Chapter 4: Mass Gatherings

INTRODUCTION

Mass gathering medical care refers to the provision of medical services to organized events or venues with relatively large numbers of people in a defined geographic area. Typically, mass gatherings are considered to be events that have at least 1000 people; however, this does not have to be the case.^1,2 Although the principles of mass gathering medical care traditionally apply to congregations of large numbers of people, these principles also apply to smaller venues with a relatively high concentration of people in a limited space and those where it may not be easy to access the general system of EMS. Therefore, the principles of mass gathering medical care also apply to athletic events with fewer than 1000 people, as well as airplanes, cruise ships, and wilderness environments.

Table 4-1 lists some of the major factors affecting planning for a mass gathering event. Physical barriers may inhibit easy entry and exit from the site. These barriers can make it difficult to get medical resources into, and to get patients out of, the event location. Reliable communication between medical personnel, event organizers, and outside medical resources is key to a successful medical response. Environmental factors will also affect the response, especially at extremes of cold, wet weather that can precipitate hypothermia or hot weather that can precipitate dehydration and heat stroke. Finally, event planners should consider possible public health threats of widespread communicable disease and the potential for a terrorist attack with explosive or other devices.

EPIDEMIOLOGY

The need for mass gathering medical care was first described after two spectators collapsed and died during a University of Nebraska football game in 1965.³ The event organizers were not prepared to manage medical emergencies in the midst of the event, and consequently, when these two patients needed medical care, the organizers were not able to meet the need. Medical directors have become experienced in mass gathering medicine, and case reports are described for sporting events, concerts, expositions, and other large congregations of people.²

One of the largest global gatherings, the Islamic Hajj pilgrimage to Mecca, Saudi Arabia (reaching 2.5 million in 2009), has required officials to manage threats to public safety from outbreaks of infectious disease to major traumatic injuries from stampedes. Other notable global mass gatherings include the 2010 World Expo in Shanghai, China, which attracted approximately 70 million visitors, and the FIFA 2010 World Cup in South Africa, during which more than 1 million foreign visitors entered the country.⁴ As large-scale global mass gatherings become more common, it is evident that there is a need for a global effort to develop ...