Mass-gathering health research foundational theory: part 1 - population models for mass gatherings

Mass Gathering Events at an Event Hall in Osaka Are a Non-direct Risk of Admission to a Neighboring Emergency Hospital

BACKGROUND

The influence of planned mass gathering events on surrounding residents is not understood sufficiently.

OBJECTIVES

The purpose of this study was to investigate how events at an event hall affect a neighboring emergency hospital throughout the year.

METHODS

This was a single-center, retrospective, observational study conducted on all patients who presented to the emergency department from January 1 to December 31, 2019. The event hall is located 200 meters from the hospital, and various events such as music concerts and professional baseball games are held at the hall throughout the year. We collected patient information from the electronic medical records. The factors associated with hospitalization were assessed using a multivariable logistic regression analysis.

RESULTS

This study comprised 18,907 patients who visited our emergency department. The number of patients on event days was 9,981 and that on no-event days was 8,922. The mean (SD) number of patients visiting on event days was 56.4 (14.9), and that on no-event days was 47.5 (14.1) (p<0.05). The multivariable logistics regression analysis showed age (adjusted odds ratio (AOR): 1.03; 95% confidence interval (CI): 1.03-1.04), male gender (AOR: 1.21; 95% CI: 1.13-1.31), transportation by emergency medical services (AOR: 2.56; 95% CI: 2.37-2.75), rain days (AOR: 1.14; 95% CI: 1.04-1.23), and event day (AOR: 1.11; 95% CI: 1.02-1.20) to be independent risk factors of hospitalization.

CONCLUSIONS

In this study, we found that event day was one of the independent risk factors of admission to the hospital from the emergency department.

Mass Gathering Event Medical Preparedness and Response: A Review of Canadian Legislation and Guidelines

INTRODUCTION

The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.

METHODS

This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.

RESULTS

Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.

CONCLUSIONS

No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

The Impact of In-Event Health Services at Europe's Largest Electronic Dance Music Festival on Ems and Ed in the Host Community

BACKGROUND

Electronic dance music festivals (EDMF) can cause a significant disruption in the standard operational capacity of emergency medical services (EMS) and hospitals. We determined whether or not the presence of in-event health services (IEHS) can reduce the impact of Europe's largest EDMF on the host community EMS and local emergency departments (EDs).

METHODS

We conducted a pre-post analysis of the impact of Europe's largest EDMF in July 2019, in Boom, Belgium, on the host community EMS and local EDs. Statistical analysis included descriptive statistics, independent t-tests, and χ2 analysis.

RESULTS

Of 400,000 attendees, 12,451 presented to IEHS. Most patients only required in-event first aid, but 120 patients had a potentially life-threatening condition. One hundred fifty-two patients needed to be transported by IEHS to nearby hospitals, resulting in a transport-to-hospital rate of 0.38/1000 attendees. Eighteen patients remained admitted to the hospital for >24 h; one died after arrival in the ED. IEHS limited the overall impact of the MGE on regular EMS and nearby hospitals. No predictive model proved optimal when proposing the optimal number and level of IEHS members.

CONCLUSIONS

This study shows that IEHS at this event limited ambulance usage and mitigated the event's impact on regular emergency medical and health services.

Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.

Validation of a Belgian Prediction Model for Patient Encounters at Football Mass Gatherings

BACKGROUND

To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium's largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model.

METHODS

Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test.

RESULTS

A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = -5.566, P <.001, r = -.61; Hartman: Z = -4.245, P <.001, r = .47).

CONCLUSION

When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.

Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective

BACKGROUND

Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

METHOD

This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

RESULTS

In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

CONCLUSIONS

This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Validation of a Belgian Prediction Model for Patient Encounters at Belgium's Largest Public Cultural Mass Gathering

OBJECTIVE

To compare actual patient presentation rates from Belgium's largest public open-air cultural festival with predictions provided by existing models and the Belgian Plan Risk Manifestations model.

METHODS

Retrospectively, actual patient presentation rates gathered from the Ghent Festivities (Belgium) during 2013-2019 were compared to predicted patient presentation rates by the Arbon, Hartman, and PRIMA models.

RESULTS

During 7 editions, 8673000 people visited the Ghent Festivities; 9146 sought medical assistance resulting in a mean patient presentation rate (PPR) of 1.05. The PRIMA model overestimated the number of patient encounters for each occasion. The other models had a high rate of underprediction. When comparing deviations in predictions between the PRIMA model to the other models, there is a significant difference in the mean deviation (Arbon: T = 0.000, P < 0.0001, r = -0.8701; Hartman: T = 0.000, P < 0.0001, r = -0.869).

CONCLUSION

Despite the differences between the predictions of all 3 models, our results suggest that the PRIMA model is a valid tool to predict patient presentations to IEHS during public cultural MG. However, to substantiate the PRIMA model even further, more research is needed to further validate the model for a broad range of MG.

Measuring the Masses: The Current State of Mass-Gathering Medical Case Reporting (Paper 1)

INTRODUCTION

Case reports are commonly used to report the health outcomes of mass gatherings (MGs), and many published reports of MGs demonstrate substantial heterogeneity of included descriptors. As such, it is challenging to perform rigorous comparisons of health services and outcomes between similar and dissimilar events. The degree of variation in published reports has not yet been investigated.

OBJECTIVE

Examine patterns of post-event medical reporting in the existing literature and identify inconsistencies in reporting.

METHODS

A systematic review of case reports was conducted. Included were English studies, published between January 2009 and December 2018, in Prehospital and Disaster Medicine (PDM) or Current Sports Medicine Reports (CSMR). Analysis of each paper was used to develop a list of 27 categories of data.

RESULTS

Seventy-five studies were initially reviewed with 54 publications meeting the inclusion criteria. Forty-two were full case reports (78%) and 12 were conference proceedings (22%). Of the 27 categories of data studied, only 13 were consistently reported in more than 50% of publications. Reporting patterns included inconsistent use of terminology/language and variable retrievability of reports. Reporting on event descriptors, hazard and risk analysis, and clinical outcomes were also inconsistent.

DISCUSSION

Case reports are essential tools for researchers and event team members such as medical directors and event producers. The authors found that current case reports, in addition to being inconsistent in content, were generally descriptive rather than explanatory; that is, focused on describing the outcomes as opposed to exploring possible connections between context and health outcomes.

CONCLUSION

This paper quantifies and demonstrates the current state of heterogeneity in MG event reporting. This heterogeneity is a significant impediment to the functional use of published reports to further the science of MG planning and to improve health outcomes. Future work based on the insights gained from this analysis will aim to align and standardize reporting to improve the quality and value of event reporting.

Measuring the Masses: Domains Driving Data Collection and Analysis for the Health Outcomes of Mass Gatherings (Paper 3)

INTRODUCTION

Without a robust evidence base to support recommendations for medical services at mass gatherings (MGs), levels of care will continue to vary and preventable morbidity and mortality will exist. Accordingly, researchers and clinicians publish case reports and case series to capture and explain some of the health interventions, health outcomes, and host community impacts of MGs. Streamlining and standardizing post-event reporting for MG medical services and associated health outcomes could improve inter-event comparability, thereby supporting and promoting growth of the evidence base for this discipline. The present paper is focused on theory building, proposing a set of domains for data that may support increasingly comprehensive, yet lean, reporting on the health outcomes of MGs. This paper is paired with another presenting a proposal for a post-event reporting template.

METHODS

The conceptual categories of data presented are based on a textual analysis of 54 published post-event medical case reports and a comparison of the features of published data models for MG health outcomes.

FINDINGS

A comparison of existing data models illustrates that none of the models are explicitly informed by a conceptual lens. Based on an analysis of the literature reviewed, four data domains emerged. These included: (i) the Event Domain, (ii) the Hazard and Risk Domain, (iii) the Capacity Domain, and (iv) the Clinical Domain. These domains mapped to 16 sub-domains.

DISCUSSION

Data modelling for the health outcomes related to MGs is currently in its infancy. The proposed illustration is a set of operationally relevant data domains that apply equally to small, medium, and large-sized events. Further development of these domains could move the MG community forward and shift post-event health outcomes reporting in the direction of increasing consistency and comprehensiveness.

CONCLUSION

Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Measuring the Masses: Mass-Gathering Medical Case Reporting, Conceptual Modeling - The DREAM Model (Paper 5)

INTRODUCTION

Without a robust evidence base to support recommendations for first aid, health, and medical services at mass gatherings (MGs), levels of care will continue to vary. Streamlining and standardizing post-event reporting for MG medical services could improve inter-event comparability, and prospectively influence event safety and planning through the application of a research template, thereby supporting and promoting growth of the evidence base and the operational safety of this discipline. Understanding the relationships between categories of variables is key. The present paper is focused on theory building, providing an evolving conceptual model, laying the groundwork for exploring the relationships between categories of variables pertaining the health outcomes of MGs.

METHODS

A content analysis of 54 published post-event medical case reports, including a comparison of the features of published data models for MG health outcomes.

FINDINGS

A layered model of essential conceptual components for post-event medical reporting is presented as the Data Reporting, Evaluation, & Analysis for Mass-Gathering Medicine (DREAM) model. This model is relational and embeds data domains, organized operationally, into "inputs," "modifiers," "actuals," and "outputs" and organized temporally into pre-, during, post-event, and reporting phases.

DISCUSSION

Situating the DREAM model in relation to existing models for data collection vis a vis health outcomes, the authors provide a detailed discussion on similarities and points of difference.

CONCLUSION

Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020)

Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

Mass Gathering Emergency Medicine Organization for the Union of European Football Associations' Under-21 Championship 2019 in Bologna, Italy

Football events represent a type of Mass Gathering Events (MGE) where crowd behavior, temperature and Heat Index, absence of free water, and alcohol consumption can lead to an increased need for medical assistance in participants. This report describes the environmental issues, organization, and healthcare assistance provided during the four matches of the Union of European Football Associations' (UEFA) Under-21 tournament held in Bologna in June, 2019. The four matches had a total of 72655 spectators; 31 patients required medical assistance with a mean Patient Presentation Rate (PPR) of 0.41; Mean Transport To Hospital Rate (TTHR) of 0.04; with PPR and TTHR comparable with literature findings. Majority of patients suffered from minor injuries and illnesses, and were treated directly in stadium medical sites. Medical assistance involved volunteer rescuers, emergency nurses, and physicians; resources were efficiently allocated and provided effective care to every patient.Climate factors, heat and humidity, the absence of free water, and increased alcohol consumption appear to be associated with increased requests for medical assistance. The retrospective analysis of a wider range of environmental factors, and the historical experience developed during similar MGEs suggest the need for a more comprehensive, improved approach for adequately assessing risk and planning the necessary healthcare resources.

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

OBJECTIVE

To describe patient presentation characteristics and outcomes for people aged 16-18 years pre, during and post a planned youth mass gathering event (MGE): 'Schoolies week' on the Gold Coast, Queensland, Australia.

METHODS

This was a retrospective observational study, including patient presentations by all young adults requiring care in the ED or in-event health services (EHS) over a 21-day period in 2014. Data analysis included descriptive and inferential statistics.

RESULTS

A total of 1029 patient presentations were made by people aged 16-18 years to the ED and EHS over the 21-day study period (139 pre, 695 during [275 in ED, 420 in EHS], 195 post Schoolies week). Some ED patient characteristics and outcomes varied between the pre, during and post Schoolies periods, such as patients age (P < 0.001), usual place of residence (P < 0.001) and not waiting for treatment (P = 0.015). Of the 24 375 registered MGE attendees, 420 (1.72% [95% confidence interval 1.57-1.89], 17.2/1000) presented for in-event care. Most patients were allocated an Australasian Triage Scale category of 4 (n = 162, 65.6%), with toxicology related presentations (n = 169, 44.9%). Transportation to hospital was undertaken for seven MGE attendees (0.03% [95% confidence interval 0.01-0.06], 0.3/1000).

CONCLUSIONS

Establishment of an in-event model of care for 1 week during Schoolies served as an effective hospital avoidance strategy for a planned youth MGE. Such in-event models of care may be considered for other similar future MGE.

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting

Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered 'musculoskeletal' (eg, strains) and those due to 'illness' (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.

On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years

Introduction

Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have on-site medical care to help reduce the impact on local health care systems. Historically, the literature suggests that patient transfers off-site are frequently related to complications of substance use. However, there is a gap in understanding why patients are transferred to hospital when an on-site medical team, capable of providing first aid services blended with a higher level of care (HLC) team, is present.

Objective

The purpose of this study is to better understand patterns of injuries and illnesses that necessitate transfer when physician-led HLC teams are accessible on-site.

Methods

This is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.

Results/Discussion

On-site medical teams that included HLC team members were present for the duration of each festival, so every team was able to “treat and release” when clinically appropriate. Over the course of the combined 34 event days, there were 10,406 patient encounters resulting in 156 individuals being transferred off-site for assessment, diagnostic testing, and/or treatment. A minority of patients seen were transferred off-site (1.5%). The patient presentation rate (PPR) was 16.5/1,000. The ambulance transfer rate (ATR) was 0.12/1,000 attendees, whereas the total transfer-to-hospital rate (TTHR), when factoring in non-ambulance transport, was 0.25/1,000. In contrast to existing literature on transfers from music festivals, the most common reason for transfer off-site was for musculo-skeletal (MSK) injuries (53.8%) that required imaging.

Conclusion

The presence of on-site HLC teams impacted the case mix of patients transferred to hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required specialized imaging and testing that could not be performed in an out-of-hospital setting. These results suggest that a better understanding of the specific effects on-site HLC teams have on avoiding off-site transfers will aid in improving planning for music festivals. The findings also identify areas for further improvement in on-site care, such as integrated on-site radiology, which could potentially further reduce the impact of music festivals on local health services. The role of non-emergency transport vehicles (NETVs) deserves further attention.

TurrisSA, CallaghanCW, RabbH, MunnMB, LundA. On the way out: an analysis of patient transfers from four large-scale North American music festivals over two yearsPrehosp Disaster Med. 2019;34(1):72–81.

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.

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.

Health Service Impact from Mass Gatherings: A Systematic Literature Review

Background

During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review.

Aim

This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.

Method

This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.

Results

Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.

Conclusions

There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum.

RanseJ, HuttonA, KeeneT, LensonS, LutherM, BostN, JohnstonANB, CrillyJ, CannonM, JonesN, HayesC, BurkeB. Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):71–77.

Travelers to the FIFA world cup 2014 in Brazil: Health risks related to mass gatherings/sports events and implications for the Summer Olympic Games in Rio de Janeiro in 2016

BACKGROUND

Health threats during mass gatherings, such as the FIFA world cup 2014 differ from traditional health risks. The influence of event type, demographics of attendees and environmental conditions are still not fully understood.

METHODS

An observational, prospective case-control survey conducted at the Frankfurt international airport in Germany on 544 travelers to the FIFA world cup 2014 and 432 regular travelers to Brazil departing after the end of the world cup.

RESULTS

Travelers to the FIFA world cup 2014 were predominantly male whereas the gender distribution in the control group was more balanced. The majority in both groups obtained insect bites and sunburns as environmental risk factors. Every third traveler suffered from diarrheal complaints in both groups, whereas the proportion of travelers with flu-like symptoms was higher in the case group. Travelers to the FIFA world cup 2014 indicated alcohol intake and sexual contacts outside of a relationship more frequently than travelers in the control group.

CONCLUSIONS

The additional health risks of travelers to sporting events as the FIFA world cup 2014 should be addressed in addition to traditional health threats in pre-travel counseling for the Summer Olympic Games 2016 in Brazil.

Exploring International Views on Key Concepts for Mass-gathering Health through a Delphi Process

Introduction

The science underpinning mass-gathering health (MGH) is developing rapidly. However, MGH terminology and concepts are not yet well defined or used consistently. These variations can complicate comparisons across settings. There is, therefore, a need to develop consensus and standardize concepts and data points to support the development of a robust MGH evidence-base for governments, event planners, responders, and researchers. This project explored the views and sought consensus of international MGH experts on previously published concepts around MGH to inform the development of a transnational minimum data set (MDS) with an accompanying data dictionary (DD).

Report

A two-round Delphi process was undertaken involving volunteers from the World Health Organization (WHO) Virtual Interdisciplinary Advisory Group (VIAG) on Mass Gatherings (MGs) and the MG section of the World Association for Disaster and Emergency Medicine (WADEM). The first online survey tested agreement on six key concepts: (1) using the term “MG HEALTH;” (2) purposes of the proposed MDS and DD; (3) event phases; (4) two MG population models; (5) a MGH conceptual diagram; and (6) a data matrix for organizing MGH data elements. Consensus was defined as ≥80% agreement. Round 2 presented five refined MGH principles based on Round 1 input that was analyzed using descriptive statistics and content analysis. Thirty-eight participants started Round 1 with 36 completing the survey and 24 (65% of 36) completing Round 2. Agreement was reached on: the term “MGH” (n=35/38; 92%); the stated purposes for the MDS (n=38/38; 100%); the two MG population models (n=31/36; 86% and n=30/36; 83%, respectively); and the event phases (n=34/36; 94%). Consensus was not achieved on the overall conceptual MGH diagram (n=25/37; 67%) and the proposed matrix to organize data elements (n=28/37; 77%). In Round 2, agreement was reached on all the proposed principles and revisions, except on the MGH diagram (n=18/24; 75%).

Discussion/Conclusions

Event health stakeholders require sound data upon which to build a robust MGH evidence-base. The move towards standardization of data points and/or reporting items of interest will strengthen the development of such an evidence-base from which governments, researchers, clinicians, and event planners could benefit. There is substantial agreement on some broad concepts underlying MGH amongst an international group of MG experts. Refinement is needed regarding an overall conceptual diagram and proposed matrix for organizing data elements.

SteenkampM, HuttonAE, RanseJC, LundA, TurrisSA, BowlesR, ArbuthnottK, ArbonPA. Exploring international views on key concepts for mass-gathering health through a Delphi process. Prehosp Disaster Med. 2016;31(4):443–453.

Mass-gathering health research foundational theory: part 1 - population models for mass gatherings

BACKGROUND

The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events. Process A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured break out sessions, asynchronous collaboration, and virtual international meetings. Findings and Interpretation Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.

CONCLUSIONS

Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.