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

Learning Objectives

• Understand the basic principles of Mass Gathering Medical Care

• Define The main elements of the Incident Command System

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.

Mass gathering (Definition)

• Mass • Attended by a large number of people

• Gather \Gath"er\• To bring together; to collect, into one

place, to congregate.Merriam-Webster Medical Dictionary, © 2002

Merriam-Webster, Inc.

• NAEMSP/ACEP: A group exceeding 1000 persons

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

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

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

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

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

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

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”

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)

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

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”

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

Advantages of ICS

Prevents Chaos Prevents Individualism Prevents prolongation of the Incident– Provides supervisory authority &

reporting relationships – Provides “unity” of command– Improved coordination

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

ICS Hurricane GeorgesDominican Red Cross: 09/1998

Medical Incident Command System

Police F ire

S taging Triage Treatm ent Transporta tion

EM S

O perations P lanning Logistics F inance

U nified C om m and Post

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.

Hope for the BestPrepare for the Worst