The first step in designing any medical care system is to determine the level of medical care that is needed or desired. Levels of care may be (1) transportation only, (2) basic life support (BLS) only, (3) treatment without transportation, (4) advanced life support (ALS), or (5) aggressive ALS care targeting cardiac arrest victims. The patient population must also be established; it may be participants or performers, spectators, or employees. As mentioned above, the goal of any medical care system should be the same as that of any EMS system: to provide the maximum care possible with the resources available. Spectators should receive the same quality of care that they would have received if they had not attended the event. This goal requires the system to be cooperative, adjustable, organized, intelligent, and prepared.
If possible, the design of a medical care system should be based on factors known to positively affect patients' outcomes. For instance, a response time of 3 to 5 min can positively influence the ability to successfully resuscitate a cardiac arrest victim. Rapid CPR (optimally, performed by a bystander) is the cornerstone of BLS care, and airway management and early defibrillation are the cornerstones of ALS care. These skills must be applied if positive outcomes are to be realized. Therefore, responders who are trained at least at a BLS level should be stationed within 5 min of anyone in the venue.
Medical personnel and supplies should be allocated based on the anticipated number of patients and the seriousness of the anticipated medical problems. As stated, a general estimate of patient volume is from 0.12 to 6.00 patients per 1000 spectators and 0.3 to 4.0 cardiac arrests per 1,000,000 spectators. The medical problems encountered at mass gatherings are often similar (Table6:2). The volume of patients and the nature of their complaints can depend to a large degree on the variables previously discussed. If possible, it is helpful to obtain preevent medical intelligence from the records of previous and/or similar events or from law enforcement agencies with experience with the particular event. This investigation may give insight to the potential for violence, alcohol, and drug use.
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