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Add ICS communication chain, redundancies in mass gathering pre-plans

Despite the destruction of the medical tent, and a lack of water for attendees, a New Orleans concert continued after several attendees were injured in a stampede


In this Thursday, July 4, 2019 photo, A Chicago Police Department (CPD) officer guard people as they stream out of Chicago’s Navy Pier after reports of stabbings and threatening injuries after the 4th of July celebrations. Police said a false report of gunfire set off a stampede that trampled more than a dozen people.

AP Photo/Amr Alfiky

During Lil Wayne’s recent outdoor Lil WeezyAna Fest in New Orleans, a panic spread through the crowd, causing a large portion of the 15,000 attendees to stampede away from a perceived but unknown threat. The push did not last long, but caused damage to structures on the grounds, including concession stands and the medical tent. No significant injuries were reported, although several fans were assessed for injuries, including one person that passed out. The concert continued, although fans were unable to purchase any more beverages, including water.

Pre-planning special events and mass gatherings

While one could argue that every day in EMS has a variety of “special” events going on that could result in EMS calls, city and county emergency planners, and EMS administrators must take mass gatherings seriously. How a mass gathering or special event is defined varies widely, but if the event brings in medical staff to care for attendees, or your service changes its staffing or deployment model to account for the event, it is likely a special event.

The National Association of EMS Physicians outlines the goals for EMS planning for mass gatherings as:

  1. Ensure that care provided to attendees and participants of the event are consistent with the standards of the local community
  2. Preserve the resources of the local health systems to serve the usual needs of the community
  3. Optimally respond to extraordinary or catastrophic events

Many variables should be taken into account when determining how to best provide medical coverage for a special event, including, just to name a few:

  • Predicted weather
  • Available shelter
  • Presence of alcohol or drugs
  • Active participation versus spectator events
  • Event duration
  • Contained versus open roaming crowds
  • Geographic size of the event
  • Crowd age

Top takeaways from the Lil WeezyAna crowd stampede

Without delving much deeper into the finer points of designing medical coverage for a special event, a few takeaways can be identified from this close call. Here are my top takeaways from this incident, that can be applied to planning, staging and resource allocation for future mass gatherings.

1. Crowd assessment is threat assessment

The times we live in now call for greater security anytime people gather in large groups. While it is not necessarily EMS’s role to determine what security will be in place, knowing if attendees will be searched for weapons or alcohol is important. Likewise, EMS should know how the event staff are planning to minimize threats from vehicular assaults, snipers and drones.

2. Consider event logistics to form MCI plans

Many agencies are quite good at planning medical coverage for the predictable needs of a crowd, but plans must also now include the worst-case scenario “what ifs.” The event plan must include a provision for a mass casualty incident, whether it be from natural causes, like weather; accidental causes, such as a bleacher collapse or a race vehicle striking the crowd; or from more nefarious sources, including terrorism, gang activity or an active killer.

The service’s standard MCI plan may not be enough to accommodate a mass gathering that becomes a MCI, although it is the logical place to start. The standard plan should be expanded to include the concentration of people in a particular venue. Casualty collection points and treatment areas can likely be preplanned. Caches of triage kits, patient movement equipment and care supplies can be pre-positioned. If your service has an MCI trailer or specialty vehicle, now is the time to pull it out and review the contents.

Vehicle flow and access to the venue should be mapped out and communicated to EMS resources in the area that would respond if an MCI were to occur. Communication frequencies and ICS roles can all be pre-planned.

3. Coordinate with hospitals and other partners

Hospitals and other healthcare system partners, such as regional trauma councils or healthcare coalitions should also be consulted in the planning process, especially the MCI plan portion. They will likely share expertise from assisting with other events in the region and they are well-positioned to coordinate information sharing with regional partners. Hospitals may also consider staffing up when they know a large event is occurring or at least have a plan in place.

4. Build in redundancy

The biggest detail that caught my eye in this particular incident was the destruction of the medical tent. It is not clear if other medical tents or resources were positioned around the grounds, but this makes a great case for planning for redundancy. Fixed locations can be easily damaged by weather, overrun by panicking crowds, shut down by loss of utilities or just be positioned in the wrong place. Plans should include consideration of mobile resources as well as back-up locations to care for patients. Ideally these locations will be pre-identified so that attendees will know where they can find help.

5. Use ICS to communicate with event leadership

It was interesting to see that the New Orleans concert continued even after the stampede. Did the event leaders know that the medical tent was destroyed or that fans were now without any source of water? This makes the case that event medical staff must have an avenue for communication with the event leadership throughout the event to be able to share these concerns. If you are thinking “this would be a good place for ICS,” you are right.

6. Use resources at hand to plan baseline coverage for best case scenarios

Baseline coverage for medical events can be determined by some of the factors mentioned above, combined with your experience with previous events and availability of resources in the day-to-day system. A number of resources are available to help determine what resources should be considered for pre-planning mass gatherings, including:

Take special event coverage seriously and encourage your communities to do the same.

Stay safe out there.

Michael Fraley has over 30 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.