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Mass-Gathering Medical Care: A Review of the Literature

Published online by Cambridge University Press:  28 June 2012

Andrew M. Milsten ,
Brian J. Maguire ,
Rick A. Bissell  and
Kevin G. Seaman
Andrew M. Milsten*
Affiliation:
Clinical Assistant Professor, University of Maryland, Division of Emergency Medicine, Department of Surgery Baltimore, Marlyand
Brian J. Maguire
Affiliation:
Associate Director of Graduate Program Department of Emergency Health ServicesUniversity of Maryland, Baltimore County Baltimore, Marlyand
Rick A. Bissell
Affiliation:
Associate Professor, University of Maryland, Baltimore County, Department of Emergency Health Services Baltimore, Marlyand
Kevin G. Seaman
Affiliation:
Co-Director, EMS Fellowship Program Assistant Professor, University of Maryland, Division of Emergency Medicine, Department of Surgery, Baltimore, Marlyand
*
Division of Emergency Medicine, Department of Surgery, 419 West Redwood Street, Suite 280, Baltimore, Maryland 21201–1734 USA, E-mail: amilstej@aol.com
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Abstract

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.

Keywords

baseballcase mixconcertscrowd surfingevent planningfootballmass gatheringsmosh pitsOlympicssporting eventsrock concerts
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 17 , Issue 3 , September 2002 , pp. 151 - 162
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

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References

1.Grange, JT, Baumann, GW: The California 500: Medical care at a NASCAR Winston Cup Race Event. Ann Emerg Med 1999; 34(4): Abstract.CrossRefGoogle Scholar
2.Levitin, HW: Providing Care at Mass Gatherings. Lecture at the 1999 Scientific Assembly: ACEP. Wednesday, 13 October, 1999.Google Scholar
3.Baker, WM, Simone, B, Niemann, JT, Daly, A: Special event medical care: The 1984 Los Angeles Summer Olympic experience. Ann Emerg Med 1986;15(2):185–190.Google Scholar
4.Green, GB, Burnham, G: Health care at mass gatherings. JAMA 1998; 279(18):1485–1486.CrossRefGoogle ScholarPubMed
5.Jaslow, D: Mass gathering medical care: A practice without standards. NAEMSP News 1999;May 8.Google Scholar
6.Parrillo, S: EMS and Mass Gatherings. e medicine website Aug 1998; (emed-icine.com/emerg/topic812.html).Google Scholar
7.Leonard, RB: Information paper: Provision of emergency medical care for crowds. ACEP 1990.Google Scholar
8.Jaslow, D, Yancey, A, Milsten, A: Mass gathering medical care. Prehospital Emergency Care 2000; 4(4):359–360. NAEMSP position paper.CrossRefGoogle ScholarPubMed
9.DeLorenzo, R: Mass gathering medicine: A review. Prehosp Disast Med 1997;12(1):68–72.CrossRefGoogle Scholar
10.Sanders, AB, Criss, E, Steckl, P, et al: An analysis of medical care at mass gatherings. Ann Emerg Med 1986;15(5):515–519.Google ScholarPubMed
11.Hodgetts, TJ, Cooke, MW: The largest mass gathering: medical coverage for millennium celebrations needs careful planning. BMJ 1999; 318: 957–958.CrossRefGoogle Scholar
12.Mear, G, Batson, D: Mass Gatherings. In: Tintinelli, JE, Ruiz, E, Krome, R (eds). Emergency Medicine: A Comprehensive Study Guide, ed 4. New York: McGraw-Hill, 1996: pp 26–29.Google Scholar
13.Nordberg, M: EMS and mass gatherings. Emerg Med Serv 1990;19(5):46–48,50–51,54,56,91.Google ScholarPubMed
14.Michael, JA, Barbera, JA: Mass gathering medical care: A twenty-five year review. Prehosp Disast Med 1997;12(4):305–312.CrossRefGoogle ScholarPubMed
15.Franaszek, J: Medical care at mass gatherings. Ann Emerg Med 1986; 15(5):600–601.CrossRefGoogle ScholarPubMed
16.Thompson, JM, Savoia, G, Powell, G, et al: Level of medical care required for mass gatherings: The XV Winter Olympic Games in Calgary, Canada. Ann Emerg Med 1991;20(4):385–390.CrossRefGoogle ScholarPubMed
17.Furst, IM, Sandor, GK: Analysis of a medical tent at the Toronto Caribana Parade. Prehosp Disaster Med 2002;6(2):199–203.Google ScholarPubMed
18.Dress, JM, Horton, EH, Florida, R: Music, Mud & Medicine. Woodstock ’94: A maniacal, musical, Mass-casualty incident. Emerg Med Serv 1995; 24(1):21:30–32.Google ScholarPubMed
19.Florida, R, Goldfarb, Z: Woodstock ’94: Peace, music, and EMS. JEMS 1994;19(12):45–50.Google ScholarPubMed
20.Paul, HM: Mass Casualty: Pope's Denver visit causes mega MCI. JEMS 1993; 18(11):64–68,72–75.Google ScholarPubMed
21.Cooke, MW, Allan, TF, Wilson, S: A major sporting event does not necessarily mean an increased workload for accident and emergency departments. Euro 96 Group of Accident and Emergency Departments. Br J Sports Med 1999; 33(5):333–335.CrossRefGoogle Scholar
22.Simon, HK, Stegelman, M, Button, T: A prospective evaluation of pediatric emergency care during the 1996 Summer Olympic Games in Atlanta, Georgia. Ped Emerg Care 1998;14(1):1–3.CrossRefGoogle ScholarPubMed
23.Walsh, DW: Killer heat. Emerg Med Serv 1995;24(10):16–18.Google ScholarPubMed
24.Gordon, D: The Pope's visit: mass gatherings and the EMS system. EMS 1988;17(1):38–44.Google ScholarPubMed
25.Schulte, D, Meade, DM: The Papal chase. The Pope's visit: A “mass” gathering. Emerg Med Serv 1993;22(11):46–49,65–75,79.Google ScholarPubMed
26.Considine, JD: Woodstock's burning legacy. The Baltimore Sun newspaper. Tuesday, 27 July, 1999; 1A and 4A.Google Scholar
27.Chused, TM, Cohn, CK, Schneider, E, et al: Medical care During the November 1969 antiwar demonstrations in Washington, DC: An experience in crowd medicine. Arch Intern Med 1971; 127: 67–69.CrossRefGoogle ScholarPubMed
28.Spaite, DW, Meislin, HW, Valenzeula, TD, et al: Banning alcohol in a major college stadium: Impact on the incidence and patterns of injury and illness. College Hlth 1990; 39: 125–128.CrossRefGoogle Scholar
29.Center for Disease Control and Prevention – MMWR: Prevention and Management of Heat-Related Illness Among Spectators and Staff During the Olympic Games – Atlanta, July 6–23, 1996. JAMA 1996.;45(29):631–633.Google Scholar
30.Friedman, LJ, Rodi, SW, Kruegur, MA, et al: Medical care at the California AIDS Ride 3: Experiences in event medicine. Ann Emerg Med 1998;31(2):219–223.CrossRefGoogle ScholarPubMed
31.Blandford, AG, Obst, CD, Dunlop, HA: Glastonbury Fair: Some medical aspects of a rock music festival. The Practitioner 1972; 209: 205–211.Google ScholarPubMed
32.Pons, PT, Holland, B, Alfrey, E, et al: An advanced emergency medical care System at National Football League games. Ann Emerg Med 1980;9(4):203–206.CrossRefGoogle ScholarPubMed
33.Flabouris, A, Bridgewater, F: An analysis of demand for first-aid care at a major public event. Prehosp Disast Med 1996;11(1):48–54.CrossRefGoogle Scholar
34.Osler, DC, Shapiro, F, Shapiro, S: Medical services at outdoor music festivals. Clin Ped 1975;14(4):390–395.CrossRefGoogle ScholarPubMed
35.James, SH, Calendrillo, B, Schnoll, SH: Medical and toxicological aspects of the Watkins Glen Rock Concert. J Forens Sci 1975; 20: 71–82.CrossRefGoogle ScholarPubMed
36.Erickson, TB: Drug use patterns at rock concerts hold key to trends. Emerg Med News 1996;10.Google Scholar
37.Schneider, EL: The Organization and delivery of medical care during the mass anti-war demonstration at the Ellipse in Washington, D.C. on May 9, 1970. Am J Pub Hlth 1971;61(7):1434–1442.CrossRefGoogle Scholar
38.Chapman, KR, Carmichael, FJ, Goode, JE: Medical services for outdoor rock music festivals. CMA J 1982;126:935–938.Google ScholarPubMed
39.Ounanian, LL, Salinas, C, Shear, CL: Medical care at the 1982 US Festival. Ann Emerg Med 1986;15(5):520–527.CrossRefGoogle ScholarPubMed
40.Grange, JT, Green, SM, Downs, W: Concert medicine: Spectrum of medical problems encountered at 405 major concerts. Acad Emerg Med 1999; 6(2):202–207.CrossRefGoogle ScholarPubMed
41.Pons, PT: Providing care at mass gatherings. Lecture at the 1997 Scientific Assembly: ACEP. Sunday, 19 October, 1997.Google Scholar
42.Erickson, TB, Koenigsberg, M, Bunney, EB, et al: Prehospital Severity scoring at major rock concert events. Prehosp Disas Med 1996;12(3):195–199.Google Scholar
43.Shelton, S, Haire, S, Gerard, B: Medical care for mass gatherings at collegiate football games. Southern Med J 1997;90(11):1081–1083.CrossRefGoogle ScholarPubMed
44.Wolfe, J, Martinez, R, Scott, WA: Baseball and beer: an analysis of alcohol consumption patterns among male spectators at major-league sporting events. Ann Emerg Med 1998;31(5):629–632.CrossRefGoogle ScholarPubMed
45.Weaver, WD, Sutherland, WD, Wirkus, MJ, et al: Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in this Setting. Ann Emerg Med 1989;18(2):155–160.CrossRefGoogle Scholar
46. De Lorenzo, RA, Gray, BC, Bennett, PC, et al: Effect of crowd size on patient volume at a large, multipurpose, indoor stadium. J Emerg Med 1989; 7: 379–384.CrossRefGoogle Scholar
47.Whipkey, RR, Paris, PM, Stewart, RD: Emergency care for mass gatherings: proper planning to improve outcome. Postgrad Med 1984;76(2): 44,46–48,51,54.CrossRefGoogle ScholarPubMed
48.Nardi, R, Bettini, M, Bozzoli, C, et al: Emergency Medical Services in mass gatherings: The experience of the formula 1 Grand Prix ‘San Marino’ in Imola. European J Emer Med 1997;4(4):217–223.CrossRefGoogle ScholarPubMed
49.Sexton, PA, Burns, RS, Lerner, SE: Sunshine ’75: Rock medicine inside Diamond Head. Hawaii Med J 1975;34(8):271–275.Google ScholarPubMed
50.Brunko, M: Emergency physicians and special events. J Emerg Med 1989;7: 405–406.CrossRefGoogle ScholarPubMed
51.Stiles, MH: Medical preparation for the Olympic Games. JAMA 1968;205 (11):147–150.CrossRefGoogle ScholarPubMed
52.Strauss, N: ’69 or ’99, a Rock Festival is a combustible mix. The New York Times; 8 August, 1999: section 2: 1,31.Google Scholar
53.Sinclair, T, Morgan, L: Woodstock Degeneration. Entertainment Weekly 1999; 6 Aug: 28–33.Google Scholar
54.Crawford, AJ: Laying down the tracks. The Baltimore Sun newspaper. Monday, 27 September, 1999; 1E and 4E.Google Scholar
55.Leonard, RB: Medical support for mass gatherings. Emerg Med Clin North Am 1996;14(2):383–397.CrossRefGoogle ScholarPubMed
56.Chang, EC, Koval, E, Freer, L, Kraus, S: Planning for an annual episodic mass gathering: emergency department and clinic utilization in Yellowstone. Wilderness Environ Med 2000;11(4):257–261.CrossRefGoogle ScholarPubMed
57.McCann, T: Patriotic spirit fills marathon, but race has 3rd death in 4 years. Boston Tribune; 08 October 2001.Google Scholar
58.Eadie, JL: Health and safety at the 1980 Winter Olympics, Lake Placid, New York. J Environmental Hlth 1981;43(4):178–187.Google ScholarPubMed
59.Reardon, TF: EMS and disaster planning for the Winter Olympics. Emerg Med Serv 1979; 8(6):88–90,92,199.Google ScholarPubMed
60.Lyttle, T, Montagne, M: Drugs, music, and ideology: A social pharmacological interpretation of the Acid House Movement. Intl Journal Add 1992;27 (10):1159–1177.Google ScholarPubMed
61.Farrow, RJ: Pop Music Festivals: A special medical problem. The Practitioner 1972; 208: 380–386.Google Scholar
62.Schlicht, J, Mitcheson, M, Henry, M: Medical aspects of large outdoor festivals. The Lancet 1972; 1: 948–952.CrossRefGoogle ScholarPubMed
63.Howard County Fire and Rescue: Special event flow chart. Howard County, Maryland.Google Scholar
64.Chambers, J, Guly, H: The impact of a music festival on local health services. Health Trends 1991; 23(3):122–123.Google ScholarPubMed
65.Hewitt, S, Jarrett, L, Winter, B: Emergency medicine at a large rock festival. J Accid Emerg Med 1996; 13: 26–27.CrossRefGoogle Scholar
66.Parrillo, S: Medical care at mass gatherings: Considerations for physician involvement. Prehosp Disast Med 1995;10(4):273–275.Google ScholarPubMed
67.Federman, JH, Giordano, LM: How to Ccope with a visit from the Pope. Prehosp Disast Med 1997;12(2):86–91.CrossRefGoogle Scholar
68.Janicke, DM, Jacob, DJ, LaFountain, RB, et al: Emergency medical care in the athletes’ village: World University Games 1993. Prehosp Disast Med 1995;10(2):113–117.CrossRefGoogle ScholarPubMed
69.Wetterhall, SF, Coulombien, DM, Herndon, JM, et al: Medical care delivery at the 1996 Olympic Games. JAMA 1998;279(18):1463–1468.CrossRefGoogle ScholarPubMed
70.White, T: 30 hurt in concert crush at Washington stadium. The Baltimore Sun; 26 May, 2002Google Scholar
71.Crippen, D, Olvey, S: Acute medical care for championship auto racing. Ann Emerg Med 1985;14(3):249–253.Google ScholarPubMed
72.Gustafson, TL, Booth, AL, Fricker, RS, et al: Disease surveillance and emergency eervices at the 1982 World's Fair. AJPH 1987;77(7):861–863CrossRefGoogle ScholarPubMed
73.Brown, D: In Salt Lake City, Gold standard medicine. The Washington Post; March 2002.Google Scholar
74.Feiner, B: EMS at the 1984 Olympics. Emerg Med Serv 1984;13(2):16–19.Google ScholarPubMed
75.Martin, RK, Yesalis, CE, Foster, D, et al: Sports injuries at the 1985 Junior Olympics: An epidemiological analysis. Am J Sports Med 1987;15(6):603–608.CrossRefGoogle Scholar
76.Laskowski, ER, Najarian, MM, Smith, AM, et al: Medical coverage for multievent sports competition: A comprehensive analysis of injuries in the 1994 Star of the North America Games. Mayo Clin Proc 1995; 70: 549–555.CrossRefGoogle ScholarPubMed
77.Weiss, BP, Mascola, L, Fannin, SL: Public health at the 1984 Summer Olympics: The Los Angeles County experience. AJPH 1988;78(6):686–688.CrossRefGoogle ScholarPubMed
78.Meehan, P, Toomey, KE, Drinnon, J, et al: Public health response for the 1996 Olympic Games. JAMA 1998;279(18):1469–1472.CrossRefGoogle ScholarPubMed
79.Sharp, TW, Brennan, RJ, Keim, M, et al: Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlantic Olympic Games. Ann Emerg Med 1998;32(2):214–222.CrossRefGoogle ScholarPubMed
80.Nordberg, M: Terror at the Olympics: A bomb shatters Atlanta's international spirit. Emerg Med Serv 1996;25(11):52–57.Google Scholar
81.Geller, RJ, Lopez, GP: Poison center planning for mass gatherings: The Georgia Poison Center experience with the 1996 Centennial Olympic Games. Clin Tox 1999;37(3):315–319.Google ScholarPubMed
82.Gannon, DM, Dense, AR, Brokema, PJ, et al: The emergency care network of a ski marathon. Am J Sports Med 1985;13(5):316–320.CrossRefGoogle ScholarPubMed
83.Foster, TM: EMS meets grunge: EMS coverage of Lollapalooza 1993. JEMS 1993;18(12):47–51,53.Google ScholarPubMed
84.Jancher, T, Samaddar, C, Milzman, D: The mosh pit experience: Emergency medical care for concert injuries. Amer J Emerg Med 2000;18(1):62–63.CrossRefGoogle Scholar
85.Kao, WF, Kuo, CC, Chang, H, et al: Characteristics of patients at a Taipei summer rock concert festival. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64(9):525–530.Google Scholar
86.Richards, R, Richards, D, Whittaker, R: Method of predicting the number of casualties in the Sydney City-to-Surf Fun Runs. Med J Aust 1984;141: 805–808.CrossRefGoogle ScholarPubMed
87.Arbon, P, Bridgewater, FH, Smith, C: Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disast Med 2001;16(3):150–158.CrossRefGoogle ScholarPubMed