Mass Gathering Medical Care: A Twenty-Five Year Review

Health Care Services in Shopping Centers: A Routine Mass-Gathering Event

BACKGROUND

Shopping centers (SCs) are social areas with a group of commercial establishments which attract customers of numerous people every day. However, analysis of urgent health conditions and provided health care in SCs has not been performed so far.

OBJECTIVE

The aim of the study was to perform a comparative analysis of clients visiting SCs and demographics, complaints, and health care of patients admitted to Emergency Medical Intervention Units (EMIU) located in grand SCs in Ankara, Turkey.

METHODS

Customer and health care records of nine grand SCs in Ankara from January 1, 2018 through December 31, 2018 were evaluated retrospectively. Health care services in EMIUs of SCs were provided by employed medical staff. Data including demographic characteristics, complaints, treatment protocols, discharge, and referral to hospital of the patients were retrospectively analyzed from medical registration forms.

RESULTS

Medical records of nine grand SCs were analyzed. Number of customers could not be obtained in three SCs due to privacy issues and were not included in patient presentation rate (PPR) and transport-to-hospital rate (TTHR) calculation. Total number of customers in the remaining six SCs were 53,277,239. The total number of patients seeking medical care was 6,749. The number of patients seeking health care in six SCs with known number of customers was 4,498 and PPR ranged from 0.018 to 0.381 patients per 1,000 attendants. The median age of the recorded 4,065 patients (60.2%) was 28 (interquartile range [IQR]: 38-21), and 3,611 (53.5%) of the patients admitted to EMIUs were female. The number of patients treated in the SC was 4,634 (68.6%) and 189 patients (2.8%) were transferred-to-hospital by ambulance for further evaluation and treatment. Transportation to hospital was required in 125 patients who sought medical care in six SCs which provided total number of customers, and TTHR ranged from 0.000 to 0.005 patients per 1,000 attendants. No sudden cardiac death was seen. Medical conditions were the primary reasons for seeking health care. The most frequent causes of presentation were laceration and abrasions (639 patients, 9.4%).

CONCLUSION

The PPR and TTHR in SCs are low. The most common causes of presentation are minor conditions and injuries. Majority of urgent medical conditions in SCs can be managed by health care providers in EMIUs.

Assessment of Temporary Medical Clinics During the Arbaeenia Mass Gathering at Al-Karkh, Baghdad, Iraq, in 2014: Cross-Sectional Study

Background

During mass gatherings, public health services and other medical services should be planned to protect attendees and people living around the venue to minimize the risk of disease transmission. These services are essential components of adequate planning for mass gatherings. The Arbaeenia mass gathering signifies the remembrance of the death of Imam Hussain, celebrated by Shiite Muslims, and takes place in Karbala, which is a city in southern Iraq. This annual mass gathering is attended by millions of people from within and outside Iraq.

Objective

This study aimed to map the availability of medical supplies, equipment, and instruments and the health workforce at the temporary clinics located in Al-Karkh, Baghdad, Iraq, in 2014.

Methods

This assessment was conducted on the temporary clinics that served the masses walking from Baghdad to Karbala. These clinics were set up by governmental and nongovernmental organizations (NGOs) and some faith-based civil society organizations, locally known as mawakib. We developed a checklist to collect information on clinic location, affiliation, availability of safe water and electricity, health personnel, availability of basic medical equipment and instruments, drugs and other supplies, and average daily number of patients seen by the clinic.

Results

A total of 30 temporary clinics were assessed: 18 clinics were set up by the Ministry of Health of Iraq and 12 by other governmental organizations and NGOs. The clinics were staffed by a total of 44 health care workers. The health workers served 16,205 persons per day, an average of 540 persons per clinic, and 368 persons per health care worker per day. The majority of clinics (63% [19/30]-100% [30/30]) had basic medical diagnostic equipment. Almost all clinics had symptom relief medications (87% [26/30]-100% [30/30]). Drugs for diabetes and hypertension were available in almost half of the clinics. The majority of clinics had personal hygiene supplies and environmental sanitation detergents (78%-90%), and approximately half of the clinics had medical waste disposal supplies. Instruments for cleansing and dressing wounds and injuries were available in almost all clinics (97%), but only 4 clinics had surgical sterilization instruments.

Conclusions

Although temporary clinics were relatively equipped with basic medical supplies, equipment, and instruments for personal medical services, the health workforce was insufficient, given the number of individuals seeking care, and only limited public health service, personal infection control, and supplies were available at the clinics.

Use of Predictive Modeling to Plan for Special Event Medical Care During Mass Gathering Events

Objectives:

In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.

Methods:

Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.

Results:

BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.

Conclusions:

The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.

Evaluation of Health Care Services Provided in Political Public Meetings in Turkey: A Forgotten Detail in Politics

Background

Political parties in Turkey execute political public meetings (PPMs) during their election campaign for members of the parliament (MoP). A great number of people attend these meetings. No guidelines exist regarding preparation and organization of health care services provided during these meetings. Furthermore, there is no study evaluating health care problems encountered in previous PPMs.

Objective

Political parties arranged PPMs in 2015 during the election campaign for general election of MoP. The present study aimed to investigate the context of health care services, the distribution of assigned health staff, as well as the number and the symptoms of patients admitted in health care tents in these PPMs.

Methods

Two general elections for MoP were done in Turkey on June 7, 2015 and November 1, 2015. Health care services were provided by the City Emergency Medical Services Department (CEMSD) in the cities. Demographic characteristics, symptoms, comorbid conditions, treatment, discharge, and hospital transfer of the patients were obtained from patient medical registration records. Information about the distribution and the number of the assigned staff was received from local CEMSDs. The impact of variables such as the number of attendees, heat index, humidity, and the day of the week on the number of patients and the patient presentation rate (PPR) were analyzed.

Results

A total of 97 PPMs were analyzed. The number of total attendees was 5,265,450 people. The number of patients seeking medical help was 1,991. The PPR was 0.5 (0.23-0.91) patients per 1,000 attendees. Mean age of the patients was 40 (SD=19) years old while 1,174 (58.9%) of the patients were female. A total of 1,579 patients were treated in the tents and returned to the PPM following treatment. Two-hundred and three patients were transferred to a hospital by ambulance. Transfer-to-hospital ratio (TTHR) was 0.05 (0.0-0.13) patients per 1,000 attendees. None of the patients suffered sudden cardiac death (SCD) or cardiac arrest. Medical conditions were the main cause for admission. The most common symptoms were dizziness, low blood pressure, fatigue, and hypertension, respectively. The most commonly used medical agents included pain killers and myorelaxants. The number of attendees, heat index, and weekend days were positively correlated with the number of the patients.

Conclusion

: The majority of medical conditions encountered in PPMs are easily treatable in health care tents settled in the meeting area. The number of attendees, heat index, and weekend days are factors associated with the number of patients.

CeyhanMA, DemirGG, GülerGB. Evaluation of health care services provided in political public meetings in Turkey: a forgotten detail in politics. Prehosp Disaster Med. 2018;33(6):607–613.

Nonlinear Modelling for Predicting Patient Presentation Rates for Mass Gatherings

IntroductionMass gatherings are common in Australia. The interplay of variables, including crowd density and behavior, weather, and the consumption of alcohol and other drugs, can pose a unique set of challenges to attendees' well-being. On-site health services are available at most mass gatherings and reduce the strain on community health facilities. In order to efficiently plan and manage these services, it is important to be able to predict the number and type of presenting problems at mass gatherings.ProblemThere is a lack of reliable tools to predict patient presentations at mass gatherings. While a number of factors have been identified as having an influence on attendees' health, the exact contribution of these variables to patient load is poorly understood. Furthermore, predicting patient load at mass gatherings is an inherently nonlinear problem, due to the nonlinear relationships previously observed between patient presentations and many event characteristics.

METHODS

Data were collected at 216 Australian mass gatherings and included event type, crowd demographics, and weather. Nonlinear models were constructed using regression trees. The full data set was used to construct each model and the model was then used to predict the response variable for each event. Nine-fold cross validation was used to estimate the error that may be expected when applying the model in practice.

RESULTS

The mean training errors for total patient presentations were very high; however, the distribution of errors per event was highly skewed, with small errors for the majority of events and a few large errors for a small number of events with a high number of presentations. The error was five or less for 40% of events and 15 or less for 85% of events. The median error was 6.9 presentations per event.

CONCLUSION

This study built on previous research by undertaking nonlinear modeling, which provides a more realistic representation of the interactions between event variables. The developed models were less useful for predicting patient presentation numbers for very large events; however, they were generally useful for more typical, smaller scale community events. Further research is required to confirm this conclusion and develop models suitable for very large international events.Arbon P, Bottema M, Zeitz K, Lund A, Turris S, Anikeeva O, Steenkamp M. Nonlinear modelling for predicting patient presentation rates for mass gatherings. Prehosp Disaster Med. 2018;33(4):362-367.

Patient Presentation Trends at 15 Mass-Gathering Events in South Australia

Introduction

Mass gatherings are complex events that present a unique set of challenges to attendees’ health and well-being. There are numerous factors that influence the number and type of injuries and illnesses that occur at these events, including weather, event and venue type, and crowd demographics and behavior.

Problem

While the impact of some factors, such as weather conditions and the availability of alcohol, on patient presentations at mass gatherings have been described previously, the influence of many other variables, including crowd demographics, crowd behavior, and event type, is poorly understood. Furthermore, a large number of studies reporting on the influence of these variables on patient presentations are based on anecdotal evidence at a single mass-gathering event.

Methods

Data were collected by trained fieldworkers at 15 mass gatherings in South Australia and included event characteristics, crowd demographics, and weather. De-identified patient records were obtained from on-site health care providers. Data analysis included the calculation of patient proportions in each variable category, as well as the total number of patient presentations per event and the patient presentation rate (PPR).

Results

The total number of expected attendees at the 15 mass gatherings was 303,500, of which 146 presented to on-site health care services. The majority of patient presentations occurred at events with a mean temperature between 20°C and 25°C. The PPR was more than double at events with a predominantly male crowd compared to events with a more equal sex distribution. Almost 90.0% of patient presentations occurred at events where alcohol was available.

Conclusion:

The results of the study suggest that several weather, crowd, and event variables influence the type and number of patient presentations observed at mass-gathering events. Given that the study sample size did not allow for these interactions to be quantified, further research is warranted to investigate the relationships between alcohol availability, crowd demographics, crowd mobility, venue design, and injuries and illnesses.

Anikeeva O, Arbon P, Zeitz K, Bottema M, Lund A, Turris S, Steenkamp M. Patient presentation trends at 15 mass-gathering events in South Australia. Prehosp Disaster Med. 2018;33(4):368–374.

The Gillette Stadium Experience: A Retrospective Review of Mass Gathering Events From 2010 to 2015

Objective

Mass gathering events can substantially impact public safety. Analyzing patient presentation and transport rates at various mass gathering events can help inform staffing models and improve preparedness.

Methods

A retrospective review of all patients seeking medical attention across a variety of event types at a single venue with a capacity of 68,756 from January 2010 through September 2015.

Results

We examined 232 events with a total of 8,260,349 attendees generating 8157 medical contacts. Rates were 10 presentations and 1.6 transports per 10,000 attendees with a non-significant trend towards increased rates in postseason National Football League games. Concerts had significantly higher rates of presentation and transport than all other event types. Presenting concern varied significantly by event type and gender, and transport rate increased predictably with age. For cold weather events, transport rates increased at colder temperatures. Overall, on-site physicians did not impact rates.

Conclusions

At a single venue hosting a variety of events across a 6-year period, we demonstrated significant variations in presentation and transport rates. Weather, gender, event type, and age all play important roles. Our analysis, while representative only of our specific venue, may be useful in developing response plans and staffing models for similar mass gathering venues. (Disaster Med Public Health Preparedness. 2018;12:752-758).

Mass Gatherings and the Spread of Respiratory Infections. Lessons from the Hajj

The mass gathering of people is a potential source for developing, propagating, and disseminating infectious diseases on a global scale. Of the illnesses associated with mass gatherings, respiratory tract infections are the most common, the most easily transmitted, and the most likely to be spread widely beyond the site of the meeting by attendees returning home. Many factors contribute to the spread of these infections during mass gatherings, including crowding, the health of the attendees, and the type and location of meetings. The annual Hajj in the Kingdom of Saudi Arabia is the largest recurring single mass gathering in the world. Every year more than 10 million pilgrims attend the annual Hajj and Umrah. Attendees assemble in confined areas for several days. People with a wide range of age, health, susceptibility to illness, and hygiene sophistication come in close contact, creating an enormous public health challenge. Controlling respiratory infections at the Hajj requires surveillance, rapid diagnostic testing, and containment strategies. Although the Hajj is without equal, other mass gatherings can generate similar hazards. The geographic colocalization of the Zika virus epidemic and the 2016 Summer Olympic Games in Brazil is a current example of great concern. The potential of international mass gatherings for local and global calamity calls for greater global attention and research.

ANALYSIS OF MEDICAL ASSISTANCE PROVIDED TO SPECTATORS AT THE 2014 FIFA WORLD CUP MATCHES

Objective:

Several studies have already described the main injuries to soccer players during FIFA World Cup events; however, little is known about the main reasons spectators require medical assistance during these matches. The aim of this study is to assess the number of cases and main reasons spectators required medical assistance during the 2014 World Cup matches in Brazil.

Methods:

Data were collected from spectators who received medical assistance on all game days, and factors related to the assistance provided were analyzed.

Results:

Medical assistance was given to spectators in a total of 6,222 cases during the 64 games played in Brazil, an average of 97.2 times per game. The total number of spectators removed from the stadiums by ambulance was 167, a mean of 2.6 removals per game. The main reasons spectators required medical assistance during the World Cup games were headache, gastrointestinal problems, and trauma.

Conclusions:

Most spectators required medical assistance during the World Cup games for headache, gastrointestinal problems, and trauma; this information is fundamental to develop new prevention strategies and plan medical assistance for large-scale events. Level of Evidence IV; Case series.

Estimating the frequency and characteristics of respiratory disease outbreaks at mass gatherings in the United States: Findings from a state and local health department assessment

Mass gatherings create environments conducive to the transmission of infectious diseases. Thousands of mass gatherings are held annually in the United States; however, information on the frequency and characteristics of respiratory disease outbreaks and on the use of nonpharmaceutical interventions at these gatherings is scarce. We administered an online assessment to the 50 state health departments and 31 large local health departments in the United States to gather information about mass gathering-related respiratory disease outbreaks occurring between 2009 and 2014. The assessment also captured information on the use of nonpharmaceutical interventions to slow disease transmission in these settings. We downloaded respondent data into a SAS dataset for descriptive analyses. We received responses from 43 (53%) of the 81 health jurisdictions. Among these, 8 reported 18 mass gathering outbreaks. More than half (n = 11) of the outbreaks involved zoonotic transmission of influenza A (H3N2v) at county and state fairs. Other outbreaks occurred at camps (influenza A (H1N1)pdm09 [n = 2] and A (H3) [n = 1]), religious gatherings (influenza A (H1N1)pdm09 [n = 1] and unspecified respiratory virus [n = 1]), at a conference (influenza A (H1N1)pdm09), and a sporting event (influenza A). Outbreaks ranged from 5 to 150 reported cases. Of the 43 respondents, 9 jurisdictions used nonpharmaceutical interventions to slow or prevent disease transmission. Although respiratory disease outbreaks with a large number of cases occur at many types of mass gatherings, our assessment suggests that such outbreaks may be uncommon, even during the 2009 influenza A (H1N1) pandemic, which partially explains the reported, but limited, use of nonpharmaceutical interventions. More research on the characteristics of mass gatherings with respiratory disease outbreaks and effectiveness of nonpharmaceutical interventions would likely be beneficial for decision makers at state and local health departments when responding to future outbreaks and pandemics.

Improving Data Quality in Mass-Gatherings Health Research

Mass gatherings attract large crowds and can strain the planning and health resources of the community, city, or nation hosting an event. Mass-Gatherings Health (MGH) is an evolving niche of prehospital care rooted in emergency medicine, emergency management, public health, and disaster medicine. To explore front-line issues related to data quality in the context of mass gatherings, the authors draw on five years of management experience with an online, mass-gathering event and patient registry, as well as clinical and operational experience amassed over several decades.

Here the authors propose underlying human, environmental, and logistical factors that may contribute to poor data quality at mass gatherings, and make specific recommendations for improvement through pre-event planning, on-site actions, and post-event follow-up. The advancement of MGH research will rely on addressing factors that influence data quality and developing strategies to mitigate or enhance those factors. This is an exciting time for MGH research as higher order questions are beginning to be addressed; however, quality research must start from the ground up to ensure optimal primary data capture and quality.

GuyA, PragerR, TurrisS, LundA. Improving data quality in mass-gatherings health research. Prehosp Disaster Med. 2017;32(3):329–332.

Music Genre as a Predictor of Resource Utilization at Outdoor Music Concerts

Objectives

The aim of this study was to examine the various modern music genres and their effect on the utilization of medical resources with analysis and adjustment for potential confounders.

Methods

A retrospective review of patient logs from an open-air, contemporary amphitheater over a period of 10 years was performed. Variables recorded by the medical personnel for each concert included the attendance, description of the weather, and a patient log in which nature and outcome were recorded. The primary outcomes were associations of genres with the medical usage rate (MUR). Secondary outcomes investigated were the association of confounders and the influences on the level of care provided, the transport rate, and the nature of medical complaint.

Results

A total of 2,399,864 concert attendees, of which 4,546 patients presented to venue Emergency Medical Services (EMS) during 403 concerts with an average of 11.4 patients (annual range 7.1-17.4) each concert. Of potential confounders, only the heat index ≥90°F (32.2°C) and whether the event was a festival were significant (P=.027 and .001, respectively). After adjustment, the genres with significantly increased MUR in decreasing order were: alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music (P<.05). Medical complaints were significantly increased with alternative rock or when the heat index was ≥90°F (32.2°C; P<.001). Traumatic injuries were most significantly increased with alternative rock (P<.001). Alcohol or drug intoxication was significantly more common in hip-hop/rap (P<.001). Transport rates were highest with alcohol/drug intoxicated patients (P<.001), lowest with traumatic injuries (P=.004), and negatively affected by heat index ≥90°F (32.2°C; P=.008), alternative rock (P=.017), and country music (P=.033).

Conclusion

Alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music concerts had higher levels of medical resource utilization. High heat indices and music festivals also increase the MUR. This information can assist event planners with preparation and resource utilization. Future research should focus on prospective validation of the regression equation.

Westrol MS, KoneruS, McIntyreN, Caruso AT, ArshadFH, MerlinMA. Music genre as a predictor of resource utilization at outdoor music concerts. Prehosp Disaster Med. 2017;32(3):289–296.

Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014

Introduction

Comprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events.

Hypothesis

Patient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements.

Methods

A retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA).

Results

Between 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital.

Conclusion

This study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type.

CrabtreeN,MoS,OngL,JegatheesT,WeiD,FaheyD,LiuJ.Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.Prehosp Disaster Med.2017;32(2)187–194.

A Prospective Analysis of Patients Presenting for Medical Attention at a Large Electronic Dance Music Festival

Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified.

This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions.

Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%).

Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may decrease PPR, TTHR, and overall mortality.

FriedmanMS, PlockiA, LikourezosA, PushkarI, BazosAN, FrommC, FriedmanBW. A prospective analysis of patients presenting for medical attention at a large electronic dance music festival. Prehosp Disaster Med.2017; 32(1):78–82.

A practical approach to Events Medicine provision

In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France (Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest, medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine.

Mass Gathering Medicine New discipline to Deal with Epidemic and Infectious Diseases in the Hajj Among Muslim Pilgrimage: A Mini Review Article

Mass Gathering Medicine is one of the new disciplines in Medicine which deal with all health aspects in overcrowded areas. Mass Gathering Medicine is an important new challenging discipline which needs to be supported by all concern experts such as the World Health Organization, Centers for Disease Control and Prevention, ministries of health from all countries, universities, research centers, and all other experts in this field. Scientist and academic staffs from all countries should be encouraged to participate in narrowing the gap of knowledge for Mass Gathering Medicine. Postgraduate board or fellowship certificate should be encouraged internationally.

The Impact of an Extreme Sports Event on a District General Hospital

Background: Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. Methods and Results: We have reviewed the impact of the event on the local hospital. In total 52 riders reported 61 injuries. The hospital treated 24 (14%) riders. Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing attendees by up to 28%, 46% of injured riders were seen at the A&E department, 1 rider requiring admission for observation and 1 rider required inter-hospital transfer. Injury patterns (knee 20%, hand/wrist 18% & shoulder 18%) were similar to other reported series. Conclusions: We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.

Mass gathering medicine (Hajj Pilgrimage in Saudi Arabia): The clinical pattern of pneumonia among pilgrims during Hajj

The planned annual Hajj to the holy shrines in Makkah, Saudi Arabia, is recognized as one of the largest recurring religious mass gatherings globally, and the outbreak of infectious diseases is of major concern. We aim to study the incidence, etiology, risk factors, length of hospital stay, and mortality rate of pneumonia amongst pilgrims admitted to Al-Ansar general hospital, Madinah, Saudi Arabia during the Hajj period of December 2004-November 2013. A retrospective analysis of all patients diagnosed and admitted as pneumonia was done. Patients were assessed according to the CURB-65 scoring system and admitted to the ward or intensive care unit accordingly. Throat and nasopharyngeal swabs, sputum, and blood culture were collected prior to antibiotic treatment. 1059 patients were included in the study (23% of total hospital admissions and 20% of ICU admissions). The mean age of participants was 56.8 years, the Male:Female ratio was 3:1, and the lengths of stay in the ward and intensive care units were 5 and 14.5 days, respectively. The main organisms cultured from sputum were Klebsiella Pneumoniae, Streptococcus Pneumoniae, Haemophilus Influenzae, Staphylococcus Aureus, Pseudomonas aeruginosa, and community-acquired MRSA. The mortality rate in the ward was 2.4%, while the rate in the ICU was 21.45%. The organisms which caused pneumonia were found to be different during Hajj. The usual standard guideline for the treatment of pneumonia was ineffective for the causative organisms. Therefore, specific adjustments in the guidelines are needed. All efforts should be made to determine the infectious agent. Healthcare workers and pilgrims should adhere to preventive measures.

Formula One Night Race in Singapore: A 4-Year Analysis of a Planned Mass Gathering

Introduction

Every mass gathering presents its unique characteristics that influence medical resource utilization. Medical planning for mass gatherings involves both use of predictive models and analysis of data from similar past events. This study aimed to describe the medical presentations and the unique challenges influencing medical planning at the Formula One Singtel Singapore Grand Prix, the inaugural Formula One night race. Patient presentation characteristics, rates of patient presentation, and transportation to hospitals in association with attendance and heat index were evaluated over a 4-year period from 2009 through 2012. This will facilitate medical planning for similar events.

Methods

A database containing patient presentations from the 3-day Singapore Grand Prix in 2009, 2010, 2011, and 2012 was analyzed. Patient presentations were categorized by time of day and presenting complaints. Patient presentation rates (PPRs) were analyzed to determine correlation with attendance numbers and heat index.

Results

The average annual attendance at the Singapore Grand Prix was 81,992 from 2009 through 2012. The average PPR was 2.17 (SD=0.63)/1,000 attendees. The average transport to hospital rate (TTHR) was 0.033 (SD=0.026)/1,000 attendees. While medical coverage was provided at the circuit park between 2:00 pm to 1:00 am daily, most attendees presented from 5:00 pm to 10:00 pm. The most common presenting complaints included: musculoskeletal conditions (59%) and heat related illnesses (19%). There was no correlation between attendance numbers and PPR and the heat index and PPR.

Conclusion

Musculoskeletal conditions and heat-related illnesses were the most common presenting complaints at the Singapore Grand Prix from 2009-2012. The lack of correlation between heat index and PPR is a new finding compared with prior studies. This could be due to the minimal heat variation that occurred during the night event. Further study is required to refine models that can be used in specialized events.

HoWH, KoenigKL, QuekLS. Formula One night race in Singapore: a 4-year analysis of a planned mass gathering. Prehosp Disaster Med. 2014;29(5):1-5.

Mass gathering medicine: 2014 Hajj and Umra preparation as a leading example

The importation of infectious diseases during a mass gathering may result in outbreaks. Infectious diseases associated with mass gatherings vary depending on the type and location of the mass gathering. The annual Hajj to Makkah in Saudi Arabia is one of the largest annual religious mass gatherings in the world. Preparation for the Hajj encompasses multiple sectors to develop comprehensive plans. These plans include risk assessment, utilizing existing medical infrastructure, developing electronic and paper-based surveillance activity, and the use of information technology. In this review, we describe key features of the preparedness for the 2014 Hajj and Umra, review the recent impact of emerging viruses such as Ebola in West Africa and the Middle East respiratory syndrome coronavirus (MERS-CoV) in affected countries, and highlight the updated requirements and the required vaccines.

Suffolk Show 2011: prehospital medical coverage in a mass-gathering event

INTRODUCTION

Despite their popularity and unique characteristics, county shows, also known as agricultural fairs, are amongst the least-studied mass-gathering events. Suffolk Show is one of the biggest such events in the UK, attracting tens of thousands of people annually over a 2-day period. In addition to trade stands and livestock displays, the 2011 show included top international show jumping and other sport activities. Problem Due to the range of activities and large number of attendees of different ages and medical backgrounds, combined with a lack of objective data about medical contacts made during these events, medical officers and local emergency services find planning an appropriate level of medical coverage for county shows particularly challenging. This study involved analyzing the characteristics of medical contacts during a major county show and assessing the level of medical coverage provided.

METHODS

Data collected from St John Ambulance (SJA) and British Red Cross standard medical records of all contacts on the show ground over the two days were analyzed in terms of demographics, presenting complaints, medical history, and discharge destination. The Event Safety Guide by the Health and Safety Executive (HSE) was the agreed standard for the level of medical coverage.

RESULTS

More than 90,000 people visited the show, with a total of 180 medical contacts recorded. Patient presentation rate (per 1,000 attendees) was 2.0 and the transport to hospital rate (per 1,000 attendees) was 0.1. Of the 112 cases handled by SJA, 74 (66%) were women and 49 (44%) were 18-64 years of age. Wounds, lacerations and abrasions made up 26 (23.2%) of all presentations to SJA, followed by foot and lower limb blisters at 20 (17.8%). Hypertension was the most common medical history in presentations to SJA (11 cases, 10%), followed by asthma in 7 (6%).

CONCLUSION

The majority of presentations were due to minor injuries or ailments. An understanding of the event characteristics, demographics, and nature of medical contacts will provide organizers, medical officers, and local emergency services with information about the level of coverage and resources required. This data can further help advance knowledge of mass-gathering medicine across the various types of events.

Estimation of Healthcare Resources at Sporting Events

Background:

The consequences of a major incident at a sporting event could be catastrophic. Therefore, there should be an estimation of the healthcare resources at such events as part of the planning. Although there are National guidelines (e.g., Planning Safe Public Events: Practical Guidelines in Australia) defining the role of the healthcare system at sporting events, these guidelines either lack a simple calculating method to estimate the need for healthcare resources or the methods are complex and impractical to use. The objective of this study was to find a safe and easy method for the estimation of healthcare resources at sporting events.

Methods:

A model for the estimation of healthcare resources at music events recently has been approved in Sweden. After minor adjustments, this model was used at sport events by a number of planning officers. The models' accuracy and usability was evaluated by analyzing its outcome in a pilot and a controlled study using different sporting and non-sporting scenarios.

Results:

The pilot study showed that the model was valid and easily could be used for various sporting events. The obtained estimations were consistent with the methods used by experienced planning officers in 97% of cases. The results of the controlled study showed that by using this model, the minimum amount of resources required easily could be calculated at sporting events and by people with different backgrounds.

Conclusions:

This model safely can be used at sporting events.

Medical Support for Children's Mass Gatherings

Introduction:

Medical care must be well-planned for mass gatherings. Events such as fairs, concerts, parades, and rallies cause many people to gather in one place, increasing the chance of injuries and for the development of a disaster. In this study, the level and quality of medical care were evaluated at a mass gathering of approximately 100,000 children. The event was a television-sponsored fun fair.

Methods:

Every patient contact was documented on printed forms, including data such as the number of patients treated, gender of the patients, presence or absence of a parental escort, time distribution of patient contacts, the diagnoses for the patient contacts, specific therapies applied, duration of the treatment, and patient discharge information. All data were coded after the event and transferred into a computer database. These data were analyzed using descriptive statistics.

Results:

Of the 100,000 spectators, 192 patients (81 male [42.2%] and 111 female [57.8%]) were treated during the nine-hour period, from 09:00 hours (h) until 18:00 h. Twenty percent of all the children up to the age of 10 years needing medical assistance were not accompanied by an adult. Seventy-five percent of all patient contacts were made during the afternoon. Of those treated, 164 patients (85.4%) suffered only minor injuries and were seen for <10 minutes. The most common type of complaint was minor trauma (103 patients, 53.6%); followed by minor medical problems such as headaches or light allergic reactions (21 patients, 10.9%); insect bites (20 patients, 10.4%); and serious medical problems or trauma such as severe arterial hypertension or long bone fractures (19 patients, 9.9%). Treatment included, but was not limited to, dressings (100 patients; 52.1%), local therapy (68 patient, 35.4%), and analgesic therapy (10 patients, 5.2%). Four patients (2%) were transferred to local hospitals.

Conclusion:

Most of the medical needs in the patients attending the children's fun fair were minor. Nevertheless, for similar events in the future, the medical team should be qualified for all serious medical emergencies, as well as major trauma; and should be prepared to meet the requirements of the specific group of spectators.

The overall usage rate in the children's fun fair described was 19.2 patient encounters per 10,000 spectators. Half of all of the patients were children below the age of 14 years. Medical services should consider that this study shows that up to 33% of children seeking medical assistance may not be accompanied by adults.

Medical Support during the European Union Summit in Gothenburg, Sweden, June 2001

Introduction:

Several factors are important for the number and severity of medical emergencies during mass-gatherings. The risk of violence, the size and mobility of the crowd, the type of event, weather, and duration of the event all influence the outcome. During the European Union (EU) Summit, from 15–16 June 2001 in Gothenburg, Sweden, approximately 50,000 people participated in 43 protest marches, some which included 15,000 participants. Clashes between police and the protesters occurred.

Objective:

The objective of this study was to analyze the amount and character of injuries as well as the medical complaints in relation to the EU Summit. In addition, the aim of this study was to describe the organization and function of the healthcare services provided during the meeting.

Methods:

This study is based on the medical records of patients presenting with injuries and other types of medical emergencies at the healthcare stations during the Summit.

Results:

In total, 143 patients sought medical care. Fifty-three (37.1%) were police officers. Most patients had minor complaints, but a few were seriously injured.The Patient Presentation Rate (PPR) was 2.7. Nine victims were hospitalized as high priority.

Conclusion:

The PPR for the EU Summit was 2.7, which is in the same range as previously reported from other mass-gatherings.

Mass-Gathering Medicine: A Review of the Evidence and Future Directions for Research

A review of mass-gathering medicine literature published by the Journal Prehospital and Disaster Medicine, demonstrates the progressive development of our knowledge and understanding of the health effects of mass gatherings and the strategies that appear to contribute positively to effective health services delivery during these events. In addition, the growing need for research that can underpin a more evidence-based approach to planning for and managing these events is apparent. The call for less descriptive and more critical and conceptual analyses has been increasing in volume and, it is argued, the challenge now is to apply research frameworks that can contribute more effectively to science-based, medical practice.

Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings

Objectives:

Mass gatherings create difficult environments for which to plan emergency medical responses. The purpose of this study was to identify those variables that are associated with increased medical usage rates (MURs) and certain injury patterns that can be used to facilitate the planning process.

Methods:

Patient information collected at three types of mass gatherings (professional American football and baseball games and rock concerts) over a three-year period was reviewed retrospectively. Specific variables were abstracted: (1) event type; (2) gender; (3) age; (4) weather; and (5) attendance. All 216 events (total attendance9,708,567) studied were held in the same metropolitan region. All MURs are reported as patients per 10,000 (PPTT).

Results:

The 5,899 patient encounters yielded a MUR of 6.1 PPTT. Patient encounters totaled 3,659 for baseball games (4.85 PPTT), 1,204 for football games (6.75 PPTT), and 1,036 for rock concerts (30 PPTT). The MUR for Location A concerts (no mosh pits) was 7.49 PPTT, whereas the MUR for the one Location B concert (with mosh pits) was110 PPTT. The MUR for Location A concerts was higher than for baseball, but not football games (p= 0.005). Gender distribution was equal among patrons seeking medical care. The mean values for patient ages were 29 years at baseball games, 33 years at football games, and 20 years at concerts. The MUR at events held when the apparent temperature was £80°F significantly lower statistically than that at events conducted at temperatures <80°F were (18°C) (4.90 vs. 8.10 PPTT (p= 0.005)). The occurrence of precipitation and increased attendance did not predict an increased MUR. Medical care was sought mostly for minor/basic-level care (84%) and less so for advanced-level care (16%). Medical cases occurred more often atsporting events (69%), and were more common than were cases with traumatic injuries (31%). Concerts with precipitation and rock concerts had a positive association withthe incidence of trauma and the incidence of injuries; whereas age and gender were not associated with medical or traumatic diagnoses.

Conclusions:

Event type and apparent temperature were the variables that best predicted MUR as well as specific injury patterns and levels of care.

Non-communicable health risks during mass gatherings

Mass gatherings (MGs) have been associated with high rates of morbidity and mortality from non-communicable diseases, accidents, and terrorist attacks, thus posing complex public health challenges. We assessed the health risks and public health responses to MGs to identify an evidence-based framework for public health interventions. Human stampedes and heat-related illnesses are the leading causes of mortality. Minor traumatic injuries and medical complaints are the main contributors to morbidity and, particularly, the need for on-site medical care. Infrastructure, crowd density and mood, weather, age, and sex determine the risks to health. Many predictive models for deployment of medical resources are proposed, but none have been validated. We identified the risks for mortality and morbidity during MGs, most efficient public health interventions, and need for robust research into health risks for non-communicable diseases during MGs.

Emergence of medicine for mass gatherings: lessons from the Hajj

Although definitions of mass gatherings (MG) vary greatly, they consist of large numbers of people attending an event at a specific site for a finite time. Examples of MGs include World Youth Day, the summer and winter Olympics, rock concerts, and political rallies. Some of the largest MGs are spiritual in nature. Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported-probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Hajj routinely attracts 2·5 million Muslims for worship. WHO's global health initiatives have converged with Saudi Arabia's efforts to ensure the wellbeing of pilgrims, contain infectious diseases, and reinforce global health security through the management of the Hajj. Both initiatives emphasise the importance of MG health policies guided by sound evidence and based on experience and the timeliness of calls for a new academic science-based specialty of MG medicine.

Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework

Introduction: Mass gatherings (MG) may provide ideal conditions for influenza transmission. The evidence for an association between MG and influenza transmission is reviewed to assess whether restricting MG may reduce transmission.

Methods: Major databases were searched (Pubmed, EMBASE, Scopus, CINAHL), producing 1706 articles that were sifted by title, abstract, and full-text. A narrative approach was adopted for data synthesis.

Results: Twenty-four papers met the inclusion criteria, covering MG of varying sizes and settings, and including 9 observational studies, 10 outbreak reports, 4 event reports, and a quasi-experimental study. There is some evidence that certain types of MG may be associated with increased risk of influenza transmission. MG may also “seed” new strains into an area, and may instigate community transmission in a pandemic. Restricting MGs, in combination with other social distancing interventions, may help reduce transmission, but it was not possible to identify conclusive evidence on the individual effect of MG restriction alone. Evidence suggests that event duration and crowdedness may be the key factors that determine the risk of influenza transmission, and possibly the type of venue (indoor/outdoor).

Conclusion: These factors potentially represent a basis for a policy-making framework for MG restrictions in the event of a severe pandemic.

Care of children at a large outdoor music festival in the United Kingdom

INTRODUCTION

Limited data exist on the standard of care provided for children at mass gatherings and special events (MGSE). Some studies provide valuable insight into the proportion of pediatric patients that can be expected at various types of MGSEs, but an accurate breakdown of the range of pediatric conditions treated at major events has yet to be produced. Such data are essential for the preparation of MGSEs so that the health and safety of children at such events can be adequately safeguarded. The aim of this study is to examine the care requirements for children at a large, outdoor music festival in the United Kingdom.

METHODS

A retrospective review of all patient report forms (PRFs) from a large, outdoor music festival held in Leeds (UK) in 2003. Data were extracted from the PRFs using a standardized proforma and analyzed using an Excel computer program.

RESULTS

Pediatric cases contributed approximately 15% to the overall workload at the event. Children presented with a range of conditions that varied from those seen in the adult population. Children were more likely than adults to present for medical attention following crush injuries (OR = 2.536; 95% CI = 1.537-4.187); after a collapse/syncopal episode (OR = 2.687; 95% CI = 1.442-5.007); or complaining of nausea (OR = 3.484; 95% CI = 2.089-5.813). Alcohol/drugs were less likely to be involved in the precipitating cause for medical attention in children compared to adults (OR = 0.477; 95% CI = 0.250-0.912). No critical care incidents involving children were encountered during the event.

CONCLUSIONS

Mass gatherings and special events in the UK, such as outdoor music festivals, can involve a large number of children who access medical care for a different range of conditions compared to adults. The care of children at large, outdoor music events should not be overlooked. Event planning in the UK should include measures to ensure that appropriately trained and equipped medical teams are used at music festivals to safeguard the welfare of children who may attend. Further research into this exciting area is required.

Preparing for the surge: perspectives on marathon medical preparedness

In preparing for medical coverage of a mass participation event such as a marathon, race directors and their medical staff members need to account for the unexpected. Extremes in weather as well as the potential for outside threats need to be given consideration before race day in order to adequately prepare. Through the recruitment of local expertise from various agencies in one's community during both the planning stages, and on race day, the added stressors of such extremes will be minimized, if not eliminated. This article will provide concrete examples of how the Chicago Marathon has used its own experiences with such extremes. Readers will be given useful tools to implement in their own marathons or other mass participation events-planning to equip them better for the unexpected surge.

ASSOCIATION OF HEAT INDEX andPATIENT VOLUME AT A MASS GATHERING EVENT

In 1999, a department of emergency medicine was asked to provide medical care at a football stadium with a capacity of 61,625. Over four seasons, the department's experience has been that the number of patients seen during a game correlates closely with game-time heat and humidity (heat index).

OBJECTIVE

To determine how closely the heat index is associated with the number of patients who will require care at a mass gathering event.

METHODS

This was a retrospective review of all patient care from 1999 to 2003 at a Division I college football stadium located in the southeastern United States. All patrons seen in two emergency care centers (ECCs) were included. To control for stadium attendance, the Pearson product-moment correlation (PPMC) was calculated for each game. This statistical tool determines whether there is a positive correlation between heat index and ratio of number of patients cared for per 10,000 patrons.

RESULTS

A total of 20 games occurred, and the heat index ranged from 33 to 92. Number of patients varied from 15 to 74, and stadium attendance ranged from 53,371 to 61,625. The PPMC was calculated as 0.607, which indicates a strong positive correlation between heat index and patient volume (p < 0.005). Linear modeling predicts that for every 10-degree increase in the heat index, three more patients per 10,000 patrons will require care.

CONCLUSIONS

In this retrospective study, the heat index was strongly associated with the volume of patients who would be seen at a mass gathering event.

The quest for public health security at Hajj: the WHO guidelines on communicable disease alert and response during mass gatherings

Public health security, the provision of safeguarding health and safety for a designated population during a specific event, is paramount to the success of all mass gatherings (MG). Hajj, the pilgrimage to Makkah, Saudi Arabia - one of the largest annual MG - this year hosted over 2.5 million. Hajj presents an annual public health security challenge of extraordinary dimensions, not only due to its scale but also due to Hajj-specific environmental and host factors. Opportunities for sharing public health security insights from Hajj are limited by the lack of standardized outcome measures. The June 2008 WHO Guidelines on communicable disease alert and response for mass gatherings offer novel opportunities for both Hajj planning and assessment. We discuss the evolution of these Guidelines and the first assessment of their efficacy in a live MG environment. We examine potential opportunities for applying these Guidelines in the novel, intensely dynamic, annually recurrent Hajj environment. We believe Hajj-related findings and outcome measurements using these Guidelines will translate broadly to be of value to many non-Hajj MG sectors. Finally, we suggest areas for outcome assessment and future enquiry and invite the first Hajj-specific communicable disease alert guidelines.

The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health

OBJECTIVE

To undertake a review of the literature relating to public health planning and interventions at previous summer Olympic and Paralympic Games and other relevant major summer sporting events or mass gatherings, with a focus on official publications and peer-reviewed articles.

STUDY DESIGN

Literature review.

METHODS

A literature review was undertaken using all biomedical databases and a freetext search using Google to widen the search beyond peer-reviewed publications. Search terms used were: Olympics; Paralympics; mass gatherings; mass gathering medicine; sporting events; weather; planning; and organisation. Citations within articles were searched to identify additional references that would inform this review. This literature review concentrates on the public health aspects of population care at mass gatherings, particularly the Olympic and Paralympic Games which are set over several weeks, focusing on surveillance, prevention and health service quality.

RESULTS

The literature identified 10 areas of public health planning: public health command centre and communication; surveillance, assessment and control; environmental health and safety; infectious disease outbreaks; implications of weather conditions; health promotion; travel information; economic assessments; public transport and reduction of asthma events; and preparing athletes for potential allergies. The following themes emerged as crucial factors for the success of any public health interventions at Olympic and Paralympic Games: detailed planning of deliverables; pre-identification of critical success factors; management of risk; detailed contingency planning; and full testing of all plans prior to the event.

CONCLUSIONS

The 2012 Olympic Games will provide an exciting challenge for public health providers and systems. Preparation requires early detailed planning of policies, procedures and on-site health promotion events, in addition to helping to set up the surveillance and monitoring systems that will capture public health activity alongside medical activity. Learning from the literature review will support the identification of critical success factors and help to formulate recommendations that will allow optimal utilization of public health initiatives. All plans require full costings in advance which are supported by internal and external health-related agencies, voluntary organizations and sponsors. A risk assessment should be undertaken as part of the planning process leading to risk management plans for mitigating identified potential risks. All surveillance and monitoring systems, communication, policies and procedures will require full testing prior to commencement of the Games.

Hospital-based healthcare provider (nurse and physician) integration into an emergency medical services–managed mass-gathering event

INTRODUCTION

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.

METHODS

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

RESULTS

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.

CONCLUSION

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.

Nordic venue medical services during the 2002 Winter Olympics

This article represents a retrospective analysis of medical care provided to spectators, athletes, officials, and workforce at the cross country skiing and biathlon venue, Soldier Hollow, during the 2002 Winter Olympic Games. A retrospective chart review was performed of the primary diagnosis category assigned to each patient on medical encounter forms completed at the time medical care was provided in the athlete or spectator medical clinics. Descriptive statistics were used to characterize data from the primary diagnosis categories for groups of patients. There were 590 total medical encounters among athlete and spectator medical services over 19 operational days with 227,847 total visitors (includes spectators, athletes, and workforce). The incidence of medical encounters was 26 per 10,000 visitors. There were 215 medical encounters that were evaluated and treated by a physician in the athlete (69 cases) or spectator (146 cases) medical clinics. The most common diagnoses were related to respiratory infection or respiratory disease. There were 177 patients discharged without follow-up and 26 referred to a medical facility off venue. Six patients were transported to a hospital by ground ambulance. In conclusion, the injuries and illnesses evaluated and treated were consistent with prior studies on medical care at Olympic Games. Although some patients required ground ambulance transport off venue due to injury or illness, there were no critical injuries or illnesses that resulted in death. The level of services available to both athletes and spectators was more than adequate for the injuries and illnesses encountered.

The epidemiology of illness and injury at the alpine venues during the Salt Lake City 2002 Winter Olympic Games

The Emergency Medicine literature has described levels of medical care for mass gatherings in the United States, including for the Los Angeles 1984 Summer and Calgary 1988 Winter Olympic Games. However, there are limited data to describe the type and number of illness or injury that may occur during mass gatherings in an alpine winter environment. To describe the epidemiology of illness and injury seen among spectators at the alpine and snowboarding venues during the Salt Lake City 2002 Winter Olympic Games, we conducted a retrospective review of the Salt Lake City 2002 Olympic Medical Care database for all patient encounters during the operational period of the Games at the alpine and snowboarding venues. The three venues included were: Deer Valley Resort (DVR), Park City Mountain Resort (PCM), and Snowbasin Resort (SBA). Each venue had a medical clinic located on site for spectators and another for athletes. Physicians, nurses, emergency medical technicians, and therapists staffed the clinics. The database was created by Inter-mountain Health Care (IHC) in conjunction with Salt Lake City 2002 Winter Olympic staff and consisted of descriptive reports of all patient encounters from all venues including demographic, epidemiology, and outcome information. IHC maintains the database, and was the sole medical provider for the Games. Each venue had at least 6 days of competition events. Over the 19 days of the Olympiad, a total of 410,160 spectators and 3,961 competitive athletes attended the three venues. There were 841 spectators evaluated and treated at the venue clinics, and mobile medical staff treated 262 spectators. The top five spectator clinic diagnostic categories were: sprain/strain (n=108), miscellaneous trauma (n=103), respiratory (n=88), miscellaneous medical (n=69), and digestive (n=52). Fifty spectators required transport to a hospital for additional care: 27 required transfer by ground ambulance and the remainder were transported by private vehicle. The overall spectator medical utilization rate was 26.9. In conclusion, the rate and acuity of patients seen at the alpine venues during the 2002 Winter Olympic Games was low. Nevertheless, we recommend full on-site physician and nurse staffing with advanced trauma and cardiac life support available during similar events.

Medical care at the VIIth International Amateur Athletics Federation World Championships in Athletics ‘Sevilla ‘99’

INTRODUCTION

The World Athletics Championships are considered to be the third most important sporting event on the planet. Before the celebration of their seventh meeting in Seville, Spain, the need for medical care, as in the Olympic Games, was supposed to be low and of minimal complexity. It was nevertheless judged necessary to install strategically located assistance points, and to evaluate the results of this intervention. METHODOLOGY AND DESIGN: Following the planning phase carried out by a multidisciplinary commission of health, set up by the Organizer Committee, which prepared protocols, that were elaborated by five working groups, the operation developed during the World Championships in Athletics is described. Five clinics and several first aid stations were set up in the stadium and its surroundings, in hotels, warm-up and training tracks, the high-speed train station and the airport, as well as strategic points in the city.

RESULTS

There were 1338 medical consultations, and 35 patients (2.6%) were transferred to hospitals. 21 codes of the International Classification of Disease constituted 50.4% of the case mix. Injuries, which accounted for 36.1% of all medical visits, were more common among athletes (48.9%) than among other groups. Injuries accounted for 30.5% of all other groups combined. Spectators and other groups accounted for most (86.8 and 63.1%, respectively) of the 276 visits concerning contusions and 165 visits for heat-related illness. The overall physician treatment rate was 19.3% for athletes and 4.5/10 000 for spectators.

CONCLUSION

The preparation of a potent pre-hospital service, strategically located and dedicated to the event, was able to solve the problems that occurred. Nevertheless, a hospital alert and a coordination centre are also necessary. These data should be useful in planning medical resources for future mass sporting events.