or illicit drugs, the number of participants, event duration, crowd demographics, and venue characteristics. This review will focus on the various features of large events such that the medical planner can better understand the challenge and provide adequate resource for patient care.

Once a year during the festival of Sun-Moon Lake in Nan-Tou County, Taiwan, a long-distance swimming mass gathering (LDSMG) event takes place. This event, in which participants swim an estimated 30 km, is very popular; the total number of spectators and participants at the 2002 festival was 15,189. This study, the first pertaining to the LDSMG, aimed to review the effect of the environmental factors at this particular mass gathering event, with mass being defined here as more than 1,000 people, upon the event's patient presentation rate (PPR). This was done to provide improved medical services at this event in future years The study also aimed to collect patient data from the two medical stations (one upstream and one downstream) and analyze the differences between them. In 2002, the number of patients requiring first aid treatment was determined from data gathered on-site. A total of 63 presented at on-site medical stations (PPR, 4.15 per 1,000 attendees), where 14 patients presented to a downstream medical station and 49 to an upstream medical station. The mean age of the patients was 35.46 ± 15.14 years; ages ranged from 1 to 65 years. Forty-nine of the patients (78%) were male. Fifty-nine patients were treated with medication (3.88 per 1,000 attendees), and two were taken to hospital (0.13 per 1,000 attendees). Injuries sustained included trauma (71%), such as impact, fall, sprain, stabbed laceration and burn, hypothermia (5%), and foreign bodies (3%). The PPR at the LDSMG was related to factors including the presence or absence of seating, whether the event was outdoors or indoors, mobility of the crowd, whether the activity was contained within a boundary, attendance figures, and humidity level. The weather, particularly the relative humidity (81%), was also positively correlated with an increase in the number of presentations at the medical stations.

La sixième Coupe du monde de rugby organisée par la France a eu lieu du 7 septembre au 20 octobre 2007 sur dix stades français, un stade gallois (Cardiff) et un stade écossais (Edimbourg). Le modèle d’organisation s’est inspiré largement de celui de 1998 lors de la Coupe du monde de football (la compétition ayant lieu sur les mêmes stades en France), mais aussi des recommandations de la FFR, gestionnaire des grandes compétitions de rugby sur notre territoire (Tournoi des Six Nations, Top 14, tests matchs). Les moyens médicaux comprenaient des moyens professionnels privés et associatifs selon un cahier des charges établi par l’organisateur et validé par l’État.

The sixth Rugby World Cup was hosted by France from 7th September to 20th October 2007. The model was based on the1998 FIFA World Cup and implemented the same 10 stadiums in France, one Welsh stadium (Cardiff) and one Scottish stadium (Edinburgh). Recommendations from the FFR, host organisers for the Six Nations Tournament, the TOP 14 and various test matches, were integrated into the model. The health and safety teams were made up of highly-trained professionals from the private sector and volunteers from various associations, following the guidelines set out by the organiser and validated by the State.

This report describes not only the implementation of a coordinated emergency medical services–hospital–based healthcare team but also investigates the integration of nurse-physician teams at a mass gathering medical care event.

A review of resource utilization, patient encounters, and local ED census was performed during this period at a college football stadium.

During this 4-year period, 1681 patients presented for medical care during 26 events with a total attendance of 1 544 244 (1.09 patients per thousand attendees [PT]). The majority of patient contacts were for minor complaints (1451, 87.6%), whereas 205 (12.4%) received full evaluations (focused history and physical examination most often with pulse oximetric and electrocardiographic monitoring). A total of 109 patients were transported (4.19 PT), representing 6.48% of all patients. Patient census for the event medical deployment increased from 0.44 PT in 2001 to 1.75 PT in 2004. The number and percent of patients transported also increased between 2001 (0.02 PT, 4.48%) and 2004 (0.12 PT, 6.67%). However, 118 (57.6%) patients who received full evaluations were able to be discharged by a physician, avoiding transport. Chief complaints and management of patients receiving full evaluations were consistent across this period, with altered mental status (52.7%) and chest pain (12.7%) as the most common complaints. Average ED census during this period was found to be significantly higher on event days (176.2) than nonevent days (161.2) (t = 8.04, P < .001), although this produced only a minor impact on the emergent care system.

This study describes one potential deployment plan for a mass gathering medical event and suggests that the incorporation of physicians into a mass gathering setting may be associated with an absolute increase in patient census and transports, while decreasing the percent of patients transported. The impact on local emergency medical services and ED resources, although not specifically investigated in this study, was likely minimal.

An increasing number of large recreational events are taking place in remote environments where medical care is far away. Such events include adventure races and large outdoor trips. Wilderness event medicine (WEM) has been previously defined as the healthcare response at any discrete event with more than 200 persons located more than 1 h from hospital treatment. However, there is little literature describing the steps for providing medical care at such events.

This article provides a framework for planning and executing WEM. It reviews the published data on wilderness injury and illness rates and describes the nature of injuries as they relate to specific activities. The article then discusses the three stages of WEM: pre-event planning, medical treatment at the event, and post-event tasks.

Wilderness events include myriad activities, including orienteering, mountain biking, mountaineering, and whitewater paddling. The injury and illness rates are in the range of 1–10 per 1000 person-days of exposure, with rates one order of magnitude greater for events which last many days, include extremes of environment (heat, altitude), or are competitive in nature. Professional adventure racers may present for medical evaluation at rates as high as 1000 encounters per 1000 racer-days. Injuries depend largely on activity. Illnesses are mostly gastrointestinal, ‘flu-like’ malaise, or related to the event environment, such as humidity or altitude. Providing medical care requires the proper staff, equipment, and contingency plans. The remoteness of these events mandates different protocols than would be used at an urban mass gathering.

WEM will likely continue to grow and evolve as a specialty. Additional reports from wilderness events, perhaps facilitated through a web-based incident reporting system, will allow medical providers to improve the quality of care given at remote events. Research into wilderness activity physiology will also be useful in understanding the prevention and treatment of injuries and illnesses encountered.

Gatherings of large numbers of people at concerts, sporting events, and other occasions lead to an assembled population with a potential for a wide variety of illnesses and injuries. The collection of large numbers of people in a single location has led some authors to recommend the placement of resuscitation equipment or other medical services in close proximity to these activities. These recommendations not withstanding, data on the frequency of critical illness at mass gatherings (a group exceeding 1000 persons) are difficult to ascertain. Therefore, it was the purpose of this study to describe the incidence of critical illnesses among assembled populations at mass gatherings. An observational prospective study was conducted involving patient encounters at a large, multipurpose, indoor mass-gathering complex in Houston, Texas occurring between Septemver 1, 1996 and June 30, 1997. Demographic, treatment, disposition and diagnostic data were analyzed in a computerized database. Of the 3.3 million attendants to the 253 events analyzed during the 10-month study period, there were 2762 (0.08%) patient encounters. Fifty-two percent were women. Mean age was 32 ± 15.6 years. Of these patients, 51.1% were patrons and the remaining patients were employees or contractors of the facility. A wide variety of illness was seen with trauma (39.5%), headache (31%), and other medical complaints (29.5%) being most frequent. Disposition of the patients included 95.3% being discharged to go back to the event and 2.2% being counseled to seek other medical attention. One hundred twenty-nine patients (4.7%) were referred to the Emergency Department (ED); of these, 70 were transferred for abrasions, lacerations, or skeletal injuries and 13 for chest pain. Of those referred to the ED, 50 (38.7%) patients were transported by ambulance and only 17.4% were admitted to telemetry, with none admitted to an ICU. It is concluded that critical illness at mass gatherings is infrequent, as seen in this study, with very few being admitted to telemetry and none to an ICU. Careful consideration of cost-benefit should occur when determining allocation of resources for these activities.