1. 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

2. Learning Objectives Understand the basic principles of Mass Gathering Medical Care Define The main elements of the Incident Command System

3. 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.

4. 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

5. 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

6. 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

8. 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

9. 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

10. 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

12. 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

13. 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”

14. 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)

15. 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

16. 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”

17. 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

18. Advantages of ICS  Prevents Chaos  Prevents Individualism  Prevents prolongation of the Incident –Provides supervisory authority & reporting relationships –Provides “unity” of command –Improved coordination

19. 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

20. ICS Hurricane Georges Dominican Red Cross: 09/1998

21. Medical Incident Command System

22. 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.

23. Hope for the Best Prepare for the Worst