Background: 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. Method: Literature review and comparative analysis. Results: 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. Conclusions: 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.
Abbreviations:ALS = advanced life support ATR = ambulance transfer rate BCAS = British Columbia Ambulance Service MGM = mass gathering medicine MTR = medical transfer rate PPR = patient presentation rate WPFG = World Police and Fire Games Abstract Introduction: 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. Methods: This is a case report study. Results: 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. Conclusions: 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.
IntroductionPoint-of-Care Ultrasound (POCUS) has become an important diagnostic tool for hospital-based clinicians. This study assesses the role of POCUS at Pemberton Music Festival 2016 (Pemberton, British Columbia [BC], Canada), a remote mass gathering where physicians face limited resources, complex disposition decisions, and a dynamic clinical environment.ObjectivesThis study prospectively evaluated the impact of POCUS on patient diagnosis, management, and disposition based on the self-report of the study physicians. The authors hypothesized that having ultrasound available for use would aid in diagnostic and management decisions and would reduce the need to transfer patients off-site to other health care facilities, reducing impact on the acute health services in the host community.MethodsA handheld ultrasound was available for use by physicians in the main medical tent. All participating physicians self-reported their training and comfort using POCUS. After each POCUS scan, physicians completed a survey and recorded the indication for use, scans performed, and impact on patient diagnosis, management, and disposition.ResultsIn total, POCUS was used on 28 of the 686 patients treated in the main medical tent; POCUS was reported to narrow the differential diagnosis in 64% of cases and altered the working diagnosis in 21% of cases. Its use changed the management plan in 39% of patients. Its use was reported to reduce the burden on broader health care resource utilization in 46% of cases and prevented ambulance transport off-site in 32% of cases (nine cases in total). This corresponded to an absolute risk reduction of 1.3% for the percentage of patients transferred to hospital (PPTH; relative risk reduction of 53%).Conclusion:Physicians reported that POCUS improved the diagnosis, management, and disposition of select patients at a remote, multi-day music festival. Also, POCUS reduced ambulance transfers off-site and reduced the perceived burden on broader health care utilization.PragerR, SedgwickC, LundA, KimD, HoB, StachuraM, GutmanS. Prospective evaluation of point-of-care ultrasound at a remote, multi-day music festival. Prehosp Disaster Med. 2018;33(5):484–489.
A coordinated on-site medical team covering the entire event site and race route was deployed to reduce the severity of illness and injury at a long-distance running event.
Conflicts of interest:All authors have participated at events as volunteers and in contracted roles as operational and clinical care providers. Dr. Gutman is the president of Rockdoc Inc., an event operations company.Turris SA, Camporese M, Gutman SJ, Lund A. Mass-gathering medicine: risks and patient presentations at a 2-day electronic dance music event -year two. Prehosp Disaster Med. 2016;31(6):687-688.In June of 2015, Prehospital and Disaster Medicine published a paper on the impact of a higher level of care team on ambulance transfer rates (ATRs) during an urban, indoor music festival that took place over two consecutive days, for six hours each evening.1 This was a somewhat unique event as many music festivals are outdoor events and include "residential" camping on-site. The observational study presented the data from 2013 and documented patient presentation rates (PPR), case mix, and ATRs. One outcome of particular interest was the impact of a multi-disciplinary team capable of providing care similar to that available in the emergency department, with a specific focus on reduction of ATRs.We repeated the deployment in 2014, at the same music festival, and again embedded a data collection team in the deployment (HA, MC, ST, and SV). Details regarding the methodology are available in the original paper. The study received ethical approval from the University of British Columbia (Vancouver, British Columbia, Canada). In this letter, we briefly report the findings from 2014, the second year and final year of the study.In 2014, there were roughly 10,000 attendees on each of the two nights the event was held. One hundred individuals sought medical care in the field clinic during the event (N = 100; 49% first night and 51% second night). The average age was 19.49 years (range: 12-30 years). Forty-seven individuals (47%) treated were less than 19 years of age (the legal age for consuming alcohol). Sixty-three percent were female. Individuals arrived at the field clinic on foot (n = 59), by wheelchair (n = 37), and by stretcher (n = 4). The minority of patients arrived unaccompanied (n = 14), escorted by friends (n = 6), or with security services (n = 5). Most were escorted by members of the roving medical teams (n = 68): venue medical staff (n = 18) or contracted medical staff (n = 50). Seven arrivals were not documented.There were 53 non-acute presentations (eg, knee pain or headache), and 47 were classified as potentially urgent (n = 39; eg, moderate shortness of breath or moderate allergic reaction) or emergent (n = 8; eg, overdose or poisoning, seizures, or altered level of consciousness). Accordingly, alcohol use was documented as a contributing factor for 71/100 individuals. Recreational drug use was documented in 32/100 cases. Use of 3,4-methylenedioxy-N-methylamphetamine (MDMA), or a product sold as MDMA, was the most common form of substance use disclosed (n = 30; ie, "Ecstasy" or "Molly"). Other intoxicants reported included gamma-hydroxybutyric acid/GHB (n = 1) and cocaine (n = 4).A total of seven indi...
The Ride to Conquer Cancer Series has shown that medical coverage at multi-day, cross-national cycling events must be planned carefully to face a unique set of circumstances, including legislative issues, long-distance communication capabilities, and highly mobile participants. This combination of factors leads to potentially higher PPRs than have been reported for noncycling events. This study also illuminates the additional workload "self-treatment" visits place on the medical team.
During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they "occasionally" or "frequently" found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that "occasionally" or "frequently" HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% "agreed" or "strongly agreed" that this was the case. The dispatcher responses (n = 21) to the same item also "agreed" or "strongly agreed" that this was the case 95.5% of the time. CONCLUSION The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.
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