Physical Setting

Preparation should begin with repeated reconnaissance of the event setting with respect to the event type and expected population. Will the participants be seated at a sports event in a stadium or a political rally at a convention center or arena, or will they be ambulatory at a golf or racecourse, an aviation exhibit, or a cross-country running, biking, or equestrian event? The mobility of the attendees has important implications for the population density and expected morbidity rate. At events where spectators are predominantly ambulatory, especially on irregular terrain, lower extremity trauma should be anticipated. Reports from both the 1984 Los Angeles and 1996 Atlanta Summer Olympics revealed the highest medical care use in venues where spectators moved about during the events.

Within the venue, the medical director must investigate the total geographic area of medical responsibility as well as the physical barriers to accessing potential patients. These factors can affect the ability to discover, locate, and extricate victims from a crowd as well as the ability to transport them to the most appropriate treatment site. Are there dedicated public safety ingress and egress routes adequate to handle anticipated medical needs? What is the estimated transport time to the nearest hospital for noncritical patients and the nearest appropriate facility for critical patients? These factors hold profound implications for both the number and expertise of medical care providers needed for the event as well as their mode of transportation within the venue.

Will the event be held indoors? Adequate ventilation and access to exits are important issues indoors and are usually specified by jurisdictional fire codes. If the event is outdoors, climatic exposure, access to shelter, and protection from indigenous species must be evaluated. In both settings, access to potable water, adequate numbers and distribution of restrooms, and the geographic range of the public address system must be investigated. The history of severe weather conditions during the time of the event should be researched in anticipation of resultant illness or injury, such as heat syndromes or hypothermia and frostbite.

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