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How EMS can prepare for a mass gathering to become an MCI

Crowd size, location and similar event intelligence can help predict patient load and MCI response needs at a mass gathering


At the EMS World Expo, Matt Levy, DO, said, “It’s what happens in the first few moments of the response that dictates who is going to survive and who is not.”


This article was originally posted Nov. 5, 2018. It has been updated.

A mass gathering is a predictable and likely potential mass casualty incident that requires risk management planning and mitigation. Matt Levy, DO, during a series of presentations about event medicine, discussed the many unique challenges for EMS agencies responsible for a mass gathering event at EMS World Expo.

Levy is the medical director of the Howard County Department of Fire and Rescue Services, an associate professor of Emergency Medicine at the Johns Hopkins University, and clinical associate professor and medical director of the Department of Emergency Health Services at the University of Maryland Baltimore County. He has participated in planning and covering numerous mass gathering events.

Memorable quotes on a mass event becoming an MCI

Here are memorable quotes from Levy about mass event medicine based on his experiences in planning, response and studying significant mass event MCIs:

“It’s what happens in the first few moments of the response that dictates who is going to survive and who is not.”

“Crowd size is less important than event characteristics.”

“It should be a 5-minute or 1/8-mile to a 1/4-mile walk for a patient to reach medical aid on-site.”

“I would be very reluctant to use the medical tent as a sobering tent. Having a plan for intoxicated (but not sick or injured) patients is important.”

“A semi-trailer of backboards parked nearby might not be the most effective medical counter-measure.”

Top takeaways on mass events and mass casualty incidents

Levy’s fast-moving presentation covered a range of planning, preparation and response topics with pertinent examples from real world incidents. Here are four top takeaways.

1. Risk management and planning mitigation

An interdisciplinary planning effort can take weeks or months to complete. The risk management components include, but not are limited to:

  • Overcrowding and crowd control
  • Event access points
  • Fire prevention and safety measures
  • Medical preparedness
  • Emergency response

Partner during the planning phase with representatives from emergency management, hospitals, public health, mass transit, sanitation and other appropriate organizations.

Levy discussed the growing frequency of patients who self-evacuate or are transported by friends, law enforcement or ride-share drivers. He stressed at least two things to incorporate into planning for non-EMS transport of patients. First, hospitals should be prepared for a surge of patients arriving from all possible transport modes. Second, the hospitals may experience an unexpected convergence of patients at a single facility. The convergence may require a later re-distribution of patients to other hospitals or triage at the facility to ensure the critical patients are cared for first.

Matthew Levy.jpg

Matt Levy, DO, during a series of presentations about event medicine, discussed the many unique challenges for EMS agencies responsible for a mass gathering event at EMS World Expo.

2. Mass gathering event intelligence

Past performance of the event, like a rock band touring from city to city, typically has a similar set of characteristics, including:

  • Attendees – who is coming?
  • Timeline – when are attendees at risk of illness or injury?
  • Incident history – what injuries, illnesses or conflicts happened at other venues?

Levy listed these event intelligence categories that are important to gather and analyze for risk management planning and mitigation.

  • Type of event
  • Expected attendance
  • Dates and duration of event
  • Agencies involved
  • Attended demographic and transport mode
  • Alcohol and drug policy
  • Event history
  • Local site map

3. Predicting the number of patients at a mass gathering

The patient presentation rate can be predicted based on past event records or the number of patients treated at similar events. The predicted patient presentation rate doesn’t account for surges of patients from an unusual event, like an explosion or extreme heat. Patient presentation rates are directly impacted by:

  • Bound and focused events which restrict attendees to a building or space.
  • Events over 6 hours in duration.
  • Freely mobile crowds that can move throughout the venue.
  • Availability and use of drugs and alcohol.
  • Attendee demographics, especially age, fitness and underlying health.
  • Activities attendees are participating in during the event.

4. Use and monitor social media in the incident command post

Levy recommended that social media – both well-known channels as well as non-conventional networks which might be popular with the event attendees – be used to notify participants and monitor the event as it unfolds. Social media posts and responses from attendees, as well as responders, can be useful for situational awareness.

Learn more about mass gathering medicine

Here are some other articles from EMS1 on mass event planning and response. In addition, consider a specialty conference on event medicine like the Mass Gathering Medicine Summit or the International Institute for Race Medicine.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.