Basic Principles of Mass Gathering Medical Care Amado Alejandro Báez MD MSc EMT-P Matthew Sztajnkrycer MD PhD The Department of Emergency Medicine, Mayo Clinic College of Medicine

Learning Objectives Understand the basic principles of Mass Gathering Medical Care Define The main elements of the Incident Command System

Performance Objectives At the end of the course the student should be able to: Understand the needs and demands of mass gathering medical care Understand the basic Incident Command System (ICS) structure.

Mass gathering (Definition) Attended by a large number of people Gather \Gath"er\ To bring together; to collect, into one place, to congregate. Merriam-Webster Medical Dictionary, © 2002 Merriam-Webster, Inc. NAEMSP/ACEP: A group exceeding 1000 persons NAEMSP: National Association of EMS Physicians ACEP: American College of Emergency Physicians

Nine major Mass Gathering planning elements Crowd size Personnel Medical triage and facilities Medical care Public information and education Medical records Mutual aid Data collection Other: public access, disaster planning, weather, and event duration

Mass Gatherings Planning Components Type of Event Sports, Concert, Presidential summit Timeline for preparation Days to years Location and available facilities Urban stadium vs remote rural field

Mass gathering preparation time chart Mass gathering preparation time chart. Please note how optimal preparation should occur up to a year prior to event. Source: National Association of EMS Physicians http://www.naemsp.org

Mass Gatherings Type of Event- Anticipated conditions Rock concerts - Drugs, alcohol, trauma, heat-related Auto races and Olympic Games - Serious trauma, heat- and alcohol- related problems Athletes and primary competitors may have their own medical teams Demonstrations - Injuries and tear gas Anticipate different types of medical conditions based on the type of event. Specialized units such as rehydration, vehicular trama , VIP-care. might be needed depending on the type of event in order to care to the specific needs of your patient population

Mass Gatherings Type of Event Sporting events - Minor injuries, intoxication, heat-related problems, and cardiac problems including arrest Citizen sporting events- Heat-related illness, exhaustion, and cold-related illness

Data on Patient Contacts Mass Gatherings Data on Patient Contacts Sporting Event 0.3 to 1.6 per 1,000 Marathons 24 per 1,000 Rock Concerts 0.96 to 17 per 1,000 Associated to ETOH and Drugs Extracted from the American College of Emergency Physicians (http://www.acep.org) Provision of Medical Care for Crowds 1996.

Reports of Experience in Medical Care for Crowds Extracted from the American College of Emergency Physicians (http://www.acep.org) Provision of Medical Care for Crowds 1996.

Staffing and on-site personnel Majority of patients can be triaged and treated effectively by RN’s and EMT’s 1-2 physicians for every 50,000 people 1 paramedic/EMT team per 10,000 Anticipated usage rates, based on previous experience Non physician staff training in CPR/ AED It is important to estimate the number of attendees to your event so you can adequately staff your event.

Staffing and on-site personnel Management of Volunteers Fatigue and Motivation Shift work 2 Persons per 8 hr shift with 4 hrs of patient time and 4 hrs “off time”

Location of Treatment Facilities On-Site Aid stations at 5 min walking or 1/8 mile Dedicated rooms or Tents Off-Site BLS crew: 4 minutes away ALS: 8 minutes Hospital: 30 minutes away (Air or ground) Some large events will require on-site medical posts; these should be prepared to cater to the needs of the crowd attending the event. Basic and advanced life support ambulances should be allocated on the basis of an optimal response time.

Environmental Elements Heat: Cooling, sun screen, reduced exposure time Water: Hydration issues, water borne illness Food: Food borne pathogens (1987 Shigella) Waste: Management, disease transmission

Drugs of Abuse and Alcohol Rock concerts up to 48% of all patients Limit size (<20oz), amount and times of ETOH sales Banning entrance to intoxicated visitors Techniques for Effective Alcohol Management (TEAM) Programs Designated drivers or “Bus Trips”

Incident Command System (ICS) Definition: Method of Command, Control and Coordination of individual agencies as they work towards the common goal of stabilizing an emergency

Advantages of ICS Prevents Chaos Prevents Individualism Prevents prolongation of the Incident Provides supervisory authority & reporting relationships Provides “unity” of command Improved coordination

Applications of ICS Hazardous Materials (HazMat) incidents Planned events (e.g. Celebrations, Parades, Concerts, Official visits etc.) Response to Natural Hazards Single and Multi-agency law enforcement incidents Lack of Comprehensive resource Management Strategy Fires

ICS Hurricane Georges Dominican Red Cross: 09/1998

Medical Incident Command System

Conclusions Mass gathering can be challenging and event-specific planning considerations are needed Basic elements of the Incident Command System are: Finance, Logistics, Operations, Planning.

Hope for the Best Prepare for the Worst