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Mass Gatherings/Special Events
Topic Collection
March 21, 2025

Topic Collection: Mass Gatherings/Special Events

Thousands of pre-planned mass gatherings and special events (e.g., sporting events, festivals, conventions, visits by dignitaries) occur each year across the country and abroad.  Unfortunately, in today’s environment, special events attended by large numbers of people may be considered as terrorist targets due to large concentrations of crowds, the symbolic nature of the event, high-profile attendees, and increased media attention. Extreme weather events such as heat and storms can also quickly turn a mass gathering into a mass casualty event. The COVID-19 pandemic has added another layer of infectious disease risk to mass gatherings. Large concentrations of people may overwhelm the healthcare capacity in a given area, particularly when alcohol or drugs are present. Finally, surging crowds (which may be induced by panic) can cause trampling or suffocation events. It is for these reasons that local, state, and federal authorities should anticipate the public health and medical issues presented by mass gatherings and prepare adequately for a range of response operations. Using incident management systems for planning and operating these events as “planned emergencies” allows a rapid transition to emergency response should an incident occur.

The resources in this Topic Collection include lessons learned, case studies, research, tools, and templates designed to help emergency medical staff create robust plans for mass critical care before an incident strikes their jurisdiction. This Collection does not include resources on mass casualty response but is designed to support pre-incident mass gathering contingency planning. More specific information can be found in the following ASPR TRACIE Topic Collections: Fatality Management, Responder Safety and Health, Burn, Active Shooter and Explosives, Mental/Behavioral Health (non-responders), Pre-Hospital Victim Decontamination, Alternate Care Sites, Pediatric, and Trauma Care and Triage. This Collection was refreshed in June 2024.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

District of Columbia Department of Health, Health Emergency Preparedness and Response Administration. (2011). Special Events Health, Medical and Safety Planning Guide.
This document outlines the recommended procedures for creating a Health, Medical, and Safety Plan for a special event. It is directed to the event applicants/organizers and includes a list of requirements for medical care by type and size of event (page 5), checklists, and templates that can be tailored to a variety of jurisdictions.
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Federal Emergency Management Agency. (2012). Operational Templates and Guidance for EMS Mass Incident Deployment.
The goal of this detailed report is to share model policies and practices across a variety of disciplines and provider types and help the emergency medical services (EMS) field deploy more effectively to planned and spontaneous mass care incidents. Case studies and event templates are included that can help EMS planners develop related policies and templates.
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Ganguli, S., Friedman, M., and Bazos, A. (2014). Raves and Saves: Massive Music Festivals Call for Advanced Emergency Care. Emergency Physicians Monthly.
The authors discuss electronic dance music festivals and explain drug-related complications and physical injuries that are most common during these festivals. The authors share a "game plan" and ten takeaways for healthcare providers responsible for preparing for these types of events which have a high potential to require advanced medical interventions.
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Hartman, N., Williamson, A., Sojka, B., et al. (2009). Predicting Resource Use at Mass Gatherings Using a Simplified Stratification Scoring Model. (Abstract only.) The American Journal of Emergency Medicine. 27(3): 337-43.
The authors tested a classification system that stratifies events based on weather, number in attendance, presence of alcohol, demographic in attendance, and crowd intentions to predict medical needs at mass gatherings. The system predicted needs better for "minor" and "intermediate" events (less so for "major" events).
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Leonard, R., Winslow, J., and Bozeman, W. (2006). Planning Medical Care for High-Risk Mass Gatherings. The Internet Journal of Rescue and Disaster Medicine 6(1).
The authors outline security requirements for mass gatherings with a focus on presidential and dignitary visits (and good discussion of the role of the local and federal agencies) and describe the role of emergency medical services coverage for various threats that could lead to mass casualties (e.g., hot weather and terrorist incidents).
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Lukins, J.L., Feldman, M.J., Summers, J.A., and Verbeek, P.R. (2004). A Paramedic-Staffed Medical Rehydration Unit at a Mass Gathering. (Abstract only.) Prehospital Emergency Care. 8(4): 411-416.
The authors described using a paramedic-staffed medical rehydration unit at an event attended by more than 450,000 people during the summer as an adjunct treatment facility to prevent overload on the field hospital.
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Massachusetts Emergency Management Agency, Massachusetts Department of Public Health, City of Boston, et al. (2014). After Action Report for the Response to the 2013 Boston Marathon Bombings.
This after-action report is a review of response and recovery activities of public safety, public health, and medical personnel related to the April 15, 2013 bombings, the care and support of those impacted by the events in the following days, and the search and apprehension of the bombing suspects. It details how a “planned disaster” turned into a successful emergency response, featuring best practices, lessons learned, and recommendations for the purpose of assisting public safety, public health, and medical personnel involved in the response in further developing actions that went well, and taking corrective measures to address areas needing improvement.
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Milsten, A.M., Seaman, K.g., Liu, P., et al. (2003). Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings. (Abstract only.) Prehospital and Disaster Medicine. 18(4):334-46.
The authors examined medical utilization rates during three types of mass gatherings over a three-year period. They found that event type and temperature best predicted specific injuries and medical utilization rates.
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Minnesota.gov. (2015). Special Event and Mass Gathering Medical Care Planning Guideline.
This event classification matrix was developed to help local emergency healthcare providers develop medical plans for large events based on risk.
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Northwest Center for Public Health Practice. (2010). Mass Gatherings: Are You Prepared?
This free 90-minute course focuses on mass gathering preparation. The course is based on a hypothetical three-day music festival and includes various scenarios and case studies. Users can also access the print version of the course from this site.
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Perron, A.D., Brady, W.J., Custalow, C.B., and Johnson, D.M. (2005). Association of Heat Index and Patient Volume at a Mass Gathering Event. (Abstract only.) Prehospital Emergency Care. 9(1):49-52.
The authors examined the relationship between heat index and the need for medical care during events at a Division I college football stadium located in the southeastern United States. They concluded that for every 10-degree increase in the heat index, three more patients per 10,000 patrons will require care.
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Schwartz, B., Nafziger, S., Milsten, A., et al. (2015). Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement. Prehospital Emergency Care. 19(4).
This comprehensive review can be helpful to medical directors and emergency medical systems operations planners, as it includes definitions, a literature review of contributing factors to medical needs, an overview of the role of the medical director, and strategies for determining on-site medical resources.
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State of New Hampshire. (2014). Mass Gathering Standard Operating Guideline Template.
This standard operating guideline published by the State of New Hampshire can be customized to meet the needs of other states during mass gathering emergency medical services resource planning. The template covers all areas that need to be addressed and includes a scoring matrix helpful to predict risk and coverage needs.
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Education and Training

Federal Emergency Management Agency. (2013). IS-15.B: Special Events Contingency Planning for Public Safety Agencies.
This web-based course teaches first responders about pre-event planning, forming the planning team, event hazard analysis, and responding to incidents during special events in their community.
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Northwest Center for Public Health Practice. (2010). Mass Gatherings: Are You Prepared?
This free 90-minute course focuses on mass gathering preparation. The course is based on a hypothetical three-day music festival and includes various scenarios and case studies. Users can also access the print version of the course from this site.
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Texas A&M Engineering Extension Service. (2016). Sports and Special Events Incident Management.
This 16-hour course is offered around the U.S. to emergency responders and others involved in planning for sport/special event management. Topics include incident management, multi-disciplinary management, and planning and after-action reporting.
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World Health Organization. (2024). Managing Health Risks During Mass Gatherings.
This webpage includes links to several trainings on mitigating health risks during mass gatherings. Topics include health security where humans interact with animals, supporting implementation of International Health Regulations for member states, mitigating health risks at points of travel, and preparing for epidemics and pandemics.
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Guidance

ASPR TRACIE. (2016). Healthcare Coalition Involvement in Mass Gatherings.
This presentation discusses how planning for and responding during mass gatherings can serve as proxy for a real response, and describes how healthcare coalitions can be involved in mass gathering planning and execution. A link to the archived webinar is included.
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ASPR TRACIE. (2024). Solar Eclipses: Planning Resources.
This resource can help emergency healthcare planners and providers prepare for and address response concerns related to the 2024 solar eclipse (and unplanned and planned mass gatherings in rural and urban areas). Resources in sections 1 through 6 are specific to the eclipse event; the rest of the sections include resources related to planned mass gatherings.
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Australian Institute for Disaster Resilience. (2018). Safe and Healthy Crowded Places.
This handbook can be used by major event planners to ensure staff and attendee site safety and public health. Chapter 8 focuses on emergency medical services, and Chapter 9 discusses planning and responding to hostile acts.
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Calabro, J., Rivera-Rivera, E., Reich, J., et al. (1996). Provision of Emergency Medical Care for Crowds. American College of Emergency Physicians, EMS Committee.
The authors share lessons learned from recent experiences and highlight key considerations for providing medical care at mass gatherings in a comprehensive, step-by-step document that is valuable though somewhat dated as far as terrorism-related considerations.
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Clements, B. (2010). Public Health Security for Mass Gatherings. Domestic Preparedness Journal. 6(1): 24-26.
This issue focuses on mass gathering including H1N1 and terrorism and highlights the importance of planning for related public health threats prior to a mass gathering. Several other articles in this issue are also relevant to mass gatherings and include a checklist for events.
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Committee on Homeland Security. (2008). Public Health, Safety, and Security for Mass Gatherings. U.S. House of Representatives.
Federal staff were charged with examining mass gathering events and identifying areas where additional resources would help ensure attendee safety. Their findings are categorized under three areas: countering biological threats, collaborative planning, and partnering across sectors.
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Dries, D.J., Frascone, R.J., Hick, J.L., and Salzman, J. (2012). Medical Preparation for the 2008 Republican National Convention: A Practical Guide. (No preview available.) The Journal of Trauma and Acute Care Surgery. 73(6): 1614-23.
The authors stress the need for planners to anticipate "low-probability, high impact incidents" (e.g., chemical, biological, and nuclear attacks) when planning for National Special Security Events and include specific supply recommendations for on-site care.
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Koski, A., Pappinen, J., Kouvonen, A., et al. (2022). Preparedness for Mass Gatherings: Rescue and Emergency Medical Services' Workloads During Mass Gathering Events. Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine. 30(1):15.
This article analyzed the strain on emergency medical services (EMS) due to mass gatherings by examining EMS data in Finland over a three-year period and nine mass gathering events. The authors found that EMS workload increases during mass gatherings, especially during the night and in proximity to the mass gathering. EMS workload increases during events were due to violence, traffic accidents and other accidents and injuries.
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Leonard, R., Winslow, J., and Bozeman, W. (2006). Planning Medical Care for High-Risk Mass Gatherings. The Internet Journal of Rescue and Disaster Medicine 6(1).
The authors outline security requirements for mass gatherings with a focus on presidential and dignitary visits (and good discussion of the role of the local and federal agencies) and describe the role of emergency medical services coverage for various threats that could lead to mass casualties (e.g., hot weather and terrorist incidents).
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Margolis, A., Leung, A., Friedman, M., et al. (2022). Position Statement: Mass Gathering Medical Care. Prehospital Emergency Care. 25(4).
The authors provide guidance for emergency medical staff, leadership, and emergency physicians when providing care and responding to mass gathering events, in the form of a consensus statement based on the peer-reviewed literature and expert opinion.
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Schwartz, B., Nafziger, S., Milsten, A., et al. (2015). Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement. Prehospital Emergency Care. 19(4).
This comprehensive review can be helpful to medical directors and emergency medical systems operations planners, as it includes definitions, a literature review of contributing factors to medical needs, an overview of the role of the medical director, and strategies for determining on-site medical resources.
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Tavan, A., Dehghani Tafti, A., Nekoie-Moghadam, M, et al. (2019). Risks Threatening the Health of People Participating in Mass Gatherings: A Systematic Review. Journal of Education and Health Promotion. 8:209.
The authors of this systematic review searched multiple databases for information on public health issues arising from mass gatherings, from which they identified forty potential risks from five domains including environmental, psychological, individual, management, and public health risks.
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Tennessee Department of Health. (2022). Mass Gatherings.
This website from the Tennessee Department of Health discusses laws relating to mass gatherings in the state It contains links to state codes that specify the ratio of healthcare providers to people assembled (1 physician : 10,000 attendees), a survey, and state-specific contact information.
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Turris, S., Rabb, H., Munn, M., et al. (2021). Measuring the Masses: Understanding Health Outcomes Arising from Mass Gatherings, Reporting Gaps, and Recommendations (Paper 2). (Abstract only.) Prehospital Disaster Medicine. 36(2): 243-245.
The authors highlight inconsistency in data collection specific to mass gatherings and note gaps and make recommendations in the following areas: language and terminology; data modelling; hazard and risk analysis; capacity analysis; and health outcomes measurement and reporting.
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World Health Organization. (2015). Public Health for Mass Gatherings: Key Considerations.
While geared towards public health professionals, this guidance document is based on lessons learned from mass gatherings around the world and includes chapters on communications, protection of food and water, and event medical services.
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Infectious Disease

* Khan, K., Clark, C., Freifeld, B.S., et al. (2010). Preparing for Infectious Disease Threats at Mass Gatherings: The Case of the Vancouver 2010 Olympic Winter Games. Canadian Medical Association Journal. 182(6).
The authors created a model that integrated data on worldwide patterns of commercial air traffic with data on global surveillance of infectious diseases using Web-based intelligence-gathering tools. This allowed them to combine information on locations from where large numbers of people are expected to travel to attend a mass gathering with reports of infectious disease threats of public health significance.
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* The Lancet: Infectious Diseases. (2012). Mass Gatherings Health.
This webpage provides links to articles on mass gathering health. Articles on the Hajj pilgrimage, disease prevention, non-communicable disease risks, and crowd and environmental management are included.
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Lessons Learned: General

ASPR TRACIE. (2020). Civil Unrest During a Pandemic-Notes from Minneapolis.
On Monday, May 25, 2020, in Minneapolis, George Floyd died after a police officer held his knee on Mr. Floyd's neck for close to nine minutes. Cellphone video footage of the death spread quickly, and protests began in Minneapolis, other cities across the U.S., and abroad. ASPR TRACIE's Senior Editor, Dr. John Hick, also serves as an Emergency Medicine Physician for Hennepin Healthcare, located in downtown Minneapolis. We spoke with him and Seth Jones, Hennepin Healthcare's Emergency Preparedness Program Manager, to better understand how days of civil unrest affected emergency management, the emergency department, emergency medical services, and the community hospitals, and how this factored into the hospital's pandemic response.
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ASPR TRACIE. (2021). Healthcare Preparation for and Response to Local Civil Unrest.
Incidents of civil unrest can affect critical infrastructure components, including healthcare facilities. Civil unrest can affect traffic; patient and staff access to the emergency department and other healthcare services; emergency medical services safety and hospital access; and patient and staff safety around and inside the hospital. ASPR TRACIE met with representatives from several cities who shared lessons learned from recent incidents and, in some cases, how these lessons have been incorporated into their plans.
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Baird, M.B., O'Connor, R.E., Williamson, A.L., et al. (2010). The Impact of Warm Weather on Mass Event Medical Need: A Review of the Literature. (Abstract only.) American Journal of Emergency Medicine. 28(2):224-9.
From an in-depth literature review, the authors found that most studies found a positive relationship between heat/humidity and the frequency of patient presentation. In addition to the literature review, the authors propose an algorithm for predicting patient volume at mass events.
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Centers for Disease Control and Prevention. (2000). Public Health Aspects of the Rainbow Family of Living Light Annual Gathering: Allegheny National Forest, Pennsylvania, 1999. Morbidity and Mortality Weekly Report. 49(15): 324-326.
Nearly 20,000 attended this event, held in a remote location that was not accessible by vehicle and did not have sanitary facilities. The festival provided alternative medical care and local public health employees were permitted to visit the site daily (but were requested to keep their interactions informal). Local emergency department staff asked all patients seeking care during a certain time period if they had attended the festival. Of the 115 recorded attendees seeking healthcare, one death was reported, as were a variety of infections, musculoskeletal injuries, insect/dog/snake bites, and other conditions.
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Centers for Disease Control and Prevention. (2005). Surveillance for Early Detection of Disease Outbreaks at an Outdoor Mass Gathering: Virginia, 2005. Morbidity and Mortality Weekly Report. 55(3): 71-74.
This report details a sentinel disease surveillance system used to monitor injury and illness among more than 40,000 campers attending a 10-day event. The incidence of gastroenteritis was 22.2 per 1,000 (four clusters were discovered); nearly 15,000 heat-related events were recorded; and nearly 4,000 other injuries and illnesses were noted. These findings illustrate the importance and utility of health screening and surveillance at mass gatherings.
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Grant, W.D., Nacca, N.E., Prince, L.A., and Scott, J.M. (2010). Mass-Gathering Medical Care: Retrospective Analysis of Patient Presentations over Five Years at a Multi-Day Mass Gathering. (Abstract only.) Prehospital Disaster Medicine. 25(2):183-7.
The authors reviewed the data from patients seen during the New York State Fair over five years to identify the range and nature of injury and illness. The most common reason for seeking medical assistance was dehydration, primarily by females.
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Locoh-Donou, S., Guofen, Y., Welcher, M., et al. (2013). Mass-Gathering Medicine: A Descriptive Analysis of a Range of Mass-Gathering Event Types. (Abstract only.) American Journal of Emergency Medicine. 31(5): 843-846.
The authors reviewed cases from two years' worth of planned mass gathering events to determine the nature of illness/ injury. They found most cases were mild; the average patient age was 33 years old and female.
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Lukins, J.L., Feldman, M.J., Summers, J.A., and Verbeek, P.R. (2004). A Paramedic-Staffed Medical Rehydration Unit at a Mass Gathering. (Abstract only.) Prehospital Emergency Care. 8(4): 411-416.
The authors described using a paramedic-staffed medical rehydration unit at an event attended by more than 450,000 people during the summer as an adjunct treatment facility to prevent overload on the field hospital.
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Michael, J. and Barbera, J.A. (1997). Mass Gathering Medical Care: A Twenty-Five Year Review. (Abstract only.) Prehospital and Disaster Medicine. 12(4): 72-79.
The authors examined international mass gathering literature to better understand the relationship between size of the gathering and the frequency of patients seeking medical aid. Events that took place on hot weather days had higher numbers of patient visits and statistically more cardiac events occurred at sporting and papal events.
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Milsten, A.M., Maguire, B.J., Bissell, R.A., and Seaman, K.G. (2002). Mass-Gathering Medical Care: A Review of the Literature. (Abstract only.) Prehospital and Disaster Medicine.17(3):151-62.
The authors examine medical utilization rates during large events to determine the role of intervening variables such as temperature, attendance, and alcohol and drug use.
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Milsten, A.M., Seaman, K.g., Liu, P., et al. (2003). Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass Gatherings. (Abstract only.) Prehospital and Disaster Medicine. 18(4):334-46.
The authors examined medical utilization rates during three types of mass gatherings over a three-year period. They found that event type and temperature best predicted specific injuries and medical utilization rates.
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* The Lancet: Infectious Diseases. (2012). Mass Gatherings Health.
This webpage provides links to articles on mass gathering health. Articles on the Hajj pilgrimage, disease prevention, non-communicable disease risks, and crowd and environmental management are included.
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Van Remoortel, H., Scheers, H., Lauwers, K., et al. (2022). Mass Gathering Events: A Retrospective Analysis of the Triage Categories, Type of Injury or Medical Complaint and Usage Rates. (Abstract only.) Emergency Medicine Journal .
The authors reviewed multiple events in Belgium held five or more times and attended by more than 10,000 people between 2009 and 2018 to determine the most prevalent triage categories and injuries. “First aid” was the most common triage category; “skin wounds” were the most common injury. Injuries differed by type of venue (indoor versus outdoor), highlighting planning considerations for future events.
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Zeitz, K.M., Zeitz, C.J., and Arbon, P. (2005). Forecasting Medical Work at Mass-Gathering Events: Predictive Model Versus Retrospective Review. (Abstract only.) Prehospital and Disaster Medicine. 20(3): 164-168.
The authors compared two methods of forecasting and discuss each model’s utility when planning to provide medical care at mass gathering events.
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Lessons Learned: Music/Other Festivals

Bledsoe, B., Songer, P., Buchanan, K., et al. (2012). Burning Man 2011: Mass Gathering Medical Care in an Austere Environment. (Abstract only.) Prehospital Emergency Care. 16(4): 469-76.
The authors provide an overview of the planning and emergency care process associated with Burning Man 2011. The authors listed several challenges to providing emergency medical care, including attendance size, distance to "definitive medical care," and the need for physicians because some of the necessary care exceeded paramedics' scope.
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Craigie, R.J., Farrelly, P.J., Santos, R., et al. (2018). Manchester Arena Bombing: Lessons Learnt from a Mass Casualty Incident. BMJ Military Health. 166(2).
The authors share lessons learned from an arena bombing in Manchester, UK including: the benefit of treating injured parents and children in the same ward; preparing civilian surgeons with surgical trauma skills; canceling elective surgical commitments to make room in the event of a mass casualty incident; and understanding that secondary effects of mass casualty incidents affect medical services regionally.
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Douglas, N., Carew, J., Johnson, D., et al. (2020). Safety and Efficacy of an On-Site Intensive Treatment Protocol for Mild and Moderate Sympathomimetic Toxicity at Australian Music Festivals. (Abstract only.) Prehospital Disaster Medicine. 35(1): 41-45.
Patients with serotonin and sympathomimetic toxicity (SST) after ingestion of amphetamine-based drugs have presented at music festivals across the globe. The authors reviewed on-site SST treatment as an alternative to immediate hospital transport. Of 13 patients, one with mild SST and two with severe SST required transport; the authors encourage considering on-site treatment for those presenting with mild to moderate SST.
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Feldman, M., Lukins, J., Verbeek, R., et al. (2009). Use of Treat-and-Release Medical Directives for Paramedics at a Mass Gathering. (Abstract only.) Prehospital Emergency Care. 9(2).
The authors examined records from a large single-day summer concert; more than 450,000 attended and 1,870 presented for medical attention. Of the patients treated and released by paramedics, none were found to require subsequent ambulance transport, leading the authors to conclude that treat-and-release medical directives helped divert patients from requiring care at actual facilities.
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Ganguli, S., Friedman, M., and Bazos, A. (2014). Raves and Saves: Massive Music Festivals Call for Advanced Emergency Care. Emergency Physicians Monthly.
The authors discuss electronic dance music festivals and explain drug-related complications and physical injuries that are most common during these festivals. The authors share a "game plan" and ten takeaways for healthcare providers responsible for preparing for these types of events which have a high potential to require advanced medical interventions.
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Grange, J.T., Green, S.M., and Downs, W. (1999). Concert Medicine: Spectrum of Medical Problems Encountered at 405 Major Concerts. Academic Emergency Medicine. 6(3): 202-207.
The authors examined patient cases of those reporting to first aid stations at five major concert venues in southern California over a five-year period. They found that music type was only able to account for 4% of injury variability, and trauma-related complaints were most frequent across all types of concerts.
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Hutton, A., Ranse, J., Verdonk, N., et al. (2014). Understanding the Characteristics of Patient Presentations of Young People at Outdoor Music Festivals. (Abstract only.) Prehospital Disaster Medicine. 29(2):160-6.
The authors reviewed patient report forms from 26 outdoor music festivals held in four States of Australia during 2010. They found that more females presented than males, and were more likely to report minor illnesses (e.g., headaches). Males were more likely to present with injuries, namely cuts to their face and hands. Alcohol and substance use made up 15% of all presentations.
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Krul, J., Sanou, B., Swart, E.L., and Girbes, A.R. (2012). Medical Care at Mass Gatherings: Emergency Medical Services at Large-Scale Rave Events. (Abstract only.) Prehospital Disaster Medicine. 27(1):71-74.
The authors reviewed Dutch rave dance parties over a five-year period and determined that "a medical team of six healthcare workers for every 10,000 rave party visitors" would suffice. They made additional planning recommendations regarding staff and treatment protocols.
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McQueen, C. and Davies, C. (2012). Health Care in a Unique Setting: Applying Emergency Medicine at Music Festivals. Open Access Emergency Medicine. 4: 69-73.
The authors conducted a literature review on medical care provided at music festivals in the United Kingdom over 25 years. They examined workload, care provided, equipment and related standards, and planning needs.
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Munn, M., Lund, A., Golby, R., and Turris, S. (2016). Observed Benefits to On-site Medical Services during an Annual 5-day Electronic Dance Music Event with Harm Reduction Services. (Abstract only.) Prehospital Disaster Medicine. 31(2):228-34.
The authors reviewed the 2014 Shambhala Music Festival (a seven-day event held in Canada) which was attended by a total of 67,120 people. The majority of the 1,393 patient encounters were for non-urgent complaints; less than one percent were transferred by ambulance. The festival featured harm reduction services (e.g., distribution of educational materials, pill checking facilities, and a dedicated women's space) that also helped minimize risk to attendees.
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Texas Task Force on Concert Safety. (2022). Report from the Texas Task Force on Concert Safety.
In 2021, ten people died and hundreds were injured during the Astroworld Festival in Texas. This report published shortly afterwards highlights the task force’s findings, which focused on five themes: unified command and control, permitting, training, planning with risk assessment, and centralized resources.
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Thierbach, A.R., Wolcke, B.B., Piepho, T., et al. (2003). Medical Support for Children's Mass Gatherings. (Abstract only.) Prehospital Disaster Medicine. 18(1):14-9.
The authors describe the medical care provided to children at a television-sponsored fair. During this event, approximately 20% of the children (under 10 years of age) seeking medical attention were not accompanied by adults; the authors emphasize that medical providers consider this finding and be qualified to handle all types of medical emergencies.
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Turris, S., Callaghan, C., Rabb, H., et al. (2019). On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years. (Abstract only.) Prehospital Disaster Medicine. 34(1):72-81.
Analyses of 34 music festival event days revealed 10,406 patient encounters, with 156 patients transferred offsite for further evaluation. While the authors found that the presence of higher level of care teams may have reduced the number of patient transfers for intoxication, they identified areas for improvement in on-site care (e.g., on-site radiology) and non-emergency transport vehicles to reduce the impact of music festivals on local healthcare providers.
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Westrol, M., Koneru, S., McIntyre, N., et al. (2017). Music Genre as a Predictor of Resource Utilization at Outdoor Music Concerts. (Abstract only.) Prehospital Disaster Medicine. 32(3): 289-296.
The authors reviewed ten years’ worth of patient logs from an “open-air, contemporary amphitheater” to understand the relationship select variables had on the use of medical resources. Overall results indicated that music genre (alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music), higher temperatures, and whether the event was a “festival” were significantly related to medical complaints. Alcohol/drug intoxicated patients were significantly more likely to be transported to the hospital, and intoxication was found to be significantly more present at hip hop/rap concerts. The authors encourage planners to incorporate these considerations into their work.
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Lessons Learned: Political Events

CNA. (2013). Command, Control, and Coordination: A Quick-Look Analysis of the Charlotte-Mecklenburg Police Departments Operations during the 2012 Democratic National Convention. Bureau of Justice Assistance.
This report summarizes the events that occurred during the 2012 Democratic National Convention in Charlotte, NC. It identifies the strengths and areas for improvement that were demonstrated during the event. Section 2.8 specifically addresses the aspects of Fire/EMS and Public Health agencies with some discussion of the robust amount of on-site and peri-venue support.
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* Hick, J.L., Frascone, R.J., Grimm, K., et al. (2009). Health and Medical Preparedness and Response to the 2008 Republican National Convention. (Abstract only.) Disaster Medicine and Public Health Preparedness. 3(4):224-32.
The authors describe the health and medical planning for and impact of the Republican National Convention on the City of St. Paul and the Minneapolis-St. Paul metropolitan area.
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National Capital Region. (2009). 2009 Presidential Inauguration January 17 21: 2009 Regional After-Action Report Summary.
This after action report summarizes the events that occurred during the January 20, 2009 Presidential inauguration of Barack Obama. It identifies the strengths (including several coalition activities and the use of the Health Emergency Coordination Center) and areas for improvement that were demonstrated during the event.
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Lessons Learned: Races/Other Sporting Events

Almond, C., Shin, A., Fortescue, E., et al. (2005). Hyponatremia among Runners in the Boston Marathon. The New England Journal of Medicine. 352:1550-1556.
The authors studied a cohort of marathon runners to determine the incidence and risk factors of hyponatremia. They found that considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia.
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Basdere, M., Ross, C., Chan, J.L., et al. (2014). Acute Incident Rapid Response at a Mass-Gathering Event through Comprehensive Planning Systems: A Case Report from the 2013 Shamrock Shuffle. (Abstract only.) Prehospital Disaster Medicine. 29(3): 320-5.
The authors describe the "Chicago Model" used to prepare for the 2013 "Shamrock Shuffle" and include lessons learned.
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Billows, G.L. (2010). EMS in the Fast Lane. Mass-Gathering Medicine at the Indianapolis Motor Speedway. (Abstract only.) Journal of Emergency Medical Services. 35(9): suppl 11-3.
The Indianapolis Motor Speedway is home to the Indy 500, which is attended by hundreds of thousands of spectators every year. This article highlights the preparation, staffing, and resources dedicated to this event in 2010, including the unique aspect of having an on-site emergency department.
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Boston Public Health Commission. (2013). 2013 Boston Marathon Emergency Support Function 8 (ESF-8) Public Health and Medical Planning, Response, and Recovery Operations (April 15-April 26): Final After Action Report.
This after action report provides an overview of the Boston Marathon bombing and the collaborative planning between public health and healthcare that occurred before and in the weeks just after the incident. The report focuses on 10 specific public health and healthcare capabilities and lists related observations, strengths, areas for improvement, and recommendations. There is “a particular emphasis on the recovery efforts and public health's role as it relates to mass care and human service efforts.”
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Burdick, T.E. (2005). Wilderness Event Medicine: Planning for Mass Gatherings in Remote Areas. (Abstract only.) Travel Medicine and Infectious Disease. 3(4): 249-258.
The author reviews data on wilderness injury and illness rates and shares a framework for planning and carrying out Wilderness Event Medicine, broken into three stages: event planning, medical treatment at the event, and post-event tasks.
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Centers for Disease Control and Prevention. (1994). Carbon Monoxide Levels During Indoor Sporting Events: Cincinnati, 1992-1993. Morbidity and Mortality Weekly Report. 43(2): 21-23.
This report shares results from a study on carbon monoxide measurements during a tractor pulls, monster truck jumps, and a mud race held in an indoor arena. Poisoning symptoms and treatment strategies are also included.
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Chiampas, G. and Jaworski, C. (2009). Preparing for the Surge: Perspectives on Marathon Medical Preparedness. (Abstract only.) Current Sports Medicine Repots. 8(3):131-5.
The authors explain medical considerations for mass gatherings and other lessons learned from the Chicago Marathon.
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Clancy, T. and Cortacans, H.P. (2014). Super Ready: How a Regional Approach to Super Bowl EMS Paid Off. EMS World.
The authors discuss their experiences preparing for Superbowl XLVIII, held in the MetLife Stadium in East Rutherford, New Jersey. Together with several partners, they developed a comprehensive, 500-page plan, categorized by jurisdictional areas, with appendices for general areas of operation and support functions.
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Grange, J.T., Bodnar, J.A., and Corbett, S.W. (2009). Motocross Medicine. (Abstract only.) Current Sports Medicine Reports. 8(3): 125-130.
The authors provide an overview of the sport and related medical issues. They emphasize that on-scene caregivers should have a solid understanding of spine and head trauma, and which injuries need to be transported versus treated at the scene.
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Hiltunen, T., Kuisma, M., Mtt., T., et al. (2007). Prehospital Emergency Care and Medical Preparedness for the 2005 World Championship Games in Athletics in Helsinki. (Abstract only.) Prehospital and Disaster Medicine. 22(4):304-11.
The authors analyzed the medical preparedness, ambulance patient characteristics, emergency care, and the use of pre-hospital resources during the 2005 World Championship Games in Athletics in Helsinki, Finland.
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Khan, A., Abdulrahman, S., Ranse, J., et al. (2021). Mass Gathering Medicine in Soccer Leagues: A Review and Creation of the SALEM Tool. International Journal of Environmental Research and Public Health. 18(19): 9973.
The SALEM tool was created to provide planning and risk assessment guidance for mass gatherings (primarily soccer games in Saudi Arabia) . Table 1 lists incidents and casualties at soccer games from 1946-2015. Table 2 lists the factors used in the Saudi SALEM model (e.g., nature of event, expected number of attendees, age group, location of healthcare resources, past incidents). Table 3 illustrates how events are then categorized (from low to severe risk). Planners in the U.S. may consider using this tool in preparation for mass gathering events.
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Lund, A., Turris, S., Wang, P., et al. (2014). An Analysis of Patient Presentations at a 2-day Mass-Participation Cycling Event: The Ride to Conquer Cancer Case Series, 2010-2012. (Abstract only.) Prehospital and Disaster Medicine. 29(4): 429-36.
The authors examined three years’ worth of data from this race and concluded that medical plans for similar events (multi-day, cross-national) must take into account “legislative issues, long-distance communication capabilities, and highly mobile participants.”
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Massachusetts Emergency Management Agency, Massachusetts Department of Public Health, City of Boston, et al. (2014). After Action Report for the Response to the 2013 Boston Marathon Bombings.
This after-action report is a review of response and recovery activities of public safety, public health, and medical personnel related to the April 15, 2013 bombings, the care and support of those impacted by the events in the following days, and the search and apprehension of the bombing suspects. It details how a “planned disaster” turned into a successful emergency response, featuring best practices, lessons learned, and recommendations for the purpose of assisting public safety, public health, and medical personnel involved in the response in further developing actions that went well, and taking corrective measures to address areas needing improvement.
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Memish, Z., Steffen, R., White, P., et al. (2019). Mass Gatherings Medicine: Public Health Issues Arising from Mass Gathering Religious and Sporting Events. Lancet. 393(10185):2073-2084.
This article reviews public health threats during mass gathering events, including concerns about infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and other public health concerns such as heat stroke and dehydration.
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Murthy, N., Holland, D., Chamberlain, A., et al. (2021). The 6 E Framework of Public Health Preparedness for Mass Gatherings-Lessons Learned from Super Bowl LIII, Fulton County, Georgia, 2019. Journal of Public Health Management and Practice. 27(5):197-204.
The authors discuss the public health preparedness efforts required to host Superbowl LIII in Atlanta, Georgia in 2019. The “6 E Framework” developed to prepare for the event allowed coordination of federal, state, and local stakeholders and may be applicable for other mass gathering events.
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Nakanishi, Y. (2022). Lessons Learned from Staging the Olympics During a Pandemic. Respirology. 27(5):331-332.
This article explains the precautions that were used during the Tokyo Olympics amid the COVID-19 pandemic, which included restricting the number of people who travelled into Japan for the games, testing, and basic infection control. The precautions were successful in preventing clusters of COVID-19 outbreaks between athletes and game officials.
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Nguyen, R.B., Milsten, A.M., and Cushman, J.T. (2008). Injury Patterns and Levels of Care at a Marathon. (Abstract only.) Prehospital Disaster Medicine. 23(6):519-25.
The authors analyzed medical care reports from five first-aid stations set up along a marathon route. The primary reason for seeking medical attention was "medication request;" secondary reasons included musculoskeletal injuries, dizziness, dermal injuries, and headache.
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Perron, A.D., Brady, W.J., Custalow, C.B., and Johnson, D.M. (2005). Association of Heat Index and Patient Volume at a Mass Gathering Event. (Abstract only.) Prehospital Emergency Care. 9(1):49-52.
The authors examined the relationship between heat index and the need for medical care during events at a Division I college football stadium located in the southeastern United States. They concluded that for every 10-degree increase in the heat index, three more patients per 10,000 patrons will require care.
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Sabra, J.P., Cabaas, J.G., Bedolla, J., et al. (2014). Medical Support at a Large-Scale Motorsports Mass-Gathering Event: The Inaugural Formula One United States Grand Prix in Austin, Texas. (Abstract only.) Prehospital and Disaster Medicine. 29(4): 392-398.
The authors share the details of preparation for an inaugural mass-gathering motorsports event, and review and describe the details of the medical care rendered to 566 patients during the 3-day event.
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Smith, J., Hopkins, S., Turner, C., et al. (2022). Public Health Impact of Mass Sporting and Cultural Events in a Rising COVID-19 Prevalence in England. Epidemiology and Infection. 150(42).
The authors conducted phone interviews and online surveys to understand the impact of mass gatherings such as sports and cultural events on transmission of COVID-19. They identified cases associated with these events, and differing prevalence based on the kind of event. The article recommends face coverings, minimizing crowding when ventilation is poor, and avoiding behaviors like shouting in enclosed venues.
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Tang, N., Kraus, C.K., Brill, J.D., et al. (2008). Hospital-Based Event Medical Support for the Baltimore Marathon, 2002-2005. (Abstract only.) Prehospital Emergency Care. 12(3):320-6.
The authors analyzed four years' worth of data on injuries and illnesses and related evaluation, treatment, and disposition among Baltimore Marathon participants. Care was provided by an on-site event medical team comprised of physicians and staff from an urban, academic emergency department.
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Vassil, J., Winn, L., and Heslop, D. (2020). The Sun Herald Sydney City-2-Surf Fun Run - Historical Injury Patterns and Factors Influencing Injury Type and Frequency. (Abstract only.) Prehospital Disaster Medicine. 35(2): 189-196.
With nearly 80,000 entrants, the Sydney City-2-Surf Fun Run is the world’s largest annual run. The authors examined injury patterns during the event from 2010-2016 and found significant relationships between the number of heat exhaustion patients and temperature at noon. Musculoskeletal injuries were more likely where the course was steepest, and “heartbreak hill” was the scene of a cluster of cardiovascular events. These findings can help others plan for similar events.
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Yasutaka, T., Murakami, M., Iwasaki, Y., et al. (2022). Assessment of COVID-19 Risk and Prevention Effectiveness Among Spectators of Mass Gathering Events. Microbial Risk Analysis. 21.
This article analyzes the COVID-19 risk among spectators at sporting events in Japan. It found that face masks and handwashing can reduce the risk of infection and that the number of new infections depend on the size of the crowd.
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Lessons Learned: Religious Events

Daniel, D., Avraham, E., and Jaffe, E. (2022). The Crowd Crush at Mount Meron: Emergency Medical Services Response to a Silent Mass Casualty Incident. (Abstract only.) Disaster Medicine and Public Health Preparedness .
The authors describe Magen David Adom’s response to a mass casualty incident that took place during a religious festival in Israel. Pre-planning was key to a smooth response, as was the use of volunteers and having ambulances and staff onsite that treated and transported patients.
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Hnatowa, D. and Gordon, D. (1991). Medical Planning for Mass Gatherings: A Retrospective Review of the San Antonio Papal Mass. (Abstract only.) Prehospital and Disaster Medicine. 6(4):443-450.
The heat index reached 102 degrees Fahrenheit during this event, which attracted close to 100,000. The authors summarize medical problems; 72% were heat-related.
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Illiyasa, F.T., Manib, S., Pradeepkumarc, A.P., and Mohana, K. (2013). Human Stampedes during Religious Festivals: A Comparative Review of Mass Gathering Emergencies in India. (Abstract only.) International Journal of Disaster Risk Reduction. 55:10-18.
The authors reviewed stampede data from religious, entertainment, and political gatherings over the last five decades in India to develop a risk reduction framework for mass gatherings. The framework emphasizes inter-agency, multi-disciplinary contemplation related to hazard identification and mitigation measures.
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Shafia, S., Booy, R., Haworth, E., et al. (2008). Hajj: Health Lessons for Mass Gatherings. Journal of Infection and Public Health. 1: 27-32.
Hajj is attended by nearly 2 million people every year; the authors highlight Hajj-related outbreaks and share how the collaboration between health policy makers and community stakeholders leaders in the United Kingdom resulted in quick identification and reduction of the infections.
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Plans, Tools, and Templates

ASPR TRACIE. (2024). Resources for Hospitals During Civil Unrest.
This ASPR TRACIE TA response provides resources related to protecting community hospitals and providing care during civil unrest.
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Bulson, J. (2013). Large Gathering Medical Plan Template.
Emergency medical services planners and other healthcare providers can tailor this template to their facility and event. It includes sample forms and schematics for several injuries and scenarios.
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* Castle, R., Courson, R., et al. (2024). Emergency Action Planning and Implementation in Athletic Settings. Journal of Emergency Medical Services.
This series on emergency preparedness in athletic settings includes articles on the unique challenges and strategies related to response in athletic settings and drafting an emergency action plan.
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District of Columbia Department of Health, Health Emergency Preparedness and Response Administration. (2011). Special Events Health, Medical and Safety Planning Guide.
This document outlines the recommended procedures for creating a Health, Medical, and Safety Plan for a special event. It is directed to the event applicants/organizers and includes a list of requirements for medical care by type and size of event (page 5), checklists, and templates that can be tailored to a variety of jurisdictions.
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Emergency Management Australia. (1999). Safe and Healthy Mass Gatherings. A Health, Medical and Safety Planning Manual for Public Events.
This comprehensive plan (from Australia) includes sections on pre-event planning (including medical care), safety issues (including occupational health and safety and a detailed description of on-site safety risks), and public health. Chapter 6 focuses on medical care and contains information on aid posts, site hospitals, teams, and equipment.
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Federal Emergency Management Agency. (2010). Special Events Contingency Planning.
This job aids manual groups information into five chapters: pre-event planning; event operational considerations; incident command and control; additional planning; and post-event actions.
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Federal Emergency Management Agency. (2012). Operational Templates and Guidance for EMS Mass Incident Deployment.
The goal of this detailed report is to share model policies and practices across a variety of disciplines and provider types and help the emergency medical services (EMS) field deploy more effectively to planned and spontaneous mass care incidents. Case studies and event templates are included that can help EMS planners develop related policies and templates.
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* Khan, K., Clark, C., Freifeld, B.S., et al. (2010). Preparing for Infectious Disease Threats at Mass Gatherings: The Case of the Vancouver 2010 Olympic Winter Games. Canadian Medical Association Journal. 182(6).
The authors created a model that integrated data on worldwide patterns of commercial air traffic with data on global surveillance of infectious diseases using Web-based intelligence-gathering tools. This allowed them to combine information on locations from where large numbers of people are expected to travel to attend a mass gathering with reports of infectious disease threats of public health significance.
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Kingsley, B., Khan, A., El-Ganainy, A., et al. (2021). Guidance for Health Risk Assessment at Recurrent Mass Gatherings: The Jeddah Tool Framework. Prehospital Disaster Medicine. 36(3): 348-353.
The authors describe the Jeddah Tool, a mass gathering (MG) risk assessment tool that can help planners “improve the understanding of health risk assessment at MGs in the overarching contexts of health emergencies and disaster risk reduction, in line with international goals.” It uses both qualitative and quantitative methods to identify and calculate risks and provide recommendations but is also the sole tool to measure “reputational risk” of an adverse incident on the event, hosting nation, or community. The Jeddah tool has been used to assess risks during the Hajji among other events.
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Lund, A., Turris, S., Rabb, H., et al. (2021). Measuring the Masses: Mass-Gathering Medical Case Reporting, Conceptual Modeling - The DREAM Model (Paper 5). (Abstract only.) Prehospital Disaster Medicine. 36(2):227-233.
The authors describe the Data Reporting, Evaluation, & Analysis for Mass-Gathering Medicine (DREAM) model and how it can be used to collect pre- and post-event data to improve planning for mass gatherings.
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Minnesota.gov. (2015). Special Event and Mass Gathering Medical Care Planning Guideline.
This event classification matrix was developed to help local emergency healthcare providers develop medical plans for large events based on risk.
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Northwest Healthcare Response Network. (2021). Civil Unrest Tip Sheet.
This tip sheet can serve as a template for hospital emergency planners to use when preparing for civil unrest events in the community. It includes considerations for pre-planning and for when events occur with proximity to a healthcare facility.
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Oregon Department of Human Services, Public Health Division. (n.d.). Regulations Governing Health and Safety at Outdoor Mass Gatherings. (Accessed 6/26/2024.)
Though written specifically for the State of Oregon, these rules can be used as a model for other jurisdictions when planning for a mass gathering. The document specifies rules for emergency medical facilities, fire protection, security personnel, traffic control, water supply, drainage, sewer facilities, trash storage and disposal, and sanitary food service.
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Orlando Health. (2018). Questions Every Hospital Must Ask About Whether They’re Supporting Their Non-resident/Foreign Citizen Patients.
This white paper is based on the significant experience Orlando Regional Medical Center had after the Pulse Nightclub shooting and can help health care facility emergency planners plan for and better support non-resident/foreign patients in general and after a mass casualty/mass fatality incident.
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State of New Hampshire. (2014). Mass Gathering Standard Operating Guideline Template.
This standard operating guideline published by the State of New Hampshire can be customized to meet the needs of other states during mass gathering emergency medical services resource planning. The template covers all areas that need to be addressed and includes a scoring matrix helpful to predict risk and coverage needs.
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U.S. Department of Homeland Security. (2008). Mass Evacuation Planning Guide for Major Events: NASCAR Pilot.
This mass evacuation template can help NASCAR-sanctioned facilities develop and implement a mass evacuation plan while protecting spectators, competitors, and the general public in the event of an incident.
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World Health Organization. (2023). The Generic All-Hazards Risk Assessment Tool for Mass Gathering Events.
This evidence-based tool can assist WHO member states and mass gathering event organizers as they identify hazards which may result from events with large numbers of people. It can “assess and quantify the overall level of risk” and identify precautions which can make the event safer.
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Preparing for VIPs

Bulson, J., Mattice, C., and Bulson, T. (2012). A Systematic Approach to Very Important Person Preparedness for a Trauma Center. (Abstract only.) Journal of Trauma Nursing. 19(1):11-14.
Pre-event communication with agencies like the U.S. Secret Service can ensure a smoother response and quick access to care for a very important person (e.g., White House staff). This article describes how a Michigan hospital system created a program to bolster that communication.
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* Hick, J.L., Frascone, R.J., Grimm, K., et al. (2009). Health and Medical Preparedness and Response to the 2008 Republican National Convention. (Abstract only.) Disaster Medicine and Public Health Preparedness. 3(4):224-32.
The authors describe the health and medical planning for and impact of the Republican National Convention on the City of St. Paul and the Minneapolis-St. Paul metropolitan area.
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Medical College of Georgia, Augusta. (2000). Policy/Procedure for Celebrities/VIPs Who Present for Evaluation or Treatment in Emergency and Express Care Services.
This document outlines policy and procedures that can be applied when a celebrity or VIP presents for emergency care. Implementing these considerations can help ensure security and personal comfort while these patients are being assessed.
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Scaglione, B. and Luizzo, A. (2019). Aspects of Hospital Security: Protecting the VIP-Part II. Journal of Healthcare Protection Management. 34(2): 46-52.
In this article, the authors define the term "VIP" as it relates to healthcare (e.g., foreign leaders, entertainers, athletes) and describe plan components specific to preparedness, security needs, and contingency planning.
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Smith, M. and Shesser, R. (1988). The Emergency Care of the VIP Patient. (Abstract only.) The New England Journal of Medicine. 319: 1421-1423.
The arrival of a VIP patient can present a host of challenges. In this (somewhat dated) article, the authors list the initial, clinical care, and administrative issues that can be addressed by emergency managers in a plan for such events.
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Resource Requirements

* Castle, R., Courson, R., et al. (2024). Emergency Action Planning and Implementation in Athletic Settings. Journal of Emergency Medical Services.
This series on emergency preparedness in athletic settings includes articles on the unique challenges and strategies related to response in athletic settings and drafting an emergency action plan.
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Grange, J.T., Baumann, G.W., and Vaezazizi, R. (2003). On-Site Physicians Reduce Ambulance Transports at Mass Gatherings. (Abstract only.) Prehospital Emergency Care. 7(3):322-6.
The authors found that the presence of on-site physicians significantly reduced (p < 0.001) the number of ambulance transports during a large motorsports event in California.
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Hartman, N., Williamson, A., Sojka, B., et al. (2009). Predicting Resource Use at Mass Gatherings Using a Simplified Stratification Scoring Model. (Abstract only.) The American Journal of Emergency Medicine. 27(3): 337-43.
The authors tested a classification system that stratifies events based on weather, number in attendance, presence of alcohol, demographic in attendance, and crowd intentions to predict medical needs at mass gatherings. The system predicted needs better for "minor" and "intermediate" events (less so for "major" events).
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Lønnee, M., Geving Andersen, K., Stagelund, S., et al. (2021). Use of Medical Supplies at the Roskilde Festival 2016: A Prospective Observational Study. (Abstract only.) Prehospital Disaster Medicine. 36(3): 306-312.
This study found that the most frequently used medical supplies during Denmark’s 2016 Roskilde Festival were aluminum rescue blankets, non-rebreather masks, and suction catheters for airway management. Blood glucose test strips, electrocardiogram electrodes, and urinary test strips were the most frequently used diagnostic supplies, and non- and sterile gloves were the most frequently used personal protection equipment. The authors encourage the incorporation of these supply considerations into plans for mass gathering events.
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Thackway, S., Churches, T., Fizzell, J., et al. (2009). Should Cities Hosting Mass Gatherings Invest in Public Health Surveillance and Planning? Reflections from a Decade of Mass Gatherings in Sydney, Australia.
The authors examine the public health response to mass gatherings in Sydney, including resource deployment and using planning for mass gatherings as a preparedness exercise for other health emergencies.
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Agencies and Organizations

World Association for Disaster and Emergency Medicine. Mass Gathering.
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World Health Organization. Managing Health Risks During Mass Gatherings.
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This Collection was refreshed in August 2022. It was comprehensively reviewed in May 2016 by the following subject matter experts (listed in alphabetical order):

Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Marc Barbiere, Fairfax County Health Department, Office of Emergency Preparedness; James Bolen, MS, Planning & Operations Manager, Butler County (Ohio) Emergency Management Agency; Julie Bulson, MPA, BSN, RN, Director, Emergency Preparedness Spectrum Health; Scott Cormier, Vice President, Emergency Management, EC, and Safety, Medxcel; Emily Falone, MS, CEM, HHS ASPR, Region 3; Stephen Formanski, PsyD, HHS ASPR, Region 3 REC; Joanna Gaines, PhD, MPH, MA, CHES, LCDR, U.S. Public Health Service, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine; Thomas L. Grace, RN, PhD, Vice President, Emergency Preparedness, Hospital and Healthsystem Association of PA; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Carol Jacobsen, RN, Director, Public Health Programs, Ohio Hospital. Association; Mark P. Jarrett, MD, MBA, MS, SVP & Chief Quality Officer, Associate Chief Medical Officer, Northwell Health and Professor of Medicine, Hofstra Northwell School of Medicine; Ted Kennedy, Certified Healthcare Executive, Operations Division, Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, US Department of Health & Human Services; Deborah Knickerbocker, CEM, Resources and Mobilization Section (RAMS), HHS ASPR OEM; Joseph P. Lamana, Director, Operations Division, Office of Emergency Management, HHS/ASPR; Andrew Milsten, MD, MS, FACEP, Associate Professor, Emergency Medicine, Director, Disaster Medicine and Emergency Management, Fellowship, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center; Office of Health Affairs Staff, U.S. Department of Homeland Security; and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital.
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