EM · Mass-gathering and event medicine
Mass-gathering and event medicine — PICE classification, casualty prediction and event medical planning
Also known as Mass-gathering medicine · Event medicine · Mass gathering medical care · PICE classification · Potential injury creating event · Patient presentation rate · PPR · Transport to hospital rate · TTHR · MIMMS · Crowd crush · Compressive asphyxia · Event medical planning · Festival medicine
Mass-gathering and event medicine — the provision of healthcare to defined crowds at planned events and the planning required to do it safely. The WHO functional definition of a mass gathering (a crowd with the potential to strain the planning and response resources of the host community; an operational threshold of 1000 or more attendees) and the distinction from a mass casualty incident (the casualty-generating event that shifts the standard of care to the population — the greatest good for the greatest number). The PICE (Potential Injury Creating Event) classification of any event by Type (planned or unplanned, primary or secondary), Category (static or dynamic), Status (controlled or uncontrolled) and Stage (0 to 4 by need for outside aid). The Arbon predictive model for patient presentation rate (PPR 1 to 2 per 1000 attendees, up to 5 per 1000 for high-risk events) and transport to hospital rate (TTHR 5 to 20 per cent). Event archetypes (sport, concert, pilgrimage, festival), the MEDPLAN six-domain medical plan, MIMMS CSCATT command, SALT triage, crowd crush as compressive asphyxia, MDMA-related hyperthermia and hyponatraemia, crush syndrome, and the escalation triggers that convert a mass gathering into a mass casualty incident.
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8 MCQs with explanations
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Meet the patient
A 22-year-old man is half-carried into the on-site medical post at an outdoor summer music festival on day two — 36 degrees Celsius in the shade, headline act in an hour. He is agitated, pulling off his shirt, drenched in sweat; a friend says he took two pills about four hours ago and has been drinking non-stop from the free water points. Rectal temperature 41.2 degrees Celsius, heart rate 144, GCS 13, glucose normal.[1]
This is the single patient who holds the whole topic together. He is simultaneously heat stroke and MDMA toxicity — hyperthermia from the drug and the weather, hyponatraemia from the water he drank to stay safe — and the casualty wave is still building behind him. The two questions every event-medicine stem turns on: is this presentation within the predicted load the plan was sized for, and has that load now overtaken the team's capacity? Hold those two questions and PICE, Arbon and the escalation triggers all slot into place.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
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- [1]Arbon P, Bridgewater FHG, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates Prehosp Disaster Med, 2001.PMID 11875799
- [2]Arbon P. Mass-gathering medicine: a review of the evidence and future directions for research Prehosp Disaster Med, 2007.PMID 17591185
- [3]Arbon P, Bottema M, Zeitz K, et al. Nonlinear Modelling for Predicting Patient Presentation Rates for Mass Gatherings Prehosp Disaster Med, 2018.PMID 29962363
- [4]Jaslow D, Yancy A 2nd, Milsten A Mass gathering medical care. National Association of EMS Physicians Standards and Clinical Practice Committee Prehosp Emerg Care, 2000.PMID 11045418
- [5]Jaslow D, Drake M, Lewis J. Characteristics of state legislation governing medical care at mass gatherings Prehosp Emerg Care, 1999.PMID 10534032
- [6]Turris S, Lund A, Munn MB, et al. Measuring the Masses: Domains Driving Data Collection and Analysis for the Health Outcomes of Mass Gatherings (Paper 3) Prehosp Disaster Med, 2021.PMID 33602378
- [7]Turris S, Rabb H, Chasmar E, et al. Measuring the Masses: A Proposed Template for Post-Event Medical Reporting (Paper 4) - CORRIGENDUM Prehosp Disaster Med, 2021.PMID 33818337
- [8]Hutton A, Munn MB, White S, et al. Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees' Planned Alcohol and Recreational Drug Use? Prehosp Disaster Med, 2021.PMID 34187607
- [9]Steenkamp M, Hutton AE, Ranse JC, et al. Exploring International Views on Key Concepts for Mass-gathering Health through a Delphi Process Prehosp Disaster Med, 2016.PMID 27212053
- [10]Born CT, Briggs SM, Ciraulo DL, et al. Disasters and mass casualties: I. General principles of response and management J Am Acad Orthop Surg, 2007.PMID 17602028
- [11]Nocera A Australian major incident nomenclature: it may be a 'disaster' but in an 'emergency' it is just a mess ANZ J Surg, 2001.PMID 11277146
- [12]Peiris D A historical perspective on crush syndrome: the clinical application of its pathogenesis, established by the study of wartime crush injuries J Clin Pathol, 2017.PMID 27920043
- [13]Al-Tawfiq JA, Rashid H, Parker S, et al. Public health preparedness and infectious disease risk management across religious mass gatherings: a comparative analysis of Hajj, Umrah, Arba'een and Kumbh Mela J Travel Med, 2026.PMID 41934233
- [14]Ren D, Breslin K, Goodwin T, et al. Evaluation of Pediatric Triage Decisions Using the SALT (Sort, Assess, Life-saving Intervention, Treatment/Transport) Triage System across Training Levels Disaster Med Public Health Prep, 2025.PMID 41339328