1. 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

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

3. 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.

4. 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, © Merriam-Webster, Inc.
NAEMSP/ACEP: A group exceeding persons
NAEMSP: National Association of EMS Physicians
ACEP: American College of Emergency Physicians

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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 ( Provision of Medical Care for Crowds 1996.

11. Reports of Experience in Medical Care for Crowds
Extracted from the American College of Emergency Physicians ( Provision of Medical Care for Crowds 1996.

12. 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.

13. 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”

14. 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.

15. 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

16. 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”

17. 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

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

19. 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

20. ICS Hurricane Georges Dominican Red Cross: 09/1998

21. Medical Incident Command System

22. 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.

23. Hope for the Best Prepare for the Worst