Mass-gathering medicine: Educational opportunities

Hundreds of mass gatherings—triathlons, adventure races, parades, concerts, and music festivals—take place throughout BC each year and, for the most part, they are safe and enjoyable community events. However, attendees at these events can be isolated from access to regular emergency services and medical care,[1] and illness, injuries, and fatalities do occur. In 2014 at least four young Canadians died attending music festivals.[2,3]

Mass gatherings require health and medical services, harm-reduction strategies, operational plans, and emergency contingency plans to be in place, and they offer a plethora of educational opportunities.

A mass gathering can be defined as any occasion that attracts sufficient people to strain the planning and resources of the community, city, or nation hosting the event.[4] Mass-gathering health is a young and rapidly evolving discipline with ties to emergency medicine, disaster medicine, and public health. Much of the literature refers to mass-gathering medicine (MGM), a subset of mass-gathering health, which focuses on emergency medical care at mass gatherings; however, mass-gathering health also encompasses broader contributors to health at mass gatherings including security and policing, water quality, food safety, health promotion, injury/illness prevention, and harm reduction.

Mass gatherings take place in dynamic environments. Planning and provision of health and emergency medical services is challenging. Patterns of injury and illness differ from those typically encountered in the community.[4] Medical responses are complicated by logistical challenges, such as weather extremes, crowding, site access, and communication difficulties.[5-7]

These unique challenges, along with increased rates of morbidity, mean that baseline 911 emergency services alone may not ensure the safety of attendees. As well, there is a growing awareness of the impact of mass gatherings on local communities and a requirement to avoid compromising baseline emergency services.[8] Consequently, there is a shift away from a purely first-aid model of care and toward on-site multidisciplinary medical teams (e.g., nurses, physicians, paramedics) offering a higher level of care.

A learning environment 
The diversity of patients, health care expertise, and environments at mass gatherings provides an abundance of learning opportunities for medical students and residents. The multidisciplinary nature of mass-gathering medical teams exposes learners to the roles and skills of allied health care professionals and allows opportunity to practise communication and collaboration skills. The range of patient presentations with variable acuity provides opportunities to hone clinical skills such as history taking, physical examination, first aid, acute treatment, and appropriate disposition of patients. Mass gatherings also expose students to the nuances of prehospital care, encouraging flexibility and adaptability in variable conditions and low-resource environments.

Evolution of mass-gathering medicine at UBC
The faculty, residents, and students at UBC have driven the field of mass-gathering medicine from a grass-roots level. The Mass Gathering Medicine Interest Group at UBC (http://mgm.med.ubc.ca) is made up of a multidisciplinary team of professionals collaborating to expand the literature about mass gatherings and to contribute to the care and standards provided at these events. The group supports two types of formal learning opportunities.

MGM clinical learning
Learners began participating at mass gatherings during the 2008 Pemberton Music Festival, a 3-day event involving more than 40 000 attendees per day and a medical team of more than 160 providers. Learner opportunities were found subjectively to be extremely valuable, and involvement of medical learners grew from the grass-roots level. Between 2008 and 2013, a formal MGM elective hosted 61 residents and 126 medical students during 77 events, with overwhelmingly positive reviews. 

MGM student club
The MGM club, launched in 2012 through the UBC Medical Undergraduate Society, attracts students with interests in emergency, wilderness, sport, and mass-gathering medicine. The club provides didactic workshops and access to clinical learning, research, leadership, and education at large-scale community events. There are now chapters of the student club in Alberta and Quebec.
—Andrew Guy (UBC Medicine, class of 2017)
—Rosie Earle, BSc (UBC Medicine, class of 2016)
—Sheila A. Turris, PhD
—Adam Lund, MD, MDE, FRCPC

References

1.    Krul J, Sanou B, Swart EL, et al. Medical care at mass gatherings: Emergency medical services at large-scale rave events. Prehosp Disaster Med 2012;27:71-74.
2.    CTV News. Overdose death at BC music fest prompts police warning. Last modified 4 August 2014. www.ctvnews.ca/canada/overdose-death-at-b-c-music-fest-prompts-police-wa....
3.    CBC News. Veld music festival deaths linked to ‘party drugs,’ police say. Last modified 4 August 2014. www.cbc.ca/news/canada/toronto/veld-music-festival-deaths-linked-to-part....
4.    Arbon P. Mass-gathering medicine: A review of the evidence and future directions for research. Prehosp Disaster Med 2007;22:131-135.
5.    De Lorenzo RA. Mass gathering medicine: A review. Prehosp Disaster Med 1997;12:68-72.
6.    Milsten AM, Seaman KG, Liu P, et al. Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings. Prehosp Disaster Med 2003;18:334-346.
7.    Lund A, Wong D, Lewis K, et al. Alternative communication strategies for medical dispatch at events with high ambient noise. Prehosp Disaster Med 2013;28:1-7. 
8.    Heiby MJ, Barnhardt W, Berry T, et al. The impact of a mass gathering events with an on-site medical management team on municipal 911 emergency medical services. Am J Emerg Med 2013;31:256-257.