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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.

Major factors affecting planning for a mass gathering event include venue entry and exit, communication, environment, and potential public health threats. Physical barriers may inhibit easy entry and exit from the site. These barriers can make it difficult to get medical resources in to, and to get patients out from, 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.

The need for mass gathering medical care was first recognized 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. Since that time, 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

Despite the fact that mass gatherings are generally attended by individuals in good health, these events tend to have a higher incidence of illness and injury than that which would be found in the general population.4 The incidence of usage of medical care at mass gatherings has been reported to range from 4 to 440 patients per 10,000.2 The wide variance in medical usage rate is a function of the type of event and environmental factors.

In preparing for a mass gathering event, medical directors should develop an organized approach through the development of a medical action plan.5

Physician Medical Oversight

All mass gathering events should have an identified physician medical director who is responsible for developing the medical action plan. The medical director is also responsible for providing medical oversight before ...

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