Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T12:28:08.290Z Has data issue: false hasContentIssue false

17 - Management of Mass Gatherings

from PART II - OPERATIONAL ISSUES

Published online by Cambridge University Press:  05 August 2011

By
Michael S. Molloy ,
Zane Sherif ,
Stan Natin  and
John McDonnell
Edited by
Kristi L. Koenig  and
Carl H. Schultz
Kristi L. Koenig
Affiliation:
University of California, Irvine
Carl H. Schultz
Affiliation:
University of California, Irvine
Get access

Summary

Some people think football is a matter of life and death. I don't like that attitude. I can assure them it is much more serious than that.

Bill Shankly, Liverpool Football Club Manager, In Sunday Times (UK) 1981

OVERVIEW

Introduction

Globally, the management of mass gatherings encompasses a wide range of activities because of varying types of events and baseline medical and health infrastructures. Mass gathering medical care can be challenging because it is provided in unfamiliar environments without access to standard hospital resources.

The material in this chapter will assist Event Medical Officers/Command Physicians/Medical Directors, team physicians, and other medical and health personnel to plan for and provide medical services at mass gatherings. In many countries routine prehospital care is the domain of emergency medical technicians and paramedics. In others there is a mixed model with physician involvement and occasionally physician direction. Although nomenclature is inconsistent across countries, this chapter will use the term “medical director” to denote the physician in charge of medical management at a mass gathering. Mass gathering medicine involves a spectrum ranging from additional prehospital resources being directed to a specific area for a defined time period to more sophisticated models in which resources remain in place over a prolonged time. This can include temporary field hospitals and the conversion of fixed facilities into sites where many medical, nursing, and paramedical staff provide care for one hundred thousand or more persons for periods lasting from 6 hours to 4 weeks.

Keywords

event planningmass gatheringsmedical oversightmedical staff selectiontriage systemmedical reconnaissancemedical resources
Type
Chapter
Information
Koenig and Schultz's Disaster Medicine
Comprehensive Principles and Practices
 , pp. 228 - 252
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Levett, J. A new opportunity for public health development: Athens 2004. Prehosp Disaster Med. 2004;19(2):130–132.Google Scholar
The role of the emergency physician in mass casualty/disaster management. ACEP position paper. JACEP. 1976;5(11):901–902.
,Manifesto for Emergency Medicine in Europe. Council of the European Society for Emergency Medicine. Eur J Emerg Med. 1998;5(4):389–390.Google Scholar
Hsu, EB, Jenckes, MW, Catlett, CL, Robinson, KA, Feuerstein, C, Cosgrove, SE, et al. Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review. Prehosp Disaster Med. 2004;19(3):191–199.Google Scholar
McDonald, R. Career Focus – Event medicine. BMJ Classified. 2001 15th December;323(7324).Google Scholar
Kerr, GW, Wilkie, SC, McGuffie, CA. Medical cover at Scottish football matches: have the recommendations of the Gibson Report been met? Br J Sports Med. 1999;33(4):274–275.Google Scholar
Avery, JG, Chitnis, JG, Daly, PJ, Pollock, GT. Medical planning for a major event: the Pope's visit to Coventry Airport, 30 May 1982. Br Med J (Clin Res Ed). 1982;285(6334):51–53.Google Scholar
Federman, JH, Giordano, LM. How to cope with a visit from the Pope. Prehosp Disaster Med. 1997;12(2):86–91.Google Scholar
El Bashir, H, Rashid, H, Memish, ZA, Shafi, S. Meningococcal vaccine coverage in Hajj pilgrims. Lancet. 2007;369(9570):1343.Google Scholar
Morrison, DJ. Heatstroke on the Hajj. Lancet. 1980;1(8174):935.Google Scholar
Ahmed, QA, Arabi, YM, Memish, ZA. Health risks at the Hajj. Lancet. 2006;367(9515):1008–1015.Google Scholar
Schulte, D, Meade, DM. The papal chase. The Pope's visit: a “mass” gathering. Emerg Med Serv. 1993;22(11):46–9, 65–75, 9.Google Scholar
Madani, TA, Ghabrah, TM, Al-Hedaithy, MA, et al. Causes of hospitalization of pilgrims in the Hajj season of the Islamic year 1423 (2003). Ann Saudi Med. 2006;26(5):346–351.Google Scholar
Al-Ghamdi, SM, Akbar, HO, Qari, YA, Fathaldin, OA, Al-Rashed, RS. Pattern of admission to hospitals during Muslim pilgrimage (Hajj). Saudi Med J. 2003;24(10):1073–1076.Google Scholar
,County Board of Commissioners, Union County, North Carolina. Ordinance Pertaining to Mass Gatherings. 1974:224–7 Docket 12.
An Ordinance for the Regulation of Mass Gatherings in Alleghany County. Alleghany County, North Carolina, 1975.
,Arkansas State Board of Health. Mass Gathering regulations. 1973.
Arnold, JL, Levine, BN, Manmatha, R, et al. Information-sharing in out-of-hospital disaster response: the future role of information technology. Prehosp Disaster Med. 2004;19(3):201–207.Google Scholar
Arbon, P, Bridgewater, FH, Smith, C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disaster Med. 2001;16(3):150–158.Google Scholar
Jaslow, D, Drake, M, Lewis, J. Characteristics of state legislation governing medical care at mass gatherings. Prehosp Emerg Care. 1999;3(4):316–320.Google Scholar
Best, JP, McIntosh, AS, Savage, TN. Rugby World Cup 2003 injury surveillance project. Br J Sports Med. 2005;39(11):812–817.Google Scholar
Cheng, D, Yakobi-shvili, R, Fernandez, J. Major sport championship influence on ED sex census. Am J Emerg Med. 2005;23(3):408–409.Google Scholar
Roberts, DM, Blackwell, TH, Marx, JA. Emergency medical care for spectators attending National Football League games. Prehosp Emerg Care. 1997;1(3):149–155.Google Scholar
Moreno, Millan E, Bonilla, F, Alonso, JM, Casado, F. Medical care at the VIIth International Amateur Athletics Federation World Championships in Athletics ‘Sevilla '99’. Eur J Emerg Med. 2004;11(1):39–43.Google Scholar
Bock, HC, Cordell, WH, Hawk, AC, Bowdish, GE. Demographics of emergency medical care at the Indianapolis 500 mile race (1983–1990). Ann Emerg Med. 1992;21(10):1204–1207.Google Scholar
Ma, OJ, Millward, L, Schwab, RA. EMS medical coverage at PGA tour events. Prehosp Emerg Care. 2002;6(1):11–14.Google Scholar
Morimura, N, Katsumi, A, Koido, Y, et al. Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan. Prehosp Disaster Med. 2004;19(3):278–284.Google Scholar
The price of pop. Lancet. 1971;2(7726):696–697.
Carveth, SW. Eight-year experience with a stadium-based mobile coronary-care unit. Heart Lung. 1974;3(5):770–774.Google Scholar
Fisher, JM. The British Association for Immediate Care (BASICS). Its experience in major disasters, with special reference to the role of the medical incident officer. Injury. 1990;21(1):45–48; discussion 55–57.Google Scholar
Slater, D. Hillsborough television drama. Br Med J. 1997;314(7084):901–902.Google Scholar
Wardrope, J, Hockey, MS, Crosby, AC. The hospital response to the Hillsborough tragedy. Injury. 1990;21(1):53–4; discussion 5–7.Google Scholar
Heller, T. Personal and medical memories from Hillsborough. Br Med J. 1989;299(6715):1596–1598.Google Scholar
Walker, E. Not all those who died after Hillsborough did so by 3:15 pm. Br Med J. 1997;314(7089):1283.Google Scholar
DeAngeles, D, Schurr, M, Birnbaum, M, Harms, B. Traumatic asphyxia following stadium crowd surge: stadium factors affecting outcome. WMJ. 1998;97(9):42–45.Google Scholar
Khoosal, DI, Broad, JA, Smith, RJ, Settle, JA. A one-year psychological follow-up of the most severely burned victims of the Bradford fire. Burns Incl Therm Inj. 1987;13(5):411–415.Google Scholar
Sivaloganathan, S, Green, MA. The Bradford fire disaster. Part 2. accident reconstruction: who died, when and why. Med Sci Law. 1989;29(4):284–286.Google Scholar
Sivaloganathan, S, Green, MA. The Bradford fire disaster. Part 1. The initial investigations: who died, where and how? Med Sci Law. 1989;29(4):279–283.Google Scholar
Ayton, FD, Hill, CM, Parfitt, HN. The dental role in the identification of the victims of the Bradford City football ground fire. Br Dent J. 1985;159(8):262–264.Google Scholar
Sharpe, DT, Roberts, AH, Barclay, TL, et al. Treatment of burns casualties after fire at Bradford City football ground. Br Med J (Clin Res Ed). 1985;291(6500):945–948.Google Scholar
Sharpe, DT, Foo, IT. Management of burns in major disasters. Injury. 1990;21(1):41–4; discussion 55–57.Google Scholar
Leonard, RB. Medical support for mass gatherings. Emerg Med Clin North Am. 1996;14(2):383–397.Google Scholar
Brock, SH, Schlicht, J. Medical aspects of large outdoor festivals. Lancet. 1972;1(7761):1178.Google Scholar
Schlicht, J, Mitcheson, M, Henry, M. Medical aspects of large outdoor festivals. Lancet. 1972;1(7757):948–952.Google Scholar
Erickson, TB, Aks, SE, Koenigsberg, M, Bunney, EB, Schurgin, B, Levy, P. Drug use patterns at major rock concert events. Ann Emerg Med. 1996;28(1):22–26.Google Scholar
Ounanian, LL, Salinas, C, Shear, CL, Rodney, WM. Medical care at the 1982 US Festival. Ann Emerg Med. 1986;15(5):520–527.Google Scholar
Nix, CM, Khan, IJ, Hoban, M, Little, G, Keye, G, O'Connor, HJ. Oxegen 2004: the impact of a major music festival on the workload of a local hospital. Ir Med J. 2006;99(6):167–169.Google Scholar
Chapman, KR, Carmichael, FJ, Goode, JE. Medical services for outdoor rock music festivals. Can Med Assoc J. 1982;126(8):935–938.Google Scholar
Tait, I. General practitioner and his music festival. Br Med J (Clin Res Ed). 1981;283(6292):647–648.Google Scholar
Grange, JT, Green, SM, Downs, W. Concert medicine: spectrum of medical problems encountered at 405 major concerts. Acad Emerg Med. 1999;6(3):202–207.Google Scholar
O'Keefe, JS, Kheir, JN, Martin, ML, Leslie, LF, Neal, JG, Edlich, RF. Balcony collapse at the University of Virginia graduation: what hath Jefferson wrought? J Emerg Med. 1999 17(2):293–297.Google Scholar
Martinez, JM. Medical coverage of cycling events. Curr Sports Med Rep. 2006;5(3):125–130.Google Scholar
Yan, CB, Rubin, AL. Equipment and supplies for sports and event medicine. Curr Sports Med Rep. 2005;4(3):131–136.Google Scholar
Grange, JT. Planning for large events. Curr Sports Med Rep. 2002;1(3):156–161.Google Scholar
Mortelmans, LJ, Rossom, P, Du Bois, M, Jutten, G. Carbon monoxide load in indoor carting. Eur J Emerg Med. 2003;10(2):105–107.Google Scholar
DeLorenzo, RA, Gray, BC, Bennett, PC, Lamparella, VJ. Effect of crowd size on patient volume at a large, multipurpose, indoor stadium. J Emerg Med. 1989;7(4):379–384.Google Scholar
Larkin, M. Medical teams geared up for winter Olympics. Lancet. 2002;359(9304):412.Google Scholar
Baker, WM, Simone, BM, Niemann, JT, Daly, A. Special event medical care: the 1984 Los Angeles Summer Olympics experience. Ann Emerg Med. 1986;15(2):185–190.Google Scholar
Thackway, SV, Delpech, VC, Jorm, LR, McAnulty, JM, Visotina, M. Monitoring acute diseases during the Sydney 2000 Olympic and Paralympic Games. Med J Aust. 2000;173(6):318–321.Google Scholar
Wetterhall, SF, Coulombier, DM, Herndon, JM, Zaza, S, Cantwell, JD. Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit. JAMA. 1998;279(18):1463–1468.Google Scholar
Morimura, N, Takahashi, K, Katsumi, A, et al. Mass gathering medicine for the First East Asian Football Championship and the 24th European/South American Cup in Japan. Eur J Emerg Med. 2007;14(2):115–117.Google Scholar
Madzimbamuto, FD. A hospital response to a soccer stadium stampede in Zimbabwe. Emerg Med J. 2003;20(6):556–559.Google Scholar
Tang, N, Kraus, CK, Brill, JD, Shahan, JB, Ness, C, Scheulen, JJ. Hospital-based event medical support for the Baltimore marathon, 2002–2005. Prehosp Emerg Care. 2008;12(3):320–326.Google Scholar
Bowdish, GE, Cordell, WH, Bock, HC, Vukov, LF. Using regression analysis to predict emergency patient volume at the Indianapolis 500 mile race. Ann Emerg Med. 1992;21(10):1200–1203.Google Scholar
Auerbach, PS, Gelb, AM, Turns, JE. Emergency medical services at the 1984 Democratic National Convention. Ann Emerg Med. 1985;14(7):709–711.Google Scholar
Avsarogullari, L, Ikizceli, I, Sozuer, E, Yurumez, Y, Kilic, S. Hand injuries during a Muslim Sacrifice Festival. Am J Emerg Med. 2004;22(6):508–509.Google Scholar
The Football Association of Ireland – Club Licensing Manual. Dublin, Ireland: FAI 2004:118.
Murphy, D, Jabbar, N, Eldin, M, Gillen, P. Audit of the impact of a major pop concert on the workload of two regional hospitals. Ir Med J. 2001;94(1):15.Google Scholar
Zeitz, KM, Schneider, DP, Jarrett, D, Zeitz, CJ. Mass gathering events: retrospective analysis of patient presentations over seven years. Prehosp Disaster Med. 2002;17(3):147–150.Google Scholar
Chambers, J, Guly, H. The impact of a music festival on local health services. Health Trends. 1991;23(3):122–123.Google Scholar
Grange, JT, Baumann, GW, Vaezazizi, R. On-site physicians reduce ambulance transports at mass gatherings. Prehosp Emerg Care. 2003;7(3):322–326.Google Scholar
Sanders, AB, Criss, E, Steckl, P, Meislin, HW, Raife, J, Allen, D. An analysis of medical care at mass gatherings. Ann Emerg Med. 1986;15(5):515–519.Google Scholar
Zeitz, KM, Zeitz, CJ, Arbon, P. Forecasting medical work at mass-gathering events: predictive model versus retrospective review. Prehosp Disaster Med. 2005;20(3):164–168.Google Scholar
Bacon, J. The Event Safety Guide. 2nd ed. Sudbury, Suffolk, UK: HSE Books; 1999.
Calabro, J, Krohmer, J, Rivera-Rivera, E, Balcombe, D, Reich, J. Provision of Emergency Medical Care for Crowds. American College of Emergency Physicians; 1996.
Jaslow, D, Yancy, A, Milsten, A. Mass gathering medical care. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care. 2000;4(4):359–360.Google Scholar
Jaslow, D, Yancy, A, Milsten, A. Mass Gathering Medical Care: The Medical Director's Checklist. National Association of EMS Physicians (NAEMSP); 2000.
Barbeschi, M, Healing, T. Communicable disease alert and response for mass gatherings – Key considerations. World Health Organization; June, 2008.
Ryan, JM, Noone, E, Plunkett, PK. Review of a mobile accident and emergency unit at a rock concert. Ir Med J. 1994;87(5):148–149.Google Scholar
Milsten, AM, Seaman, KG, Liu, P, Bissell, RA, Maguire, BJ. Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings. Prehosp Disaster Med. 2003;18(4):334–346.Google Scholar
Milsten, AM, Maguire, BJ, Bissell, RA, Seaman, KG. Mass-gathering medical care: a review of the literature. Prehosp Disaster Med. 2002;17(3):151–162.Google Scholar
Black, JJ. Emergency use of the Airtraq laryngoscope in traumatic asphyxia: case report. Emerg Med J. 2007;24(7):509–510.Google Scholar
Maharaj, CH, Ni Chonghaile, M, Higgins, BD, Harte, BH, Laffey, JG. Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes – a manikin study. Am J Emerg Med. 2006;24(7):769–774.Google Scholar
Timmermann, A, Russo, SG, Rosenblatt, WH, et al. Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation. Br J Anaesth. 2007;99(2):286–291.Google Scholar
Code of Practice for Safety at Outdoor Pop Concerts and other Musical Events. Department of Education, The Stationery Office, Government of Ireland Publications, 1996.
Code of Practice for Safety at Sports Grounds. Department of Education, The Stationery Office, Government of Ireland Publications, 1996.
Code of Practice for Safety at Indoor Concerts. Department of Environment and Local Government, The Stationery Office, Government of Ireland Publications, 1998.
Mcdonnell, JG. Need for adequate sunscreen and after sun products at summer events. Personal communication ed. Dublin: email 2002.
Stubbe, M, Swinnen, R, Crusiaux, A, Mascart, F, Lheureux, PE. Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest. Eur J Emerg Med. 2007;14(1):14–24.Google Scholar
Stubbe, M, Mortelmans, LJ, Desruelles, D, et al. Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study. Emerg Med J. 2007;24(9):648–653.Google Scholar
Crocco, TJ, Sayre, MR, Liu, T, Davis, SM, Cannon, C, Potluri, J. Mathematical determination of external defibrillators needed at mass gatherings. Prehosp Emerg Care. 2004;8(3):292–297.Google Scholar
Motyka, TM, Winslow, JE, Newton, K, Brice, JH. Method for determining automatic external defibrillator need at mass gatherings. Resuscitation. 2005;65(3):309–314.Google Scholar
Britten, S, Whiteley, MS, Fox, PF, Goodwin, MI, Horrocks, M. Medical treatment at Glastonbury Festival. Br Med J. 1993;307(6910):1009–1010.Google Scholar
Delaney, JS, Drummond, R. Mass casualties and triage at a sporting event. Br J Sports Med. 2002;36(2):85–88; discussion 8.Google Scholar
Friedman, LJ, Rodi, SW, Krueger, MA, Votey, SR Medical care at the California AIDS Ride 3: experiences in event medicine. Ann Emerg Med. 1998;31(2):219–223.Google Scholar
Smith, FW. Where is the crowd doctor? Br J Sports Med. 1998;32(3):198.Google Scholar
Trites, P, Stephenson, D. Preparing a field hospital for a “mass” gathering. Can Nurse. 1984;80(11):48–50.Google Scholar
Banner, G. The Rhode Island Medical Emergency Distribution System (MEDS). Disaster Manage Response. 2004;2(2):53–57.Google Scholar
Lorenzo, RA, Boyle, MF, Garrison, R. A proposed model for a residency experience in mass gathering medicine: the United States Air Show. Ann Emerg Med. 1993;22(11):1711–1714.Google Scholar
Galante, JM, Jacoby, RC, Anderson, JT. Are surgical residents prepared for mass casualty incidents? J Surg Res. 2006;132(1):85–91.Google Scholar
Goldman, B. Spectator events: medical preparation a must. Can Med Assoc J. 1988;138(2):164–165.Google Scholar
Madge, SN, Kersey, JP, Murray, G, Murray, JR Are we training junior doctors to respond to major incidents? A survey of doctors in the Wessex region. Emerg Med J. 2004;21(5):577–579.Google Scholar
Mann, NC, MacKenzie, E, Anderson, C. Public health preparedness for mass-casualty events: a 2002 state-by-state assessment. Prehosp Disaster Med. 2004;19(3):245–255.Google Scholar
Rubin, AL. Safety, , security, and preparing for disaster at sporting events. Curr Sports Med Rep. 2004;3(3):141–145.Google Scholar
Rutherford, WH. The place of exercises in disaster management. Injury. 1990;21(1):58–60; discussion 3–4.Google Scholar
Michael, JA, Barbera, JA. Mass gathering medical care: a twenty-five year review. Prehosp Disaster Med. 1997;12(4):305–312.Google Scholar
Arbon, P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131–135.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×