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.
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.
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
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. 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
11.
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
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)
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
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.
