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Çalışkan C, Kuday AD, Özcan T, Dağ N, Kınık K. Quantitative Metrics in Mass-Gathering Studies: A Comprehensive Systematic Review. Prehosp Disaster Med 2024; 39:195-205. [PMID: 38576262 DOI: 10.1017/s1049023x2400027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Mass gatherings are events where many people come together at a specific location for a specific purpose, such as concerts, sports events, or religious gatherings, within a certain period of time. In mass-gathering studies, many rates and ratios are used to assess the demand for medical resources. Understanding such metrics is crucial for effective planning and intervention efforts. Therefore, this systematic review aims to investigate the usage of rates and ratios reported in mass-gathering studies. METHODS In this systematic review, the PRISMA guidelines were followed. Articles published through December 2023 were searched on Web of Science, Scopus, Cochrane, and PubMed using the specified keywords. Subsequently, articles were screened based on titles, abstracts, and full texts to determine their eligibility for inclusion in the study. Finally, the articles that were related to the study's aim were evaluated. RESULTS Out of 745 articles screened, 55 were deemed relevant for inclusion in the study. These included 45 original research articles, three special reports, three case presentations, two brief reports, one short paper, and one field report. A total of 15 metrics were identified, which were subsequently classified into three categories: assessment of population density, assessment of in-event health services, and assessment of out-of-event health services. CONCLUSION The findings of this study revealed notable inconsistencies in the reporting of rates and ratios in mass-gathering studies. To address these inconsistencies and to standardize the information reported in mass-gathering studies, a Metrics and Essential Ratios for Gathering Events (MERGE) table was proposed. Future research should promote consistency in terminology and adopt standardized methods for presenting rates and ratios. This would not only enhance comparability but would also contribute to a more nuanced understanding of the dynamics associated with mass gatherings.
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Affiliation(s)
- Cüneyt Çalışkan
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Türkiye
- Department of Emergency Aid and Disaster Management, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Türkiye
| | - Ahmet Doğan Kuday
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Türkiye
| | - Tuğba Özcan
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Türkiye
| | - Nihal Dağ
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Türkiye
- Department of Emergency Aid and Disaster Management, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Türkiye
| | - Kerem Kınık
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Türkiye
- Department of Emergency Aid and Disaster Management, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Türkiye
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De Cauwer H, Barten DG, Tin D, Mortelmans LJ, Ciottone GR, Somville F. Terrorist Attacks against Concerts and Festivals: A Review of 146 Incidents in the Global Terrorism Database. Prehosp Disaster Med 2022; 38:1-8. [PMID: 36541015 PMCID: PMC9885432 DOI: 10.1017/s1049023x22002382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mass gatherings are vulnerable to terrorist attacks and are considered soft targets with potential to inflict high numbers of casualties. The objective of this study was to identify and characterize all documented terrorist attacks targeted at concerts and festivals reported to the Global Terrorism Database (GTD) over a 50-year period. METHODS The GTD was searched for all terrorist attacks against concerts and festivals that occurred world-wide from 1970 through 2019. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. Ambiguous incidents were excluded if there was doubt about whether they were exclusively acts of terrorism. Chi-square tests were performed to evaluate trends over time and differences in attack types. RESULTS In total, 146 terrorist attacks were identified. In addition to musical concerts, festivals included religious, cultural, community, and food festivals. With 53 incidents, South Asia was the most heavily hit region of the world, followed by the Middle East & North Africa with 25 attacks. Bombings and explosions were the most common attack types. The attacks targeted attendees, pilgrims, politicians, or police/military members who secured the concerts and festivals. CONCLUSION This analysis of the GTD, which identified terrorist attacks aimed at concerts and festivals over a 50-year period, demonstrates that the threat is significant, and not only in world regions where terrorism is more prevalent or local conflicts are going on. The findings of this study may help to create or enhance contingency plans.
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Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Luc J. Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium; REGEDIM, Free University Brussels, Belgium; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Gregory R. Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis Somville
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium; Faculty of Medicine and Health Sciences. University of Antwerp, Wilrijk, Belgium; Faculty of Medicine, University of Leuven, Leuven, Belgium; CREEC (Center for research and education in Emergency Care). University of Leuven, Leuven, Belgium
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Van Remoortel H, Scheers H, Lauwers K, Gillebeert J, Stroobants S, Vranckx P, De Buck E, Vandekerckhove P. Mass gathering events: a retrospective analysis of the triage categories, type of injury or medical complaint and medical usage rates. Emerg Med J 2022; 39:708-711. [PMID: 35393345 DOI: 10.1136/emermed-2021-211745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adequate on-site first aid delivery at mass gatherings (MGs) is one of the cornerstones to ensure safe and healthy MGs. We investigated medical usage rates, frequency of triage categories and type of injury or medical complaint, among attendees at MGs in Belgium. METHODS We analysed the Medical Triage and Registration Informatics System database, which includes prospectively collected person-level data regarding individuals visiting on-site posts at MGs in Belgium. MGs attended by >10 000 people and organised ≥5 times between 2009 and 2018 were included. We determined the proportion of patients in each triage category ('first aid' vs 'medical condition' vs 'medical emergency' vs 'no treatment') and each type of injury or medical complaint, and we calculated patient presentation rate (PPR) and transfer to hospital rate (TTHR). RESULTS Twenty-eight MGs, totalling 194 events, were included involving 148 265 patient visits. 'First aid' was the most common triage category (80%, n=118 514). The need for a nurse/physician ('medical condition'), and for the treatment of life-threatening conditions ('medical emergency') was rare (8.9%, n=13 052, and 0.6%, n=860, of all patient presentations, respectively), but remarkably higher during indoor electronic dance music (EDM) events (17.8% (n=26 391) and 4.0% (n=5930), of all patient presentations, respectively). 'Skin wounds' were the most common injury category (42.4%, n=62 275). 'Respiratory problems', 'neurological problems', 'intoxication', 'heart complaints' and 'gastrointestinal complaints' were more frequent during indoor (electronic) dance, whereas 'burns', 'fracture/contusion' and 'skin wounds' were higher during outdoor music, sports events and city festivals, respectively. PPR (per 10 000 attendees) was highest for outdoor EDM and outdoor music (median 130 (IQR 79) and 129 (IQR 104), respectively). TTHR (per 10 000 attendees) was highest for indoor EDM (median 4.4 (IQR 8.5)). CONCLUSION Medical usage rates, proportion of patients in triage and injury or medical complaint categories varied across different MG categories, suggesting opportunities for planning medical coverage at these events.
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Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium .,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Hans Scheers
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Karen Lauwers
- Humanitarian Services, Belgian Red Cross, Mechelen, Belgium
| | - Johan Gillebeert
- Belgian Red Cross, Mechelen, Belgium.,Emergency Department, ZNA Stuivenberg, Antwerpen, Belgium
| | | | - Pascal Vranckx
- Belgian Red Cross, Mechelen, Belgium.,Department of Cardiology and Intensive Care, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven Institute for Healthcare Policy, Leuven, Belgium.,Cochrane First Aid, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven Institute for Healthcare Policy, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium.,Centre for Evidence-Based Health Care, University of Stellenbosch, Cape Town, South Africa
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