Mass-gatherings events provide a difficult setting for which to plan an appropriate emergency medical response. Many of the variables that affect the level and types of medical needs, have not been fully researched. This review examines these variables.Methods:An extensive review was conducted using the computerized databases Medline and Healthstar from 1977 through May 2002. Articles selected contained information pertaining to mass-gathering variables. These articles were read, abstracted, analyzed, and compiled.Results:Multiple variables are present during a mass gathering, and they interact in complex and dynamic ways. The interaction of these variables contributes to the number of patients treated at an event (medical usage rate) as well as the observed injury patterns. Important variables include weather, event type, event duration, age, crowd mood and density, attendance, and alcohol and drug use.Conclusions:Developing an understanding of the variables associated with mass gatherings should be the first step for event planners. After these variables are considered, a thorough needs analysis can be performed and resource allocation can be based on objective data.

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.

The objectives of this study were to introduce a damage and loss-of-function survey tool that can be used to standardize future assessment of hospital performance, to assess the impact of the 2010 Chilean earthquake on the functions of the public hospital system in the Bío-Bío Province, and to translate these results as lessons that can be applied to U.S. hospitals. This study focused on damage to structural and nonstructural components, utility services, and equipment, as well as loss of supplies and personnel. Structural engineers completed a visual inspection of facilities, and hospital administrators were surveyed to assess the overall impact on operations. All hospitals lost communications, electrical power, and water for several days. All hospitals reported some physical damage although only one suffered significant structural damage. The lessons learned from Chile are applied to U.S. practice of hospital seismic mitigation.

This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly. Since EMS providers treat a variety of patients and operate in a variety of environments, providers may be exposed to potentially pathogenic organisms, serving as vectors for the exposure of their patients to these same organisms. Proper application of accepted standards for hand hygiene can help reduce the presence of microbes on provider hands and subsequent transmission to patients and the environment.

IntroductionFrequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient’s likelihood of frequent Emergency Medical Services (EMS) use. To provide effective care to eligible individuals, MICH providers must have a working understanding of the common conditions they will encounter.ObjectiveThe purpose of this descriptive study was to evaluate the diagnosis prevalence and comorbidity among participants in the Queen Anne’s County (Maryland USA) MICH Program. This fundamental knowledge of the most common medical conditions within the MICH Program will inform future mobile integrated health programs and providers.MethodsThis study examined preliminary data from the MICH Program, as well as 2017 Maryland census data. It involved secondary analysis of de-identified patient records and descriptive statistical analysis of the disease prevalence, degree of comorbidity, insurance coverage, and demographic characteristics among 97 program participants. Diagnoses were grouped by their ICD-9 classification codes to determine the most common categories of medical conditions. Multiple linear regression models and chi-squared tests were used to assess the association between age, sex, race, ICD-9 diagnosis groups, and comorbidity among program enrollees.ResultsResults indicated the most prevalent diagnoses included hypertension, high cholesterol, esophageal reflux, and diabetes mellitus. Additionally, 94.85% of MICH patients were comorbid; the number of comorbidities per patient ranged from one to 13 conditions, with a mean of 5.88 diagnoses per patient (SD=2.74).ConclusionOverall, patients in the MICH Program are decidedly medically complex and may be well-suited to additional community intervention to better manage their many conditions. The potential for MICH programs to simultaneously improve patient outcomes and reduce health care costs by expanding into larger public health and addressing the needs of the most vulnerable citizens warrants further study.ScharfBM, BissellRA, TrevittJL, JenkinsJL.Diagnosis prevalence and comorbidity in a population of mobile integrated community health care patients.Prehosp Disaster Med. 2019;34(1):46–55.

Objective: To develop an evaluation method for comparing the performance of emergency medical services (EMS) systems in telephone assessment. Methods: An analysis of the telephone assessment task reveals three functional sub-tasks which may or may not be present in any EMS system: 1) "triage," or deciding whether or not to send EMS vehicle (s); 2) "prioritization," or deciding about the optimal delay of intervention; and 3) choice of the level of intervention. Each of these sub-tasks may generate false positive and false negative errors of various magnitudes ("costs"). With a sufficient sample of cases for which the "ideal" decisions are known, the sensitivity and specificity of each sub-task can be measured as well as the average costs of errors per call. EMS systems often differ between countries, and even within the same country, in their implementation of the three sub-tasks and in their local context (health care system, social values, etc.). A matrix (real decisions x ideal decisions) of the values ("costs") of all possible types of errors can be established locally by consensus for each particular EMS system. Using the same range of values for these matrices, the performance of EMS systems in telephone assessment can be compared based on the average cost of errors per call. Longitudinal and individual measurements also may be used locally for quality improvement within each EMS system. Results: This method has been applied successfully at the Montreal EMS system, Urgences Sante (detailed results will be presented in another paper by the same authors). Interested participants at the Congress will be encouraged to join in an international study.

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