Mass Gathering Medicine Research Articles

Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement

Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, protection of continuing medical service to the populations surrounding the event venue, and preparation for surge to respond to extraordinary events. Pre–event planning among jurisdictional public health and EMS, acute care hospitals, and event EMS is essential, but should also include, at a minimum, event security services, public relations, facility maintenance, communications technicians, and the event planners and organizers. Previous documented experience with similar events has been shown to most accurately predict future needs. Future work in and guidance for mass gathering medical care should include the consistent use and further development of universally accepted consistent metrics, such as Patient Presentation Rate and Transfer to Hospital Rate. Only by standardizing data collection can evaluations be performed that link interventions with outcomes to enhance evidence-based EMS services at mass gatherings. Research is needed to evaluate the skills and interventions required by EMS providers to achieve desired outcomes. The event-dedicated EMS Medical Director is integral to acceptable quality medical care provided at mass gatherings; hence, he/she must be included in all aspects of mass gathering medical care planning, preparations, response, and recovery. Incorporation of jurisdictional EMS and community hospital medical leadership, and emergency practitioners into these processes will ensure that on-site care, transport, and transition to acute care at appropriate receiving facilities is consistent with, and fully integrated into the community's medical care system, while fulfilling the needs of event participants. Key words: mass gathering medicine; event medicine; event medical care planning; EMS medical director; prehospital

Editorial introductions

Editorial introductions

Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event.

Music festivals, including electronic dance music events (EDMEs), increasingly are common in Canada and internationally. Part of a US $4.5 billion industry annually, the target audience is youth and young adults aged 15-25 years. Little is known about the impact of these events on local emergency departments (EDs). Drawing on prospective data over a 2-day EDME, the authors of this study employed mixed methods to describe the case mix and prospectively compared patient presentation rate (PPR) and ambulance transfer rate (ATR) between a first aid (FA) only and a higher level of care (HLC) model. There were 20,301 ticketed attendees. Seventy patient encounters were recorded over two days. The average age was 19.1 years. Roughly 69% were female (n=48/70). Forty-six percent of those seen in the main medical area were under the age of 19 years (n=32/70). The average length of stay in the main medical area was 70.8 minutes. The overall PPR was 4.09 per 1,000 attendees. The ATR with FA only would have been 1.98; ATR with HLC model was 0.52. The presence of an on-site HLC team had a significant positive effect on avoiding ambulance transfers. Twenty-nine ambulance transfers and ED visits were avoided by the presence of an on-site HLC medical team. Reduction of impact to the public health care system was substantial. Electronic dance music events have predictable risks and patient presentations, and appropriate on-site health care resources may reduce significantly the impact on the prehospital and emergency health resources in the host community.

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.

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

SummaryThe 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.

Mass gatherings medicine: international cooperation and progress

In July, 2012, we discussed plans to move the complex public health issues surrounding mass gatherings into a formal scientific discipline, and to create a global network for mass gatherings research, training, and capacity development.1,2 We believed that it was important for this network to be led by Saudi Arabia, since the country has extensive experience through many decades of managing millions of pilgrims from 184 countries at the largest yearly recurring religious mass gathering in the world—the Hajj.

Ziad Memish: father of mass gatherings medicine

Ziad Memish is currently the Deputy Minister of Health for Public Health for the Government of Saudi Arabia. The son of a diplomat with the Saudi Foreign Office, he grew up travelling with his parents, living and studying in different countries. “I have always admired what my father used to do helping Saudi citizens in need abroad. My first ambition was to be a diplomat like my father, but seeing my older brother train as an invasive cardiologist in Canada persuaded me to change into medicine”, he says.

A Systematic Review of Noncommunicable Health Issues in Mass Gatherings

The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering. A systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events. Across all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare. The rate of noncommunicable health issues varies across events and very serious emergencies are rare.

Suffolk Show 2011: Prehospital Medical Coverage in a Mass-gathering Event

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. 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. 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%). 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.

Mass-gathering medicine: a descriptive analysis of a range of mass-gathering event types

ObjectiveTo identify and evaluate the volume, nature, and severity of patient presentations encountered by emergency medical services (EMS) at all mass-gathering events held at or near a southeastern US university. In addition, to compare the existing literature base (single mass-gathering event held in large urban population centers) with a broader variety of events varying in crowd size and locations. MethodsThis was a retrospective review of all EMS records from mass-gathering patient presentations (individual-patient cases) between October 24, 2009, and August 27, 2011. All patrons seen by event-based EMS were included. Events categories included the following: football, concerts, public exhibitions, and nonfootball athletic events. Event volumes were defined as follows: low (<1000 patrons), medium (between 1001 and 15 000 patrons), and large (>15 000 patrons). Case presentation-management categories included the following: trauma, medical, and support (minimal medical intervention required, eg, minor dressing for abrasion, water, etc). Severity categories included the following: mild, moderate, and severe based on the following definitions using both provider assessment and the use of transport to a hospital: minor cases were considered non–life threats and did not result in a transport to a hospital; moderate cases were associated with transports to a hospital; and severe cases were life threats with transport to a hospital. ResultsWe studied 79 events over the study period. Event volumes were 16.45% high, 79.75% medium, and 3.80% low. A total of 670 cases presented, with a mean of 8.48 cases/event. The football category had the highest mean number of cases with 37.09 cases/event, for a total of 408 cases. The nonfootball, athletic event category had the lowest mean number of cases at 1.83 cases/event. Most (81.82%) of the football events were classified as large volume. Support cases were the most common presentation (43.13%), followed closely by medical complaints (41.94%). Most cases were mild in severity (95.97%). There were 27 cases requiring transport to hospital, with 3 cases being life-threatening. The average patient age was 33 years, with 60.3% female sex. These features are similar to the published information on large event medical attendance. ConclusionsIn this retrospective, descriptive study of a broad range of event type, the most common patient presentations at mass-gathering events were mild in severity, requiring minimal medical intervention. Both transports from the event to a hospital and the occurrence of life threats were uncommon. Our findings are similar to the data found in the existing medical literature.

Mass-Gathering Medicine: Creation of an Online Event and Patient Registry

INTRODUCTION/PROBLEM: A review of the mass-gathering medicine literature confirms that the research community currently lacks a standardized approach to data collection and reporting in relation to large-scale community events. This lack of consistency, particularly with regard to event characteristics, patient characteristics, acuity determination, and reporting of illness and injury rates makes comparisons between and across events difficult. In addition, a lack of access to good data across events makes planning medical support on-site, for transport, and at receiving hospitals, challenging. This report describes the development of an Internet-hosted, secure registry for event and patient data in relation to mass gatherings. Descriptive; development and pilot testing of a Web-based event and patient registry. Several iterations of the registry have resulted in a cross-event platform for standardized data collection at a variety of events. Registry and reporting field descriptions, successes, and challenges are discussed based on pilot testing and early implementation over two years of event enrollment. The Mass-Gathering Medicine Event and Patient Registry provides an effective tool for recording and reporting both event and patient-related variables in the context of mass-gathering events. Standardizing data collection will serve researchers and policy makers well. The structure of the database permits numerous queries to be written to generate standardized reports of similar and dissimilar events, which supports hypothesis generation and the development of theoretical foundations in mass-gathering medicine.

An Emergency Medical Planning Guide for Commercial Spaceflight Events

Commercial spaceflight events transporting paying passengers into space will begin to take place at various spaceports around the country within the next few years. Many spaceports are located in remote areas that are far from major hospitals and trauma centers. Spaceport medical directors should develop emergency medical plans (EMPs) to prepare for potential medical contingencies that may occur during commercial spaceflight events. The aim of this article is to guide spaceport medical directors in emergency medical planning for commercial spaceflight events. This guide is based on our experience and a recently developed EMP for Spaceport America which incorporated a literature review of mass gathering medicine, existing planning guides for mass gathering events, and EMPs for analogous aerospace events. We propose a multipronged approach to emergency medical planning, consisting of event planning, medical reconnaissance, medical personnel, protocols, physical facility and hardware, and documentation. Medical directors should use this guide to develop an emergency medical plan tailored to the resources and constraints specific to their events.

Mass gatherings medicine and global health security

Mass gatherings medicine and global health security

Mass gathering medicine: a leisure or necessity?

International Journal of Clinical PracticeVolume 66, Issue 6 p. 530-532 PERSPECTIVE Mass gathering medicine: a leisure or necessity? J. A. Al-Tawfiq, J. A. Al-Tawfiq Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi ArabiaSearch for more papers by this authorZ. A Memish, Z. A Memish Ministry of Health, Riyadh, Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi ArabiaSearch for more papers by this author J. A. Al-Tawfiq, J. A. Al-Tawfiq Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi ArabiaSearch for more papers by this authorZ. A Memish, Z. A Memish Ministry of Health, Riyadh, Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi ArabiaSearch for more papers by this author First published: 07 May 2012 https://doi.org/10.1111/j.1742-1241.2012.02923.x Ziad A. Memish, Ministry of Health, P.O. Box 54146, Riyadh 11514, Kingdom of Saudi Arabia Tel.:+966 1 2124052 Fax: +966 1 2125052 Email: zmemish@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume66, Issue6June 2012Pages 530-532 RelatedInformation

Crowd and environmental management during mass gatherings

Crowds are a feature of large cities, occurring not only at mass gatherings but also at routine events such as the journey to work. To address extreme crowding, various computer models for crowd movement have been developed in the past decade, and we review these and show how they can be used to identify health and safety issues. State-of-the-art models that simulate the spread of epidemics operate on a population level, but the collection of fine-scale data might enable the development of models for epidemics that operate on a microscopic scale, similar to models for crowd movement. We provide an example of such simulations, showing how an individual-based crowd model can mirror aggregate susceptible-infected-recovered models that have been the main models for epidemics so far.

Emergence of medicine for mass gatherings: lessons from the Hajj

SummaryAlthough 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.

Assessing the Psychosocial Elements of Crowds at Mass Gatherings

The environmental aspects of mass gatherings that can affect the health and safety of the crowd have been well described. Although it has been recognized that the nature of the crowd will directly impact the health and safety of the crowd, the majority of research focuses on crowd behavior in a negative context such as violence or conflict. Within the mass gathering literature, there is no agreement on what crowd behavior, crowd mood and crowd type actually mean. At the same time, these elements have a number of applications, including event management and mass gathering medicine. These questions are worthy of exploration. This paper will report on a pilot project undertaken to evaluate how effective current crowd assessment tools are in understanding the psychosocial domain of a mass gathering event. The pilot project highlighted the need for a more consistent descriptive data set that focuses on crowd behavior. The descriptive data collected in this study provide a beginning insight into the science of understanding crowds at a mass gathering event. This pilot has commenced a process of quantifying the psychosocial nature of an event. To maximize the value of this work, future research is required to understand the interplay among the three domains of mass gatherings (physical, environmental and psychological), along with the effects of each element within the domains on safety and health outcomes for participants at mass gatherings.

Mass gathering medicine: a practical means of enhancing disaster preparedness in Canada

We explore the health care literature and draw on two decades of experience in the provision of medical care at mass gatherings and special events to illustrate the complementary aspects of mass gathering medical support and disaster medicine. Most communities have occasions during which large numbers of people assemble in public or private spaces for the purpose of celebrating or participating in musical, sporting, cultural, religious, political, and other events. Collectively, these events are referred to as mass gatherings. The planning, preparation, and delivery of health-related services at mass gatherings are understood to be within the discipline of emergency medicine. As well, we note that owing to international events in recent years, there has been a heightened awareness of and interest in disaster medicine and the level of community preparedness for disasters. We propose that a synergy exists between mass gathering medicine and disaster medicine. Literature review and comparative analysis. Many aspects of the provision of medical support for mass gathering events overlap with the skill set and expertise required to plan and implement a successful medical response to a natural disaster, terrorist incident, or other form of disaster. There are several practical opportunities to link the two fields in a proactive manner. These opportunities should be pursued as a way to improve the level of disaster preparedness at the municipal, provincial, and national levels.

Medical Support for the 2009 World Police and Fire Games: A Descriptive Analysis of a Large-Scale Participation Event and its Impact

In the summer of 2009, British Columbia hosted the World Police and Fire Games (WPFG). The event brought together 10,599 athletes from 55 countries. In this descriptive, Canadian study, the composition of the medical team is analyzed, the unique challenges faced are discussed, and an analysis of the illness and injury rates is presented. This event occurred during a labor dispute affecting the sole provider of emergency ambulance service in the jurisdiction, which necessitated additional planning and resource allocation. As such, the context of this event as it relates to the literature on mass gathering medicine is discussed with a focus on how large-scale public events can impact emergency services for the community. This is a case report study. There were 1,462 patient encounters. The majority involved musculo-skeletal injuries (53.8%). The patient presentation rate (PPR) was 109.40/1,000. The medical transfer rate (MTR) was 2.32/1,000. The ambulance transfer rate (ATR) for the 2009 WPFG was 0.52/1,000. In total, 31 patients were transported to the hospital, the majority for diagnostic evaluation. Only seven calls were placed to 9-1-1 for emergency ambulance service. The 2009 WPFG was a mass-gathering sporting event that presented specific challenges in relation to medical support. Despite relatively high patient presentation rates, the widely spread geography of the event, and a reduced ability to depend on 9-1-1 emergency medical services, there was minimal impact on local emergency services. Adequate planning and preparation is crucial for events that have the potential to degrade existing public resources and access to emergency health services for participants and the public at large.

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

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. Literature review. 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. 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. 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.