Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-25T21:22:32.665Z Has data issue: false hasContentIssue false
  • English
  • Français

Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings

Published online by Cambridge University Press:  28 June 2012

Andrew M. Milsten ,
Kevin G. Seaman ,
Peter Liu ,
Rick A. Bissell  and
Brian J. Maguire
Andrew M. Milsten*
Affiliation:
Assistant Medical Director, Anne Arundel County Fire Department; Assistant Professor, University of Maryland, Division of Emergency Medicine, Department ofSurgery, Baltimore, Maryland USA
Kevin G. Seaman
Affiliation:
Co-Director, EMS Fellowship Program, Assistant Professor, University of Maryland, Division of Emergency Medicine, Department of Surgery, Baltimore, Maryland USA
Peter Liu
Affiliation:
Emergency Medicine Resident, Division of Emergency Medicine, Departmentof Surgery, University of Maryland School of Medicine, Baltimore, Maryland USA
Rick A. Bissell
Affiliation:
Co-Director, EMS Fellowship Program, Associate Professor, University of Maryland-Baltimore County, Department of Emergency Health Services, Baltimore, Maryland USA
Brian J. Maguire
Affiliation:
Associate Director of Graduate Program, Department of Emergency Health Services, University of Maryland-Baltimore County, Baltimore, Maryland USA
*
Emergency Department North Arundel Hospital, 301 Hospital Drive, Glen Burnie, Maryland 21061 USA, E-mail: amilsten@aol.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Mass gatherings create difficult environments for which to plan emergency medical responses. The purpose of this study was to identify those variables that are associated with increased medical usage rates (MURs) and certain injury patterns that can be used to facilitate the planning process.

Methods:

Patient information collected at three types of mass gatherings (professional American football and baseball games and rock concerts) over a three-year period was reviewed retrospectively. Specific variables were abstracted: (1) event type; (2) gender; (3) age; (4) weather; and (5) attendance. All 216 events (total attendance9,708,567) studied were held in the same metropolitan region. All MURs are reported as patients per 10,000 (PPTT).

Results:

The 5,899 patient encounters yielded a MUR of 6.1 PPTT. Patient encounters totaled 3,659 for baseball games (4.85 PPTT), 1,204 for football games (6.75 PPTT), and 1,036 for rock concerts (30 PPTT). The MUR for Location A concerts (no mosh pits) was 7.49 PPTT, whereas the MUR for the one Location B concert (with mosh pits) was110 PPTT. The MUR for Location A concerts was higher than for baseball, but not football games (p = 0.005). Gender distribution was equal among patrons seeking medical care. The mean values for patient ages were 29 years at baseball games, 33 years at football games, and 20 years at concerts. The MUR at events held when the apparent temperature was £80°F significantly lower statistically than that at events conducted at temperatures <80°F were (18°C) (4.90 vs. 8.10 PPTT (p = 0.005)). The occurrence of precipitation and increased attendance did not predict an increased MUR. Medical care was sought mostly for minor/basic-level care (84%) and less so for advanced-level care (16%). Medical cases occurred more often atsporting events (69%), and were more common than were cases with traumatic injuries (31%). Concerts with precipitation and rock concerts had a positive association withthe incidence of trauma and the incidence of injuries; whereas age and gender were not associated with medical or traumatic diagnoses.

Conclusions:

Event type and apparent temperature were the variables that best predicted MUR as well as specific injury patterns and levels of care.

Keywords

ageattendancebaseballcase mixconcertsdeterminantsevent, type offootballgenderinjury patternsmass gatheringsmass gathering medicinemedical usage rateplanningweather
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 4 , December 2003 , pp. 334 - 346
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Grange, JT, Baumann, GW: The California 500: Medical care at a NASCAR Winston Cup Race event. Ann Emerg Med 1999;34(4):284. Abstract.CrossRefGoogle Scholar
2. Levitin, HW: Providing care at mass gatherings. Lecture at the 1999 Scientific Assembly, American College of Emergency Physicians. 13 October 1999.Google Scholar
3. Parrillo, S: EMS and mass gatherings. emedicine Web site http://emedi-cine.com/emerg/topic812.html Accessed on August 1998.Google Scholar
4. Thompson, JM, Savoia, G, Powell, G, Challis, EB, Law, P: Level of medical care required for mass gatherings: The XV Winter Olympic Games in Calgary, Canada. Ann Emerg Med 1991;20(4):385–390.CrossRefGoogle ScholarPubMed
5. Franaszek, J: Medical care at mass gatherings. Ann Emerg Med 1986;15(5):600–601.CrossRefGoogle ScholarPubMed
6. Nordberg, M: EMS and mass gatherings. Emerg Med Serv 1990;19(5):46–48,50–51,54,56,91.Google ScholarPubMed
7. Jaslow, D: Mass gathering medical care: A practice without standards. NAEA/ISP News 08 May 1999.Google Scholar
8. Jaslow, D, Yancy, A II, Milsten, A, for the National Association of EMS Physicians Standards and Clinical Practice Committee: Mass gathering medical care. Prehosp Emerg Care 2000;4:359–360.CrossRefGoogle Scholar
9. DeLorenzo, RA: Mass gathering medicine: A review. Prehosp Disast Med 1997;12(1):68–72.CrossRefGoogle Scholar
10. Michael, JA, Barbera, JA: Mass gathering medical care: A twenty-five year review. Prehosp Disast Med 1997;12(4):305–312.CrossRefGoogle ScholarPubMed
11. Cummins, RO, Ornato, JP, Thies, WH, Pepe, PE: Improving survival from sudden cardiacarrest: The “chain-of-survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991;83:1832–1847.CrossRefGoogle Scholar
12. Mear, G, Batson, D: Mass gatherings. In: Tintinelli, JE, Ruiz, E, Krome, R (eds). Emergency Medicine: A Comprehensive Study Guide, 4th ed, New York: McGraw-Hill, 1996. pp 26–29.Google Scholar
13. Grange, JT, Green, SM, Downs, W: Concert medicine: Spectrum of medical problems encountered at 405 major concerts. Acad Emerg Med 1999;6(2):202–207.CrossRefGoogle ScholarPubMed
14. Baker, WM, Simone, BM, Niemann, JT, Daly, A: Special event medical care: The 1984 Los Angeles Summer Olympic experience. Ann Emerg Med 1986;15(2):185–190.CrossRefGoogle Scholar
15. Richards, R, Richards, D, Whittaker, R: Method of predicting the number of casualties in the Sydney City-to-Surf Fun Runs. Med J Aust 1984;141: 805–808.CrossRefGoogle ScholarPubMed
16. Nardi, R, Bettini, M, Bozzoli, C: Emergency medical services in mass gatherings: The experience of the Formula 1 Grand Prix ‘San Marino’ in Imola. Eur J Emerg Med 1997;4(4):217–223.CrossRefGoogle ScholarPubMed
17. Sexton, PA, Burns, RS, Lerner, SE: Sunshine '75: Rock medicine inside Diamond Head. Hawaii Med J 1975;34(8):271–275.Google ScholarPubMed
18. Ounanian, LL, Salinas, C, Shear, CL: Medical care at the 1982 US Festival. Ann Emerg Med 1986;15(5):520–527.CrossRefGoogle ScholarPubMed
19. Flabouris, A, Bridgewater, F: An analysis of demand for first-aid care at a major public event. Prehosp Disast Med 1996;11(1):48–54.CrossRefGoogle Scholar
20. Federman, JH, Giordano, LM: How to cope with a visit from the Pope. Prehosp Disast Med 1997;12(2):86–91.CrossRefGoogle ScholarPubMed
21. Friedman, U, Rodi, SW, Krueger, MA, Votey, SR: Medical care at the California AIDS Ride 3: Experiences in event medicine. Ann Emerg Med 1998;31(2):219–223.CrossRefGoogle ScholarPubMed
22. Milsten, AM, Bissell, RA, Seaman, KG, Maguire BJ. Mass gathering medical care: A review of the literature. Prehosp Disast Med 2002;18:151–162.CrossRefGoogle Scholar
23. Chapman, KR, Carmichael, FJ, Goode, JE: Medical services for outdoor rock music festivals. Can Med Assoc J 1982;126:935–938.Google ScholarPubMed
24. Shelton, S, Haire, S, Gerard, B: Medical care for mass gatherings at collegiate football games. Southern Med J 1997;90(11):1081–1083.CrossRefGoogle ScholarPubMed
25. Schlicht, J, Mitcheson, M, Henry, M: Medical aspects of large outdoor festivals. Lancet 1972;1:948–952.CrossRefGoogle ScholarPubMed
26. Blandford, AG, Obst, CD, Dunlop, HA: Glastonbury Fair: Some medical aspects of a rock music festival. The Practitioner 1972;209:205–211.Google ScholarPubMed
27. Erickson, TB, Koenigsberg, M, Bunney, EB: Prehospital severity scoring at major rock concert events. Prehosp Disast Med 1996;12(3):195–199.Google Scholar
28. Foster, TM: EMS meets grunge: EMS coverage of Lollapalooza 1993. J Emerg Med Serv 1993;18(12):47–51,53.Google ScholarPubMed
29. Chambers, J, Guly, H: The impact of a music festival on local health services. Health Trends 1991;23(3):122–123.Google ScholarPubMed
30. Levens, LK, Durham, JE: Pop-music festivals: Some medical aspects. BMJ 1971;1:218–220.CrossRefGoogle ScholarPubMed
31. Spaite, DW, Criss, EA, Valenzuela, TD, et al: A new model for providing prehospital medical care in large stadiums. Ann Emerg Med 1988;17:825–828.CrossRefGoogle ScholarPubMed
32. Pons, PT, Holland, B, Alfrey, E, et al: An advanced emergency medical care system at National Football League games. Ann Emerg Med 1980;9(4): 203–206.CrossRefGoogle ScholarPubMed
33. De Lorenzo, RA, Gray, BC, Bennett, PC, Lamparella, VJ: Effect of crowd size on patient volume at a large, multipurpose, indoor stadium. J Emerg Med 1989;7:379–384.CrossRefGoogle Scholar
34. Boyle, MF, DeLorenzo, RA, Garrison, R: Physician integration into mass gathering medical care: The United States Air Show. Prehosp Disast Med 1993;8(2):165–168.CrossRefGoogle ScholarPubMed
35. Weaver, WD, Sutherland, K, Wirkus, MJ, Bachman, R: Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in this setting. Ann Emerg Med 1989;18(2):155–160.CrossRefGoogle Scholar
36. Gannon, DM, Derse, AR, Bronkema, PJ, Primley, DM: The emergency care network of a ski marathon. Am J Sports Med 1985;13(5):316–320.CrossRefGoogle ScholarPubMed
37. Binder, LS, Willoughby, PJ, Matkaitis, L: Development of a unique decentralized rapid-response capability and contingency mass-casualty field hospital for the 1996 Democratic National Convention. Prehosp Emerg Care 1997;1(4):238–245.CrossRefGoogle ScholarPubMed
38. Whipkey, RR, Paris, PM, Stewart, RD: Emergency care for mass gatherings: Proper planning to improve outcome. Postgrad Med 1984;76(2):44,46–48, 51,54.CrossRefGoogle ScholarPubMed
39. Janchar, T, Samaddar, R, Milzman, D: The impact of “mosh pits” on medical incidents at mass gatherings. Ann Emerg Med 1999;34(4):255. Abstract.CrossRefGoogle Scholar
40. Leonard, RB: Information paper: Provision of Emergency Medical Care for Crowds. American College of Emergency Physicians, 1990.Google Scholar
41. Pons, PT: Providing care at mass gatherings. Lecture at the 1997 Scientific Assembly, American College of Emergency Physicians. 19 October 1997.Google Scholar
42. Leonard, RB: Medical support for mass gatherings. Emerg Med Clin Am 1996;14(2):383–397.CrossRefGoogle ScholarPubMed
43. Farrow, RJ: Pop music festivals: A special medical problem. The Practitioner 1972;208:380–386.Google Scholar
44. James, SH, Calendrillo, B, Schnoll, SH: Medical and toxicolgical aspects of the Watkins Glen Rock Concert. J Forens Sci 1975;20:71–82.CrossRefGoogle ScholarPubMed
45. Hewitt, S, Jarrett, L, Winter, B: Emergency medicine at a large rock festival. J Accid Emerg Med 1996;13:26–27.CrossRefGoogle Scholar
46. Strauss, N: '69 or '99: A rock festival is a combustible mix. The New York Times 08 August 1999; section 2:1,3:1.Google Scholar
47. Schulte, D, Meade, DM: The papal chase: The Pope's visit: A “mass” gathering. Emerg Med Serv 1993; 22(11):46–49, 65–75, 79.Google ScholarPubMed
48. Simon, HK, Stegelman, M, Button, T: A prospective evaluation of pediatric emergencycare during the 1996 Summer Olympic Games in Atlanta, Georgia. Ped Emerg Care 1998; 14(1):1–3.CrossRefGoogle Scholar
49. Come, L, Dhondt, E, Vincken, W, et al. Traumatic asphyxia following a crowd-crush disaster: The “Heizel Drama“ Ann Emerg Med 1986;15(5):652–653. Abstract.Google Scholar
50. Spaite, DW, Meislin, HW, Valenzuela, TD, Criss, EA, Smith, R, Nelson, A: Banning alcohol in a major college stadium: Impact on the incidence and patterns of injury and illness. J Am Coll Health 1990;39:125–128.CrossRefGoogle Scholar