• Transportation
• First Aid
• Critical Care

• Emergency Medicine
• Transportation
• First Aid
• Critical Care

Planning for the delivery of emergency medical services at large-scale public events was the top of a review by Eric W. Ossmann, MD, Duke University Health System, Durham, North Carolina, USA. Dr Ossmann began by distinguishing a “mass gathering”—which is any event where a large number of people are involved in a coordinated activity—from a “mass casualty,” which is defined by the number and severity of injuries.

In formulating a medical plan for a mass gathering, medical responders should always plan for the unexpected but at the same time take into consideration the type of event in calculating the potential patient presentation rate (PPR), the hospital transport rate, and even the cardiac arrest rate [Arbon P. Prehosp Disaster Med. 2007]. According to Dr Ossmann, the plan itself must cover threat assessment and gap identification. Medical threat assessment includes an understanding of the population baseline risk, event-specific risks (activities and the environment), and crowd size and composition (age range and known comorbidities). Gap analysis considers the positioning and availability of on-site, local, and regional equipment, facilities, and resources.

In Dr Ossmann's opinion, one of the best papers on planning for a mass gathering was based on a 1988 model developed from the study of medical incident patterns at events in large college stadiums. Medical incidents occurred at a rate of 1.20 to 5.23 per 10 000 people, with acute emergencies occurring at a rate of 0.09 to 0.31 per 10 000 people. Cardiac arrest and patient transport were much less common.

An important paper from 1991 discussed planning for a papal mass conducted during September in the US Southwest in which the heat index (about 102°F) was expected to play a major part. The plan included pre-event public education, water stations, cooling shelters, and on-site medical care. Although the majority of the individuals (about 78%) who experienced heat illness were treated on-site, about 19% were transported to off-site facilities. In general, there is a strong correlation between heat index and PPR; PPR increases by 3% for every 10-degree increase in the heat index [Perron AD et al. Prehosp Emerg Care. 2005].

Dr Ossmann outlined 4 echelons of care that need to be addressed at any mass gathering: frontline staff (eg, ushers and security officers), mobile treatment teams, on-site medical facilities, and transfer arrangements with local hospitals.

A 25-year review of mass gathering events characterized them by size, number of off-site medical transports, and sudden cardiac deaths. Variables that best predicted medical usage, specific injury patterns, and levels of care included event type and ambient temperature [Milsten AM et al. Prehosp Disaster Med. 2003].

Dr Ossmann concluded by highlighting some key features of a robust event plan: accessible and functional first aid equipment, a large network of cardiopulmonary resuscitation-trained personnel, a dedicated event control center, a published communication plan, on-site physicians with experience and training, and internal and external surveillance and coordination.

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