Mass Gathering Medicine: a Practical Means of Enhancing Disaster Preparedness in Canada
Total Page：16
File Type：pdf, Size：1020Kb
EMS Mass gathering medicine: a practical means of enhancing disaster preparedness in Canada Adam Lund, BSc, MD, MDE*; Samuel J. Gutman, MD*; Sheila A. Turris, RN, PhD3 ABSTRACT de catastrophe. Dans la plupart des communaute´ s, des activite´ s sont organise´ es au cours desquelles un grand Background: We explore the health care literature and draw nombre de personnes se re´ unissent dans des endroits on two decades of experience in the provision of medical publics ou prive´ s dans le but de ce´le´ brer ou de participer a` care at mass gatherings and special events to illustrate the un e´ve´ nement musical, sportif, culturel, religieux, politique complementary aspects of mass gathering medical support ou autre. Collectivement, on appelle ces e´ve´ nements des and disaster medicine. Most communities have occasions rassemblements de masse. La planification, la pre´ paration et during which large numbers of people assemble in public or la prestation des services lie´s a` la sante´ lors des rassemble- private spaces for the purpose of celebrating or participating ments de masse s’inscrivent dans la discipline de la in musical, sporting, cultural, religious, political, and other me´ decine d’urgence. En outre, nous constatons qu’en raison events. Collectively, these events are referred to as mass des e´ve´ nements internationaux des dernie` res anne´ es, il y a gatherings. The planning, preparation, and delivery of eu une plus grande sensibilisation a`lame´decine de health-related services at mass gatherings are understood catastrophe, un inte´reˆ t accru pour celle-ci et une hausse du to be within the discipline of emergency medicine. As well, niveau de pre´ paration des communaute´ s aux catastrophes. we note that owing to international events in recent years, Nous proposons qu’une synergie existe entre la me´ decine there has been a heightened awareness of and interest in exerce´ e dans le cadre des grands rassemblements de masse disaster medicine and the level of community preparedness et la me´ decine de catastrophe. for disasters. We propose that a synergy exists between Me´ thode: Analyse documentaire et analyse comparative mass gathering medicine and disaster medicine. Re´ sultats: De nombreux aspects de la prestation d’un Method: Literature review and comparative analysis. soutien me´ dical lors des rassemblements de masse empie`- Results: Many aspects of the provision of medical support for tent sur l’ensemble des compe´ tences et de l’expertise mass gathering events overlap with the skill set and requises pour planifier et mettre en œuvre une intervention expertise required to plan and implement a successful me´ dicale re´ ussie permettant de re´ pondre a` une catastrophe medical response to a natural disaster, terrorist incident, or naturelle, a` un attentat terroriste ou a` toute autre forme de other form of disaster. catastrophe. Conclusions: There are several practical opportunities to link Conclusions: Il existe plusieurs possibilite´ s concre` tes per- the two fields in a proactive manner. These opportunities mettant de relier les deux domaines d’une manie` re proac- should be pursued as a way to improve the level of disaster tive. Ces possibilite´ s devraient eˆ tre conside´re´ es comme un preparedness at the municipal, provincial, and national moyen d’ame´ liorer le niveau de pre´ paration aux cata- levels. strophes, et ce, aux niveaux municipal, provincial et fe´de´ ral. RE´SUME´ Keywords: crowds, disaster medicine, emergency medical Renseignements contextuels: Nous explorons la litte´ rature services, mass gathering, prehospital care en soins de sante´ et nous nous appuyons sur deux de´ cennies d’expe´ rience dans la prestation de soins me´ dicaux lors des rassemblements de masse et des e´ve´ nements spe´ ciaux pour The Mass Gathering Medicine (MGM) Interest Group illustrer les aspects comple´ mentaires du soutien me´ dical in the Department of Emergency Medicine at the apporte´ durant les rassemblements de masse et la me´ decine University of British Columbia (UBC) formed in 2008 From the *Department of Emergency Medicine and 3School of Nursing, University of British Columbia, Vancouver, BC. Correspondence to: Dr. Adam Lund, 118 Parkside Drive, Port Moody, BC V3H 4W8; [email protected] Submitted January 9, 2010; Revised June 2, 2010; Accepted July 21, 2010. This article has been peer reviewed. ß Canadian Association of Emergency PhysiciansCJEM 2011;13(4):231-236 DOI 10.2310/8000.2011.110305 CJEM N JCMU 2011;13(4) 231 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.139, on 29 Sep 2021 at 11:44:17, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.2310/8000.2011.110305 Lund et al to formally study the provision of medical care at mass that of the baseline population.3 There is great gatherings and special events. Members of this inter- variability within and between mass gatherings. The disciplinary group, led by emergency physicians, have weather, event duration, age and behaviour of the been participating in and/or coordinating medical crowd, topography, event-specific hazards, use of responses for mass gatherings over the last two alcohol or drugs, and whether attendees are partici- decades. This experience has included management pants or simply spectators1,2,7 will vary substantially and clinical roles for the 2010 Olympic Winter Games, between events. At any single mass gathering, a 2009 World Police and Fire Games, World Cup and complex interplay of factors will affect the patient world championship sporting events, and numerous presentation rate (PPR), the acuity, and the case mix. races, festivals, and concerts. There is also great heterogeneity across the spec- Many aspects of the provision of medical support for trum of events in terms of the degree of medical mass gathering events overlap with the expertise support, services, and planning prior to and during an required to plan and implement a successful medical event.3,8–16 Services extend from simple first aid response to a natural disaster, terrorist incident, or provided by single or paired volunteers to full-service mass-casualty event. In this article, we review MGM field clinics located in tents or trailers staffed by a full and disaster medicine (DM) with a focus on the array of health care professionals. There is no complementary aspects. We propose that because consensus regarding minimum standards or defining MGM and DM share important traits, the provision the appropriate levels of service, resources, or person- of medical care during mass gatherings is an nel required. The configuration, capability, and important opportunity for health care providers to procedures of the medical team will be impacted by gain experience that would be applicable in a DM the budget available and the requirements of event response. By further developing our body of knowl- promoters and governing agencies. The number, skill edge and enabling participation in the provision of level, and event experience of the medical staff will medical care at mass gatherings, a larger proportion of alter the number of patients referred for further care, health care professionals will acquire practical experi- otherwise known as the medical transfer rate (MTR). ence that will enhance the level of disaster prepared- The MTR is one measure of the impact of the event on ness in Canada. the host community’s health care infrastructure. Staff members at MGM deployments are usually MASS GATHERING MEDICINE composed of a diverse group of health care providers who come together for the first time in temporary All communities experience occasions during which structures in the field and who must function large numbers of people assemble in public or private effectively under unfamiliar and challenging circum- spaces for the purpose of celebrating or participating stances. Staff should be credentialed in advance and in musical, sporting, cultural, religious, political, or protected from liability. They have limited opportunity other events. Collectively, these events are referred to to prepare and may have only a brief orientation to the as mass gatherings. From the medical perspective, the event and a cursory knowledge of the medical and generally prescribed definition of a mass gathering is operational plans. an event involving the gathering of individuals or MGM at an event often involves periods of crowds during which an emergency response may be extremely high patient volume with variable acuity, delayed by virtue of limited access or other chal- usually with limited history available. Mass gatherings lenges.1–6 This definition encompasses not only a wide often provide environments that complicate the provi- range of factors that impact the safety of attendees or sion of care, including high ambient noise, temperature participants at events but also the breadth of events extremes, precipitation, and uneven topography. Care and situations where this body of knowledge is is provided in temporary structures with limited relevant and applicable. Other definitions refer only resources. Health care providers are challenged to to the size of the gathering, with numbers ranging function without their familiar clinical systems while from crowds of 1,000 to 25,000.5 attempting to maintain a high standard of care, often Large crowds require dedicated first aid, medical, for large numbers of patients over a variable and and other health-related services at a rate higher than sometimes extended period of time. 232 2011;13(4) CJEM N JCMU Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.139, on 29 Sep 2021 at 11:44:17, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.2310/8000.2011.110305 Mass gathering medicine Preparation and advanced planning are crucial to the element of good disaster planning is training front-line success of any MGM deployment.