Best Practices: Mass Gathering Events

This is the season for large scale public events celebrating all that is great about our country. Many of these events will require some degree of EMS coverage, whether by statutory regulation, choice of the event sponsor or the authority having jurisdiction where the event is planned to occur. Guidelines for delivery of emergency medical care at public events can be found in the National Association of EMS Physicians soft cover book entitled Mass Gathering Medical Care: The Medical Director's Checklist, which I wrote with two colleagues several years ago. It is available through NAEMSP for a reasonable price ($20 for members and $35 for non-members).

Go to www.naemsp.org/products.html for further information and ordering instructions. The book is about 50 pages in length and is quite comprehensive. However, it is lacking a chapter on taking care of your own people. This was an unintended oversight and will be corrected whenever we decide to write an updated version. Clearly, this concept is a priority at all emergency incidents regardless of their nature.

I recently provided medical oversight at the 2006 Pro Cycling Tour in Philadelphia. This is the 156-mile professional bicycle race that goes up the Manayunk Wall. Despite the fact that I wrote the book on the subject and that I participate in Philadelphia-area mass gatherings as the EMS Medical Director several times every year, I violated several of the principles you are about to read below. When the Event EMS Director asked me at the end of the day how I let myself get sunburned, I realized that this was a good opportunity to talk about these concepts. Hopefully, those of you involved in similar events this summer will be able to avoid making the same mistakes. While the points below may seem like common sense, I am willing to bet that EMS personnel who staff special event EMS sectors more often than not are noncompliant with these principles.

1. Get a good night's rest prior to the event.

It is important for personnel to be awake and alert at events which may require rapid decision-making, walking or running distances and caring for large numbers of patients. Sleep deprivation produces a state similar to being hung over. You can never quite recover during the next period and you feel rotten the entire shift. Studies of physicians during their residency training has shown that sleep deprivation contributes to a greater number of medical mistakes and a greater risk of self-injury from driving sleepy, etc.

2. For outdoor events, use/provide sun block and insect repellant as needed.

Sunburn and mosquito bites are almost totally preventable causes of injury among EMS providers at mass gatherings. Repetitive sunburn is a major contributory factor to the risk of development of malignant melanoma later in life. Dermatologists claim that we have yet to see the epidemic of this disease due to the "suntan crowd" which became prevalent in the 1970s and 1980s. Sun block with an SPF of at least 30 (and preferably higher) should be applied to any areas of the body not covered by clothing at least one hour prior to sun exposure. I believe that I became sunburned rather quickly at the bike race because the command vest I was wearing reflected additional UV rays from my thorax onto my face.

Mosquito bites used to be just a nuisance. However, there are now several complications related to skeeters that are a risk for everyone who is a recipient of their feeding frenzy. We are seeing more abscesses today than ever before in emergency departments. Many of these are caused by methicillin resistant staph aureus (MRSA). Abscesses are complications of skin infections from any break in the skin including insect bites. Mosquitos also carry the west nile virus which causes encephalitis and can be fatal, although this is rare. Mosquito repellant should be generously applied to skin and clothing if you are working in an area of concern. However, be aware that DEET, the active ingredient in insect repellant, can cause seizures in high concentrations, so liberal use should be interpreted reasonably.