Managing the Unexpected: A Guide to Emergency Medical Care in Event Settings

Mass gatherings, from the Super Bowl to multi-day Music Festivals, can attract attendees in the hundreds of thousands. Ensuring the health and safety of such vast audiences is a unique, multi-faceted challenge. The intricate realm of event medicine highlights the necessities of planning, multi-agency cooperation, and integrated command structures. 

Understanding Mass Gatherings 

Mass gatherings aren’t merely large groups of people. Events like a major NASCAR race, which can amass an audience of nearly 200,000, create dynamic, ever-evolving environments. The noise, crowd density, emotional highs, and sporadic movement present challenges beyond conventional medical scenarios. A study from Ciottone’s Disaster Medicine¹ denotes how variables, including event type, crowd mood, and event duration, uniquely shape the medical needs of each gathering. 

The type of event and pre-planning are paramount to a successful event and integration with existing infrastructure and community resources without burdening the community’s public safety and the healthcare system. 

Strategic Planning: Laying the Foundations 

Legal Framework 

Understanding regional legalities is the first step when it comes to event medicine. Local ordinances, state laws, and regulations can dictate specific prerequisites. For example, in states like Tennessee, public health laws require specific drinking water and restroom facilities in ratios per hundred, and at least one for every 10,000 and one nurse for every 5,000 attendees.² 

Depending on state and local requirements, licensing is another important aspect to consider at events. Depending on local laws and ordinances, some events will require a mass gathering permit or license.  

Medical personnel practicing at an event must be duly licensed and legal to work in the role they’ll be performing. Multi-state licensing exists for many areas of nursing, allowing out-of-state providers to work throughout the country more easily.  

REPLICA, the EMS Compact, allows qualified personnel who hold a National Registration number through the National Registry of EMTs to traverse the national landscape more easily, provided their home state has adopted the EMS Compact and they’ll be going to work in another Compact state.³

Risk Assessment  

This phase identifies potential health threats. Is the event a day-long sports event where dehydration or injuries might be a concern? Or is it a multi-day festival where fatigue, substance use, and exposure to the elements pose added risks?  Creating a main medical area provides supplemental treatment for more long-term care that can be handled on-site or can be holding for transport to a local hospital or regional trauma center. 

Infrastructure & Resources 

Determining the number of medical tents, emergency vehicles, and evacuation routes is crucial. Furthermore, each medical station should be equipped to handle common emergencies anticipated for the event type. 

Carl Monzo and Michael Dienno at National Event Services (NES) stress the importance of an initial size-up. The event manager must evaluate the local public safety resources and infrastructure and its ability to scale up for the event. The event's size, nature, and length must be considered compared to the local community where it will be held. For a large event in New York City or Miami, local public safety and private EMS may be enough to handle the event without impacting the community. Large events in smaller communities may require a contracted event medicine provider, like NES. 

Monzo and Dienno believe the goal of an event medicine service is to care for every person at the venue possible so that there is minimal impact on the community and its ability to serve its people without being burdened by the influx of visitors. Residents should not have to wait for services because everything is involved in handling a wave of new patients affiliated with an event. 

Multi-agency Collaboration - The Power of Unity 

The synergy of collaboration is paramount to a successful event. Whether a contracted or local agency runs the event, collaboration is key. The NES team pre-plan events and meet with local EMS, EMA, fire, law enforcement, and other public figures to build relationships and learn the lay of the land. Local agencies are invaluable to a successful event, but everyone must know their counterparts' resources and limitations. Larger events often surpass the capacity and capability of a single agency. Here's where collaboration becomes the linchpin: 

• Private Medical Service Providers: Experienced entities like NES play a pivotal role. They bring specialized expertise, from handling minor ailments to life-threatening emergencies, ensuring attendees receive swift care. 

• Local Healthcare Systems: Collaboration with local hospitals and healthcare units is crucial. They can provide immediate advanced care if needed, and their experience with local health scenarios can be invaluable. 

• State Agencies: For mega-events, state-level involvement is often mandatory. They can provide additional resources, specialized teams, and logistical support, making the response more robust. 

A Coordinated Command - Streamlining Actions 

An organized command structure is the backbone of efficient emergency management. NES and other event services are well-versed in NIMS. Unified command is the name of the game. All stakeholders should be represented in the command center at events. It allows for a coordinated and quicker response adapted on the fly. 

• Clear Communication: In chaotic environments, clarity is vital. A streamlined communication system ensures that calls for assistance are quickly relayed and addressed, reducing potential response delays. Monzo and Dienno tell me many major music festivals can shut off the music from the command center so emergency announcements -such as evacuations due to weather- can be announced over every speaker at the venue. 

• Dynamic Resource Allocation: Real-time monitoring allows for dynamic reallocation of resources. Should a particular area of an event report more incidents, additional medical teams can be rerouted promptly. 

Crisis Management 

Large-scale events sometimes face large-scale crises. An integrated command ensures swift activation of contingency plans, involving not just medical units but security and event management teams as well. 

Event Medicine Considerations 

• Accessibility & Visibility: Medical points should not just be accessible; they should be visible even in massive crowds, marked clearly and perhaps elevated. 

• Specialized Units: While general medical teams can handle common issues, having specialists for specific emergencies, like substance overdose, can be a lifesaver. 

• Public Awareness: Engaging the public is key. Pre-event briefings, notifications on tickets, and mobile apps can help attendees locate medical help quickly. 

• Technological Integration: Modern problems require modern solutions. Apps providing real-time updates on medical station locations, wait times, or even telehealth consultations can make a difference in crowded settings.

While the exuberance of mass gatherings is unmatched, behind the scenes lies an intricate web of planning, collaboration, and rapid response mechanisms ensuring everyone's safety. Event medicine stands as a testament to human ingenuity, illustrating how, even amidst the largest crowds, every individual's well-being remains a priority. As events grow and evolve, the world of event medicine promises to innovate and rise to every new challenge. 

With technological breakthroughs like telemedicine and medical drones on the horizon, the future of event medicine is brimming with possibilities. 

References 

1. Aljohani, M., & Kennedy, K. E. (2016). Mass Gatherings. Ciottone's Disaster Medicine, 968–974. https://doi.org/10.1016/B978-0-323-28665-7.00202-8 

2. "Tennessee Mass Gathering Law." State of Tennessee, 2022, https://www.tn.gov/content/dam/tn/health/program-areas/eh/TN-Mass-Gathering-Law-TCA-68-112-1.pdf. 

3. "Multi-State Privilege to Practice." Interstate Commission for EMS Personnel Practice, 2023, https://www.emscompact.gov/ems-personnel/privilege-to-practice.