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 In fact, large organizations including the World Health Organization and the U.S. Federal Emergency Management Administration do not focus on the number of attendees when defining mass gatherings; rather, they recognize the impact on the surrounding resources.

There are several variables in event and crowd characteristics that may affect patient presentation rates, thus resulting in demands on the event medical staff and larger surrounding system that bear little direct relationship to the number in attendance. Some of these variables include weather conditions, presence of alcohol and/or illicit substances, type of event, violent spectator behavior, and presence of potable water. Further, events that are considered “bounded/focused” (stadium sporting events) are associated with higher patient presentation rates than those considered “unbounded/extended” (parades), likely due to the leakage of patients in the unbounded events into the surrounding healthcare system.³ Event medical directors should also consider the transport to hospital rate from the same or similar previous events when planning their event. In conjunction with the patient presentation rate, the transport to hospital rate can assist in estimating resources needed.⁴

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. 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 AND TYPES OF MASS GATHERINGS

The need for mass gathering medical care was first described after two spectators collapsed and died during a University of Nebraska football game in 1965.⁵ 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, has required officials to manage threats ...