Mass-gathering events (MGEs) such as sporting competitions and music festivals that take place in stadiums and arenas pose challenges to health care delivery that can differ from other types of MGEs. This scoping review aimed to describe factors that influence patient presentations to in-event health services, ambulance services, and emergency departments (EDs) from stadium and arena MGEs.

This scoping review followed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist and blended both Arksey and O’Malley methodology and the Joanna Briggs Institute’s (JBI’s) approach. Four databases (CINAHL, Embase, PubMed, and Scopus) were searched using keywords and terms about “mass gatherings,” “stadium” or “arena,” and “in-event health services.” In this review, the population pertains to the spectators who seek in-event health services, the concept was MGEs, and the context was stadiums and/or arenas.

Twenty-two articles were included in the review, most of which focused on sporting events (n = 18; 81.8%) and music concerts (n = 3; 13.6%). The reported patient presentation rate (PPR) ranged between one and 24 per 10,000 spectators; the median PPR was 3.8 per 10,000. The transfer to hospital rate (TTHR) varied from zero to four per 10,000 spectators, and the median TTHR was 0.35 per 10,000. Key factors reported for PPR and TTHR include event, venue, and health support characteristics.

There is a complexity of health care delivery amid MGEs, stressing the need for uniform measurement and continued research to enhance predictive accuracy and advance health care services in these contexts. This review extends the current MGE domains (biomedical, psychosocial, and environmental) to encompass specific stadium/arena event characteristics that may have an impact on PPR and TTHR.

This study aimed to examine health care workers’ (HCWs) perceptions of hospital disaster planning and preparedness within the context of building resilient health care systems. It also evaluated HCWs’ involvement in the planning process.

Thirteen HCWs from 2 Queensland hospitals participated in in-depth, semi-structured interviews. These interviews were audio-recorded with participant consent and transcribed verbatim. Transcripts, recordings, and participant details were coded for confidentiality. Thematic analysis was used to identify essential patterns in the data and make sense of them.

HCWs’ perspectives on disaster planning underscored the importance of comprehensive planning, business continuity, proactive approaches emphasizing anticipation and risk mitigation, and implementation of established plans through training, resource management, and operational readiness. HCWs’ participation in planning ranged from high engagement through collaboration and continuous improvement to moderate or lower levels focusing on regulatory compliance and resource allocation.

This study highlights HCWs’ views regarding disaster planning and preparedness for building resilient health care systems. HCWs emphasised comprehensive planning and proactive preparedness, aligning with global priorities for disaster risk reduction. They stress the importance of education, training, operational readiness, and continuous improvement. This study underlines the vital role of HCWs’ participation in disaster planning and the need for comprehensive training initiatives.

In responding to a Chemical, Biological, Radiological, and Nuclear explosive (CBRNe) disaster, clinical leaders have important decision-making responsibilities which include implementing hospital disaster protocols or incident command systems, managing staffing, and allocating resources. Despite emergency care clinical leaders’ integral role, there is minimal literature regarding the strategies they may use during CBRNe disasters. The aim of this study was to explore emergency care clinical leaders’ strategies related to managing patients following a CBRNe disaster.

Focus groups across 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. Thirty-six hospital clinical leaders from the 6 study sites crucial to hospital disaster response participated in 6 focus groups undertaken between February and May 2021 that explored strategies and decision making to optimize patient care following a CBRNe disaster.

Analysis revealed the use of rehearsals, adopting new models of care, enacting current surge management processes, and applying organization lessons were facilitating strategies. Barriers to management were identified, including resource constraints and sites operating over capacity.

Enhanced education and training of clinical leaders, flexible models of care, and existing established processes and tested frameworks could strengthen a hospital’s response when managing patients following a CBRNe disaster.

The aim of this review is to identify, evaluate, and graphically display gaps in the literature related to scarce health resource allocation in humanitarian aid settings.

A systematic search strategy was utilized in MEDLINE (via Ovid), Scopus, EMBASE, CINAHL Complete, and ProQuest Central. Articles were reviewed by 2 reviewers with a third reviewer remedying any screening conflicts. Articles meeting inclusion criteria underwent data extraction to facilitate evaluation of the scope, nature, and quality of experience-based evidence for health resource allocation in humanitarian settings. Finally, articles were mapped on a matrix to display evidence graphically.

The search strategy identified 6093 individual sources, leaving 4000 for screening after removal of duplicates. Following full-text screening, 12 sources were included. Mapping extracted data according to surge capacity domains demonstrated that all 4 domains were reflected most of all the staff domain. Much of the identified data was presented without adhering to a clear structure or nomenclature. Finally, the mapping suggested potential incompleteness of surge capacity constructs in humanitarian response settings.

Through this review, we identified a gap in evidence available to address challenges associated with scarce resource allocation in humanitarian settings. In addition to presenting the distribution of existing literature, the review demonstrated the relevance of surge capacity and resource allocation principles underpinning the developed framework.

The consumption of alcohol within the Australian community continues to rise, impacting care delivery in already over-burdened emergency departments (EDs).

This study aimed to examine the impact of alcohol-related presentations (ARPs) to EDs on days with a public holiday or sporting event.

A retrospective cohort study was undertaken using routinely collected health data pertaining to patient presentations diagnosed with an alcohol-related disorder (ICD-10-AM code F10) to two EDs in Queensland, Australia from January 1, 2016 – December 31, 2020. Descriptive and inferential statistics were used to describe and compare ARPs on event days versus non-event days and uncomplicated versus other ARPs on event days only.

Of all 5,792 ARPs, nine percent (n = 529) occurred on public holidays or sporting event days. When compared by day type, type of presentation, mode of arrival, and day of week differed between event and non-event days. On event days, uncomplicated ARPs differed to other ARPs, with uncomplicated ARPs being younger, having shorter median length-of-stay (LOS), and less likely to be admitted to hospital.

In this multi-site study, public holidays and sporting events had a noteworthy impact on ARPs to EDs. Focused refinement on the clinical management of uncomplicated ARPs is warranted to inform future resource allocation, including on event days.

The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.

This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.

Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.

No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

Events, specifically those where excessive alcohol consumption is common, pose a risk to increase alcohol-related presentations to emergency departments (EDs). Limited evidence exists that synthesizes the impact from events on alcohol-related presentations to EDs.

This integrative review aimed to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs.

An integrative literature review methodology was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Information sources used to identify studies were MEDLINE, CINAHL, and EMBASE, last searched May 26, 2021.

In total, 23 articles describing 46 events met criteria for inclusion. There was a noted increase in alcohol-related presentations to EDs from 27 events, decrease from eight events, and no change from 25 events. Public holidays, music festivals, and sporting events resulted in the majority of increased alcohol-related presentations to EDs. Few articles focused on ED length-of-stay (LOS), treatment, and disposition.

An increase in the consumption of alcohol from holiday, social, and sporting events pose the risk for an influx of presentations to EDs and as a result may negatively impact departmental flow. Further research examining health service outcomes is required that considers the impact of events from a local, national, and global perspective.

Uncomplicated acute alcohol intoxication (UAAI) requiring medical management is common at some mass gathering events. Most of the mass gathering literature reporting on medical management involving UAAI are single case studies. The common clinical practice for UAAI at mass gatherings reported in the literature involves intravenous fluids and antiemetics. However, emergency department evidence suggests that administration of intravenous fluids does not enhance patient outcomes, and in some cases extends emergency department length of stay and costs.

Using a retrospective cohort design of routinely collected data over a nine-year period (2010-2013 and 2016-2020), this study was set at an annual end-of-year ‘schoolies’ youth mass gathering event. The primary study aim was to determine the intravenous fluid management practices of UAAI at this event. Secondary study outcomes included patient demographic, clinical characteristics, and patient outcomes. Data were analyzed using time series and descriptive statistics. Ethical approval was obtained.

In total, 378 patients were identified with UAAI at the event over the nine-year period. The median patient age was 17 years (IQR: 17-18), with 47.2% (n=179) being male. Overall, the median length of stay was 74 minutes (IQR: 40 – 144). Only 7.9% (n=30) patients received intravenous cannulation and 6.3% (n=24) patients received intravenous fluids. Proportionately, the use of intravenous fluids for the management of UAAI decreased over the study years [2010, 28.6%; 2011, 32.1%; 2012, 15.6%; 2013, 6.3%; 2016, 2.6%; 2017, 0%; 2018, 1.8%; 2019, 0%; 2020, 0%].

Some mass gathering events have a higher incidence of UAAI presentations. This is particularly true for those mass gathering events with young adults and at music festivals. Knowledge translation from the emergency department context regarding UAAI clinical management could be applied to the mass gathering event setting. This clinical management should include a conservative approach to the management of UAAI.

Disasters occur globally and can impact emergency department (ED) services. Chemical, biological, radiological, and nuclear (CBRN) events have different characteristics in terms of onset and duration when compared to other disasters, such as wildfires, floods, and hurricanes. It is important to have an understanding of the impact of CBRN events on EDs to inform disaster preparedness. The purpose of this paper is to identify peer-reviewed published literature that describes the impact on EDs from CBRN events.

An integrative literature methodology was used, guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) Guidelines. MEDLINE, PsycINFO, CINAHL, Pubmed, and Scopus were searched using terms relating to CBRN events and EDs. Papers were included if they focused on the impact of real-world CBRN event(s). Information from each included paper was extracted into a table, including author(s), CBRN event characteristics, ED response characteristics, patient presentation characteristics, and outcome characteristics.

Of the 15,982 studies that were identified from the database searches, 4,012 were duplicates and 11,696 were irrelevant at the title and abstract screening stage. Therefore, 274 were screened at the full-text stage resulting in 44 studies for inclusion. Included papers were mostly from the United States of America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%). Most of the events were chemical (n=36/44, 81.9%), with Chlorine (n=9/36, 25%) being the most frequently reported chemical agent. Between 1 and 5,500 people [M=54, IQR: 22-253] presented to EDs because of CBRN events.

Emergency departments assess and manage patients who present following CBRN events. Of these patients, the majority do not require hospital admission, suggesting that the ED is integral in the health response to CBRN events. As such, EDs should be adequately prepared, from a resource and process perspective to assess, manage and discharge large numbers of CBRN-related patients.

Disasters have the potential to cause a surge of patients, some of which may require admission to an intensive care unit (ICU). Due to the high resource requirements of ICUs, normal standards of care may need to be altered to treat more people with limited resources, a care model referred to as crisis standards of care (CSC). The pragmatic implementation of CSC in ICUs due to patient surges from disasters has not been well explored in the literature.

This scoping review guided by the Joanna Briggs institute methodology for scoping reviews searched medical databases including CINHAL, PubMed, ProQuest and SCOPUS. Articles were included if they reflected on the actual implementation of CSC delivered in ICU as a result of a patient surge from a disaster. Quantitative data was extracted into tables and qualitative content was thematically analyzed.

A total of 17 papers were included in the review. The disaster event that dominated the results was COVID-19. Most papers relayed subjective accounts of how care models were impacted by patient surges. Common themes included the repurposing of other clinical areas to accommodate ICU patients, resource shortages (particularly ventilators) and staff shortages. Moral strain was felt when processes such as palliation and treatment modality were altered due to resource restrictions.

This review highlights the dearth of high-quality research in implementing CSC in ICUs. Understanding the pragmatic experiences of CSC shows not only the logistical insufficiencies that have been experienced, but the moral and clinical repercussions that these insufficiencies have caused. Inadequate preparation for future disasters, particularly short notice disasters, may lead to further implementation of CSC resulting in poorer outcomes for patients and detrimental impacts on healthcare workers. More research into the practical application of CSC in ICU may help mitigate the impact of patient surges from disasters.

As the largest body of health professionals, nurses are looked upon during a disaster for leadership, clinical assistance, and support during these events. Nurses are at the forefront of managing disasters in their communities, yet their complex role as advanced nurse practitioners, clinicians, managers, and leaders is not always fully understood and/or recognized. The aim of this paper is to explore the level of Advanced Nursing Practice (ANP) in Australia that takes place in a disaster

This scoping review was guided by Arksey and O’Malley’s framework. The review searched five relevant databases. A scoping review design was chosen as the authors expected that evidence in the field would be produced using a wide variety of methodologies.

Nurses work long hours during a disaster with hospitals and nurses becoming the center of events and the "go to" place during a disaster. During disasters nurses often have little sleep, have limited time to meet their individual/personal needs, and frequently put others needs before themselves. Nurses mentioned in these studies were reported to have worked while they were worried for themselves and their families. These nurses reported feeling capable and reported that all their experience and skills came to the fore during these challenging situations.

During disasters, most nurses are found to be flexible and adaptable, with many taking on a variety of roles. Nurses are quick to find solutions with problem-solving keys and their ability to respond to disasters "just what you do." The nurses in these studies demonstrated fundamental expertise and had the agility to pivot when the occasion demanded. As a result of this study, it is evident, and not surprising, that these Australian nurses work beyond conventional limits during a disaster.

For hospitals, learning from disaster response efforts and adapting organizational practices can improve resilience in dealing with future disruptions. However, amidst global disruptions by climate change, the coronavirus disease 2019 (COVID-19) pandemic, and other disasters, hospitals’ ability to cope continues to be highly variable. Hence, there are increasing calls to improve hospitals’ capabilities to grow and adapt towards enhanced resilience.

This study aims two-fold: (1) to characterize the current state of knowledge about how hospitals are gaining knowledge from their responses to disasters, and (2) to explore how this knowledge can be applied to inform organizational practices for hospital resilience.

This study used Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection and framework for data analysis, Covidence software, and Medical Subject Headings (MeSH) terms and keywords relevant to “hospitals,” “learn,” “disaster response,” and “resilience.” The quality appraisal used an adapted version of the Mixed Methods Assessment Tool (MMAT).

After applying inclusion and exclusion criteria and quality appraisal, out of the 420 articles retrieved, 22 articles remained for thematic and content analysis. The thematic analysis included the hospital’s functional (operational) and physical (structural and non-structural) sections. The content analysis followed nine learning areas (Governance and Leadership, Planning and Risk Assessment, Surveillance and Monitoring, Communication and Network Engagement, Staff Practices and Safety, Equipment and Resources, Facilities and Infrastructure, Novelty and Innovation, and Learning and Evaluation).

On applying the Deming cycle, only four studies described a completed learning cycle wherein hospitals adapted their organizational structures using the prior experience and evaluation gained in responding to disaster(s).

There is a gap between hospitals’ organizational learning and institutionalized practice. The conceptualized Hybrid Resilience Learning Framework (HRLF) aims to guide the hospitals’ decision makers in evaluating organizational resilience and knowledge.

In the face of disasters, both the stressful factors and the coping strategies that affect the health care workers (HCWs) should be substantially considered.

Global climate change (global warming) has been identified as the primary factor responsible for the observed increase in frequency and severity of wildfires (also known as bushfires in some countries) throughout the majority of the world’s vegetated environments. This trend is predicted to continue, causing significant adverse health effects to nearby residential populations and placing a potential strain on local emergency departments (EDs).

The aim of this literature review was to identify papers relating to wildfires and their impact on EDs, specifically patient presentation characteristics, resource utilization, and patient outcomes.

This integrative literature review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Data were collected from OvidSP, MEDLINE, DARE, CINAHL, PubMed, and Scopus databases. Various Medical Subject Headings (MeSH) and keywords identified papers relevant to wildfires/bushfires and EDs.

Literature regarding the relationship between ED presentations and wildfire events, however, is primarily limited to studies from the United States and Australia and indicates particulate matter (PM) is principally linked to adverse respiratory and cardiovascular outcomes. Observable trends in the literature principally included a significant increase in respiratory presentations, primarily with a lag of one to two days from the initial event. Respiratory and cardiovascular studies that stratified results by age indicated individuals under five, over 65, or those with pre-existing conditions formed the majority of ED presentations.

Key learnings from this review included the need for effective and targeted community advisory programs/procedures, prior to and during wildfire events, as well as pre-event planning, development, and robust resilience strategies for EDs.

Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees’ perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs.

A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees’ planned substance use.

A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees’ planned use of alcohol and recreational drugs.

This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees’ perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

Without a robust evidence base to support recommendations for medical services at mass gatherings (MGs), levels of care will continue to vary and preventable morbidity and mortality will exist. Accordingly, researchers and clinicians publish case reports and case series to capture and explain some of the health interventions, health outcomes, and host community impacts of MGs. Streamlining and standardizing post-event reporting for MG medical services and associated health outcomes could improve inter-event comparability, thereby supporting and promoting growth of the evidence base for this discipline. The present paper is focused on theory building, proposing a set of domains for data that may support increasingly comprehensive, yet lean, reporting on the health outcomes of MGs. This paper is paired with another presenting a proposal for a post-event reporting template.

The conceptual categories of data presented are based on a textual analysis of 54 published post-event medical case reports and a comparison of the features of published data models for MG health outcomes.

A comparison of existing data models illustrates that none of the models are explicitly informed by a conceptual lens. Based on an analysis of the literature reviewed, four data domains emerged. These included: (i) the Event Domain, (ii) the Hazard and Risk Domain, (iii) the Capacity Domain, and (iv) the Clinical Domain. These domains mapped to 16 sub-domains.

Data modelling for the health outcomes related to MGs is currently in its infancy. The proposed illustration is a set of operationally relevant data domains that apply equally to small, medium, and large-sized events. Further development of these domains could move the MG community forward and shift post-event health outcomes reporting in the direction of increasing consistency and comprehensiveness.

Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Without a robust evidence base to support recommendations for first aid, health, and medical services at mass gatherings (MGs), levels of care will continue to vary. Streamlining and standardizing post-event reporting for MG medical services could improve inter-event comparability, and prospectively influence event safety and planning through the application of a research template, thereby supporting and promoting growth of the evidence base and the operational safety of this discipline. Understanding the relationships between categories of variables is key. The present paper is focused on theory building, providing an evolving conceptual model, laying the groundwork for exploring the relationships between categories of variables pertaining the health outcomes of MGs.

A content analysis of 54 published post-event medical case reports, including a comparison of the features of published data models for MG health outcomes.

A layered model of essential conceptual components for post-event medical reporting is presented as the Data Reporting, Evaluation, & Analysis for Mass-Gathering Medicine (DREAM) model. This model is relational and embeds data domains, organized operationally, into “inputs,” “modifiers,” “actuals,” and “outputs” and organized temporally into pre-, during, post-event, and reporting phases.

Situating the DREAM model in relation to existing models for data collection vis a vis health outcomes, the authors provide a detailed discussion on similarities and points of difference.

Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.