Mass gathering medicine: event factors predicting patient presentation rates

Abstract

This study was conducted to identify the event characteristics of mass gatherings that predict patient presentation rates held in a southeastern US university community. We conducted a retrospective review of all event-based emergency medical services (EMS) records from mass gathering patient presentations over an approximate 23 month period, from October 24, 2009 to August 27, 2011. All patrons seen by EMS were included. Event characteristics included: crowd size, venue percentage filled seating, venue location (inside/outside), venue boundaries (bounded/unbounded), presence of free water (i.e., without cost), presence of alcohol, average heat index, presence of climate control (i.e., air conditioning), and event category (football, concerts, public exhibitions, non-football athletic events). We identified 79 mass gathering events, for a total of 670 patient presentations. The cumulative patron attendance was 917,307 persons. The patient presentation rate (PPR) for each event was calculated as the number of patient presentations per 10,000 patrons in attendance. Overdispersed Poisson regression was used to relate this rate to the event characteristics while controlling for crowd size. In univariate analyses, increased rates of patient presentations were strongly associated with outside venues [rate ratio (RR) = 3.002, p < 0.001], unbounded venues (RR = 2.839, p = 0.001), absence of free water (RR = 1.708, p = 0.036), absence of climate control (RR = 3.028, p < 0.001), and a higher heat index (RR = 1.211 per 10-unit heat index increase, p = 0.003). The presence of alcohol was not significantly associated with the PPR. Football events had the highest PPR, followed sequentially by public exhibitions, concerts, and non-football athletic events. In multivariate models, the strong predictors from the univariate analyses retained their predictive significance for the PPR, together with heat index and percent seating. In the setting of mass event medical care, we note that several factors are strongly associated with an increased patient census, including outside (external) or unbounded venues, the absence of fee water (i.e., without cost), no climate control, percent (occupied) seating, and increasing heat index. Although the presence of alcohol is noted to increase patient needs, it does not do so significantly. Regarding event type, collegiate football games have the highest patient census among the range of other events studied. These findings should be considered during the process of EMS resource planning for mass gatherings.

Preparedness for Mass Gatherings: Factors to Consider According to the Rescue Authorities

“…Understanding crowd behavior in turn allows adequate crowd management assessment in the pre-event phase [43]. In addition, event characteristics, such as the event type, alcohol and drug use, and weather affect the need of medical attention and injury profiles [8,21,[25][26][27][28]42,44]. Our results showed that awareness of event characteristics and the profile of the participants are vital factors to be noted in the emergency plan of a mass gathering event.…”

“…Different factors were shown to have an impact on the need of transport to hospital, the number of patients, and the injury patterns. These include weather [13,14], the level of the on-site medical care [15][16][17][18][19][20][21][22][23], audience profile [24], event type [25][26][27], duration [28], and geographical location [29]. Alcohol and drug use, attendance, and the age and mood of the crowd can also have an effect on the level and the need of medical response [28].…”

Risks threatening the health of people participating in mass gatherings: A systematic review

“…In the present study, environmental risks threatening the health of participants in MGs included weather risks such as cold, environmental heat,[1215161718192021222324252627282930313233343536373839404142] precipitation,[12] higher humidity,[121520313842] long distance of gatherings and austere environment,[18] mobility of population,[3142] gatherings in outside (external) and unbounded venues,[32] MGs exposed to traffic accidents,[19] the participants’ number and crowd density,[15182028293139] insect bites, and sunburns. [40]…”

“…In this study, the risks due to lack of support on resources and inefficiency of gatherings’ safety recognized in this domain were reported as Lack or shortage of patient care workers such as Physicians or Paramedics;[181926313336] flow directions;[20] risk assessment;[20] communication;[20] pre-event advice;[23] a plan for vaccination before gatherings;[2526] coordination;[26] free water as well as terrorist attacks; difficult access to water and food;[28] difficult access to medical facilities;[262732] and duration of MG.[38]…”

Travelers to the FIFA world cup 2014 in Brazil: Health risks related to mass gatherings/sports events and implications for the Summer Olympic Games in Rio de Janeiro in 2016

“…International sporting events like the Olympic Games or the FIFA world cups typically take place outdoors with partially extreme weather conditions. They are attended by people from a wide range of different nations in a rivaling mood or shared identity in regards to the sport match, and a potentially increased use of alcohol and other drugs [10,11].…”