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Mass gathering medical care generally refers to the organized care provided for groups of at least 1000 people, including both spectators and participants, although some authors put this number as high as 25,000.1-3 The event types range considerably from large community events such as parades, fundraisers, festivals, and fairs to political rallies, religious events, sporting competitions, and outdoor and indoor performances such as music concerts. However, to define a mass gathering simply by the number of participants is inadequate.1 A more conceptual definition has been suggested by Arbon, which endorses the idea that a mass gathering is a collection of people that because of its inherent features including density of people, location, or environment may limit medical access.1 Mass gatherings occur in nearly every conceivable location and condition and hence pose unique challenges to the medical provider for planning purposes and provision of medical care.


Despite a long social history of mass gatherings in the United States, the first medical literature reviewing health care in mass gatherings surfaces in the 1960s when volunteer health care providers supported antiwar demonstrators.4 During the ensuing decades, a reservoir of case reports provided information for medical planning and provision at specific mass events such as stadiums, concerts, and the Olympics. In 1990, ACEP released a guide for medical care for crowds,5 and in 2000, NAEMSP released a National Position Paper titled “Mass Gathering Medical Care,” which called for a rigorous scientific evaluation of medical care delivery in place and the adequacy of care, an assessment of injury patterns, and minimum standards for preparation and delivery of medical care.6 The statement also introduced the concept of the medical action plan and the medical director's checklist.7


Hundreds of millions of people attend mass gathering events every year in the United States alone.8

Consistent in the literature is the fact that even though large-scale mass gatherings are composed of relatively “well” proportion of the population, injuries are generated more frequently at mass gathering events than in the general population.


  • Describe types of mass gatherings and discuss varying needs based on type.

  • Describe common medical conditions and complaints at mass gathering events.

  • Discuss factors that can lead to widespread illness and development of an MCI.

  • Describe the role of the event medical director.

  • Describe types of personnel utilized in event medical support.

  • Describe event medical support planning and essential factors of consideration (eg, number of participants, access, communication, supplies, local medical resources, etc).

  • Describe environmental factors that play a role in event planning and operational adjustments.

  • Discuss contractual arrangements and terms that are important to successful medical support of mass gathering events.

  • Discuss CQI and research initiatives specific to mass gathering events.

  • Provide a basic event medical planning ...

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