Impact of mass gatherings on ambulance services and emergency departments

I presented at the Qatar Health 2020 conference regarding the impact of mass gatherings on ambulance services and emergency departments. Qatar Health 2020 is a collaborative effort between Hamad Medical Corporation and the Ministry of Public Health in preparation for the FIFA World Cup 2022.

In particular, this presentation highlights:

• the host population to event population relationship
• frameworks for understanding the impacts of mass gatherings
• current literature to inform practice
• case studies relating to music festivals, and the 2018 Commonwealth Games

REFERENCES

Arbon, P., Bridgewater, F. H., & Smith, C. (2001). Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehospital and Disaster Medicine, 16(3), 150-158.

Catherine Delany. Master of Emergency Nursing (Dissertation). A retrospective analysis of drug and alcohol-related patient presentations to the Gold Coast Health emergency departments during the 2018 Commonwealth Games. Supervisors: Julia Crilly, Jamie Ranse.

DeMott, J. M., Hebert, C. L., Novak, M., Mahmood, S., & Peksa, G. D. (2018). Characteristics and resource utilization of patients presenting to the ED from mass gathering events. The American Journal of Emergency Medicine, 36(6), 983-987.

Gold Coast Public Health Unit. (2019). Gold Coast 2018 Commonwealth Games Summary Report. Retrieved from: https://www.goldcoast.health.qld.gov.au/sites/default/files/GC2018%20Public%20Health%20Summary%20Report%20Final%20.pdf

Hughes, H. E., Colón-González, F. J., Fouillet, A., Elliot, A. J., Caserio-Schonemann, C., Hughes, T. C., ... & Lake, I. R. (2018). The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study. PloS one, 13(6), e0198665.

Lund A, Turris S, Bowles R, Steenkamp M, Hutton A, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 1 Population models for mass gatherings. Prehospital and Disaster Medicine. 29(6):648-654.

Ranse, J., Hutton, A., Keene, T., Lenson, S., Luther, M., Bost, N., ... & Hayes, C. (2017). Health service impact from mass gatherings: a systematic literature review. Prehospital and disaster medicine, 32(1), 71-77.

Ranse, J., Lenson, S., Keene, T., Luther, M., Burke, B., Hutton, A., ... & Crilly, J. (2019). Impacts on in‐event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia, 31(3), 423-428.

Ruest, S. M., Stephan, A. M., Masiakos, P. T., Biddinger, P. D., Camargo, C. A., & Kharasch, S. (2018). Substance use patterns and in-hospital care of adolescents and young adults attending music concerts. Addiction Science and Clinical Practice, 13(1), 1.

Shirley (Yunjing) Qiu. Bachelor of Nursing (Honours), First Class. A retrospective cohort study evaluating the impact of a mass gathering (the 2018 Commonwealth Games) on emergency department presentations with communicable diseases. Supervisors: Julia Crilly, Jamie Ranse, Peta-Anne Zimmerman

Turris S, Lund A, Hutton A, Bowles R, Ellerson E, Steenkamp M, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 2 Event modelling for mass gatherings. Prehospital and Disaster Medicine. 29(6):655-663



Reference from this presentation: Ranse J. (2020). Impact of mass gatherings on ambulance services and emergency departments; invited speaker for Qatar Health 2020, Doha, Qatar, 17th January.

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Impact of mass gathering events on emergency healthcare services: informing health service planning for safer communities.

I was interviewed by Gold Coast 7 News regarding funding I received from the Australian Research Council to explore the impact of mass gathering events on emergency health services.

PROJECT OVERVIEW
Mass gathering events (MGEs) occur frequently across Australia. The preparation of a MGE from an emergency healthcare service perspective is conducted with limited evidence to support decision-making. Using routinely collected data from Tourism and Events Queensland, Queensland Ambulance Service, Queensland Emergency Departments, and the Bureau of Meteorology, this research aims to determine the impact on ambulance and emergency department services in the vicinity of 750 planned MGEs over a five year period (2015 - 2019). The expected outcome includes an enhanced ability to predict the required emergency healthcare services for a MGE, therefore enhancing the planning and response, benefiting MGE attendees and the MGE host community.

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Frequency and location of mass gatherings in relation to emergency departments: A descriptive study

The full-text article is available here


ABSTRACT

Introduction: As the number of mass gathering events increases, so too does the reliance on tertiary emergency healthcare services. Approximately 1% of event attendees may present to a local emergency department for clinical assessment and/or management. Often, these attendees are transported by ambulance services. The purpose of this study is to determine the frequency and location of events held in New South Wales (NSW), Australia. This information may be used by event and health service personnel to further inform event planning such as staffing, equipment and economic considerations when large events in the community occur.

Methods: This descriptive study used data scraping of an established data warehouse to identify events held in the 2017 calendar year by name, type, location (within the state of NSW) and duration. Using Google Maps, the distance and travel time between these events and the nearest emergency department (ED) was determined. Data was analysed using simple descriptive statistics.

Results: Of the 722 events in NSW analysed, 395 were single-day events. The majority of these were concerts (n=284, 39%), followed by festivals (n=259, 36%) and sporting events (n=176, 24%). The average distance and time to arrive at an ED from an event was 15.0 (±35.8) kilometres and 15.4 (±27.2) minutes, respectively. 

Conclusion: Existing literature has highlighted that event attendees are regularly transported to emergency departments from events. This research has demonstrated that events occur frequently with varying vicinity to nearest EDs, with the majority of events occurring near territory care centres. However, there is limited research on the impact on emergency healthcare services resulting from an event.



Hutton A, Ranse J, Lipscomb R, Hutton G, Rabb H, Crilly J. (2019). Frequency and location of mass gathering events in relation to emergency departments: A descriptive study. Australasian Journal of Paramedicine.

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Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis

Free full-text article is available here (PDF) 


ABSTRACT 

Objective
The aim of this study was to describe the in‐event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition.

Methods
This research was set at one MGE in Australia. The MGE had one first aid post and one in‐event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in‐event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics.

Results
Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86–1.13], 9.85/1000) presented for in‐event first aid care, with 24/197 (12.2% [95% CI 8.33–17.49], 1.2/1000) referred to in‐event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71–78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti‐emetics (n = 11). Seven (29.2% [95% CI 14.92–49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5–12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission.

Conclusions
There was an impact on in‐event, ambulance and ED services from this MGE but the in‐event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A, Johnston A, Crilly J. (2018). Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia.

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Health service impact from mass-gatherings: A systematic literature review

ABSTRACT:

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows, and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass gathering events was the focus of this literature review.

Methods: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass gathering health, provision of in-event health services, ambulance service transportation and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusion: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum

Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 17th WADEM Congress on Disaster and Emergency Medicine. Toronto, Canada 29th April

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Health service impact from mass-gatherings: A systematic literature review

Free full-text article is available here (PDF)

ABSTRACT:
Background: During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review.

Aim: This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.

Method: This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.

Conclusions: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum.



Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review. Prehospital and Disaster Medicine. 32(1):

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Health service impact from mass-gatherings: A systematic literature review

ABSTRACT:

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass-gathering events was the focus of this literature review.

Aim: This literature review aims to develop an understanding of the impact of mass gatherings on local health services.

Method: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation and hospital utilisation.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass-gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusions: There is minimal research focusing on the impact of mass-gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass-gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass-gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum.




Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2016) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 14th International Conference for Emergency Nurses. Alice Springs, Australia. 20th October.

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The impact of mass gatherings on ambulance services and hospitals

This presentation was delivered as a webinar to members of the World Association of Disaster and Emergency Medicine.

ABSTRACT
During a mass-gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management in-event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this presentation. In particular, a case study of one outdoor music festival in 2012 in the Australian Capital Territory with approximately 20,000 participants will be analysed. This festival had one first aid post and a health team staffed by doctors, nurses and paramedics.


Ranse J. (2016). The impact of mass gatherings on ambulance services and hospitals; webinar presentation to members of the Mass Gathering Section of the World Association for Disaster and Emergency Medicine, 14th October.

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Planning Healthcare for a Mass Gathering

 

I had a conversation with Craig Hooper from Operational Health about mass gathering health. To listen to the podcast, visit http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl


The following is taken directly from the Operational Health website.

----START----

Craig chats with Assistant Professor Jamie Ranse about the clinical and operational planning that sits behind mass gatherings. Using World Youth Day 2008 as a case study, Jamie discusses the need to engage a cross section of health and healthcare providers. International perspectives are also discussed with the underlying messaging being that progress toward improved health planning at mass gathers relies on shared definitions and data points and moving away from purely descriptive journal articles to articles.

About my guest:
Assistant Professor Jamie Ranse of the University of Canberra has a keen professional and personal interest in the area of disaster and mass gathering health. He is currently undertaking a PhD exploring the experience of nurses who participate in disasters. He is an Associate Editor for the Australasian Emergency Nursing Journal, holding the disaster portfolio and peer-reviews a number of national and international journals relating to disaster and primary health care. Jamie remains engaged in the clinical setting as a casual RN at the Emergency Department of Calvary Health Care ACT.

About the Podcast Host:
Craig is a health and emergency service management specialist with more than 30 years experience in operational management, emergency planning, health service delivery and service redevelopment. More information can be found at www.cahooper.com

Academic Publications
Jamie Ranse has a large number of publications and presentations relating to Mass Gathering and Major Event health on his website, www.jamieranse.com Some of those discussed on this episode include;

Data Sets

• Ranse J, Hutton A. (2012). Minimum data set for mass gathering health research and evaluation: A discussion paper. Prehospital and Disaster Medicine. 27(6):1-8. doi:10.1017/S1049023X12001288 (Direct Link)
• Ranse J, Hutton A. (2013). Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue. Prehospital and Disaster Medicine. [author reply]. 28(2):3 (Direct Link)
• Lund A, Turris S, Bowles R, Gutman S, Hutton A, Ranse J, Arbon P. (2013). Progressing towards an international consensus on data modelling for mass gathering and mass participation events; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May. (Direct Link)

Hutton A*, Ranse J, Arbon P. (2012). Understanding and identifying potential risks for participants at music festivals; paper presented at the St John Ambulance Australia Member Convention, Sydney, New South Wales, Australia, 19th May. (Direct link)

Hutton A, Ranse J, Verdonk N, Ullah S, Arbon P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehospital Disaster Medicine. 2014;29(2):1-7. (Direct Link)

Ranse J, Arbon P. Evaluating the influential factors in mass gathering casualty presentation characteristics – World Youth Day, Sydney, Australia, 2008; paper presented at the 7th International Conference for Emergency Nurses, Gold Coast, Australia, 8th October 2009. (Direct link)

----FINISH-----

Ranse J (Interviewee), Hooper C (Producer). (2015). Mass gathering health; audio podcast for Operational Health, 23rd July. Series 2, Episode 4. Retrieved from http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl

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Patient presentations and health service impact: A case study from a mass gathering.

This is a preliminary report relating to research undertaken with an aim to enhance the understanding of the health service requirements at an outdoor music festival by describing the health service usage in one Australian jurisdiction. In particular, this research aims to describe the patient characteristics for the following patient populations:

1. Those patients who presented for onsite care at the event, provided by St John Ambulance Australia (ACT), 
2. Those patients whose care was escalated to onsite doctors, nurses and paramedics volunteering at the event with St John Ambulance Australia (ACT), 
3. Those patients whose care was escalated to the care of ACT Ambulance Service, and 
4. Those patients who had care provided at either the Canberra Hospital or Calvary Hospital in the ACT.

Ranse, J., Lenson, S., Keene, T., Luther, M., Burke, B., Hutton, A., & Jones, N. 2015.Patient presentations and health service impact: A case study from a mass gathering.[Report]

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Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study.

ABSTRACT:

Introduction: Health providers at mass gatherings aim to minimise the disruption to the health services of the surrounding community. The mass gathering literature focuses on patients presenting to onsite care providers at events, and scantly reports on patients presenting to prehospital care providers (ambulance paramedics) and hospital emergency departments (EDs). In 2012, an outdoor music festival with approximately 20,000 participants was held in Canberra. The festival had one first aid post, and a medical assistance team staffed by doctors, nurses and paramedics. This research describes the characteristics of patients and health service usage from this event.

Method: Data was collected retrospectively from the event onsite care provider (St John Ambulance Australia) patient records. These records were linked to both prehospital (ACT Ambulance Service) and hospital EDs (Canberra Hospital and Calvary Health Care ACT) patient records. A preexisting minimum data set was used to code patient characteristics. Data analysis included descriptive statistics, such as frequencies and means of central tendency.

Results: In total, 197 (9.86/1,000) patients presented for clinical assessment and/or management at the event. Two patients who required hospitalisation bypassed the onsite care providers and were transferred directly via the ambulance service to hospital. The onsite medical assistance team managed 22 patients (1.1/1,000), of whom two were referred to police, five transported to hospital and 15 discharged to the event. In total, seven patients were transported to hospital by ambulance (0.35/1,000). Hospital presentation rate and patient characteristics are currently being determined at the time of this abstract submission.

Discussion: This is the first research to describe patient presentations to onsite care providers, prehospital and hospitals from a mass gathering. This research provides insight into the health service usage associated with mass gathering. Strategies to minimising the disruption to the prehospital and hospital health services of the surrounding community will be discussed.

Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study. 12th International Conference for Emergency Nurses.

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Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study

ABSTRACT:
Background:
A number of challenges exist in providing adequate health care at a mass gathering. Health providers aim to maximise their efficiency in responding to health emergencies within the mass gathering environment, whilst minimising potential impact of surge presentations to the health service in the surrounding community or region. The mass gathering literature commonly reports on the onsite care from single events, and does not consider the effect on prehospital or hospital services.

Aim:
This research aims to enhance our understanding of the health service requirements of an outdoor music festival.

Methods:
Design: Retrospective review of patient report forms from onsite health services at outdoor music festival.
Setting: One outdoor music festival in 2012 in the Australian Capital Territory with approximately 20,000 participants. The festival had one first aid post and a health team staffed by doctors, nurses and paramedics.
Data collection: Data was obtained and linked between onsite care providers (St John Ambulance Australia), prehospital (ACT Ambulance Service) and hospitals (Canberra Hospital and Calvary Health Care ACT). A pre-existing and used minimum data set1 was used to code patient characteristics from this event.
Data analysis: Descriptive statistics such as frequency distributions and means of central tendency. 

Results:
This is a summary of some of the key findings.

• Onsite first aid care: The most frequent illness was headaches (n=94), injury was superficial lacerations (n=13), environmental was substance and/or alcohol intoxication (n=12).
• Onsite health professional care: The most frequent illness was headaches (n=3), injury was fractures (n=2), environmental was substance and/or alcohol intoxication (n=12).
• Ambulance transport: The most frequent injury was fractures (n=2), environmental was substance and/or alcohol intoxication (n=4). One patient required prehospital endotracheal intubation, Three patients required airway adjuncts, Six patients received intravenous medications from paramedics including opioids.
• Hospital services: One patient required an open reduction and internal fixation in the operating theatre. One patient required intubation and ventilator support in the Intensive Care Unit.

Discussion:
This is the first research to describe patient presentations to onsite care providers, prehospital services and hospitals from a mass gathering. This research provides insight into the health service usage from one event. Presentation to the onsite health professionals resulted in a longer length of stay in the onsite medical facility. Onsite health professionals may have diverted 15 patients who would have otherwise been seen by local ambulance and hospital services. Multi-site research should be undertaken to explore the health service usage from a variety of mass gatherings.

Our poster at #PAIC2014 Onsite health providers and ambulance paramedics at mass gatherings http://t.co/H14Z9LGzeq pic.twitter.com/e84OUXaN71

— Jamie Ranse (@jamieranse) September 19, 2014

Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. (2014). Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study; poster presented at the Paramedics Australasia International Conference 2014, Gold Coast, Australia, 18-20 September.

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