1. Mass Gatherings Medicine Dr Wayne Smith Division of Emergency Medicine UCT/US PGWC - EMS

2. Mass Gatherings Medicine 1.Mass Gathering – An Introduction 2.South African Resource Model 3.Case Study

3. Mass Gathering - Definition Large crowds are commonly associated with leisure events but may occur at religious festivals, parades, and demonstrations and during public disorder. A figure of 1000 has been suggested to constitute a mass gathering

4. South African Context No established norms and standards No Regulations Often decided upon by finances Varies from one event to the next Sport and Recreation Bill Mass Gatherings Health Regulations

5. 1995 – Rugby World Cup2003 – Cricket World Cup

6. 2010

7. Table. Football stadia incidents deadinjured 24-May-64CrushPeru318500 2-Jan-71CrushUK66100 20-Oct-82CrushRussia340unknown 11-May-85FireUK55200 29-May-85CrushBelgium41437 Mar-88CrushNepal100300 15-Apr-89CrushUK96200 13-Jan-91RiotSouth Africa4050 16-Oct-96CrushGatemala84150 11-Apr-01CollapseSouth Africa43155 9-May-01CrushGhana123unknown (from Textbook of MIMMS, UK) DateTypePlace Casualties FOOTBALL INCIDENTS

9. The average number of patients per game Pts within the stadium 12.1 8.9 6.8 20.7 24.8 14.3 6.2 12.9 7.0 9.8 11.3 Patients per game around 10,000 spectators Pts in the circumference of the stadium Sapporo Average MiyagiIbarakiNiigataSaitama Yokohama ShizuokaOsakaKobeOita

10. Mass Gatherings Medicine Risk Assessment a)Nature of the event b)Nature of the venue c)Seated or unseated d)Spectator profile e)Past history of similar events f)Expected number of spectators g)Event duration h)Seasonal considerations i)Proximity to hospitals j)Profile of hospitals k)Additional hazard

11. TEMPERATURE All EventsBaseballFootballConcerts PPR 6.14.856.757.49 Apparent temp < 27oC 4.94.586.114.69 Apparent temp > 27oC 8.15.308.908.85

12. AGE GROUP Age Range (years) BaseballFootball Sporting Events Rock Concerts RC Location A RC Location B Number 3659120448631036207829 Attendance 7,655,5071,709,7439,365,249343,318268,31875,000 <21 (%) 41.217.4 33.270.4 37.779.7 21 – 30 (%) 15.724.6 18.722.2 41.415.8 31 – 40 (%) 16.231.4 21.36.9 18.83.8 41 – 50 (%) 12.115.9 13.40 10 >50 (%) 14.610.4 13.20 10

13. PRESENCE OF ALCOHOL

14. Queuing Procedures and Duration

15. Patient Severity Distribution

16. South African Medical Resource Model

17. Resource Model Validation EventsSpectatorsAverage spectators per event Patients Ellis Park 661,224,02418,545266 Old Trafford 936,061,89065,1821446 Total 1597,2859141712 > 92% Prediction Rate where under predicted was for ILS at small events (< 5000)

18. A Hospital Response to a soccer stadium stampede in Zimbabwe FD Madzimbamuto Emerg. Med. J. 2003;20;556-559 Sunday 9 July 2000 South Africa vs Zimbabwe – National Sports Stadium Harare 8 min from full time South Africa scored to take a 2-1 lead Glass bottle thrown onto the field hitting the goal scorer Matched halted – Police respond with tear gas In ensuing stampede 13 persons killed many injured

22. Hospital Preparedness Educate staff on heat-related illness if appropriate Ensure that Hospital Disaster Plan is a “living” document ? Additional staffing for duration of the event Most importantly establish reliable communications between EMS providers, other hospital etc Be part of a holistic health response – break down the Silos and don’t shift the site of the disaster Do what we do daily and do it well – then can easily escalate when required

23. CONCLUSION Mass Gatherings shown to have higher rate of illness and injuries than general population Wherever large number of people gather in one area there is an increased risk of a major incident. Risk not just a function of number of persons attending Mass gathering Medicine new and dynamic discipline South Africa can become a leader