Mass Gatherings Medicine

1. Mass Gatherings Medicine Dr Wayne Smith Division of Emergency Medicine UCT/US PGWC - EMS

2. Mass Gathering – An Introduction South African Resource Model Case Study Mass Gatherings Medicine

3. Large crowds are commonly associated with leisure events but may occur atreligious festivals, parades, and demonstrations and during publicdisorder. A figure of 1000 has been suggested to constitute amass gathering Mass Gathering - Definition

4. No established norms and standards • No Regulations • Often decided upon by finances • Varies from one event to the next • Sport and Recreation Bill • Mass Gatherings Health Regulations SouthAfrican Context

5. 1995 – Rugby World Cup 2003 – Cricket World Cup

6. 2010

7. Table. Football stadia incidents Casualties Date Type Place dead injured 24-May-64 Crush Peru 318 500 2-Jan-71 Crush UK 66 100 20-Oct-82 Crush Russia 340 unknown 11-May-85 Fire UK 55 200 29-May-85 Crush Belgium 41 437 Mar-88 Crush Nepal 100 300 15-Apr-89 Crush UK 96 200 13-Jan-91 Riot SouthAfrica 40 50 16-Oct-96 Crush Gatemala 84 150 11-Apr-01 Collapse SouthAfrica 43 155 9-May-01 Crush Ghana 123 unknown (from Textbook of MIMMS, UK) FOOTBALLINCIDENTS

9. The average number of patients per game Average Sapporo Miyagi Ibaraki Niigata Saitama Shizuoka Osaka Kobe Oita Yokohama Pts within the stadium Patients per game around 10,000 spectators Pts in the circumference of the stadium 24.8 20.7 14.3 12.9 12.1 11.3 9.8 8.9 6.8 7.0 6.2

10. Nature of the event Nature of the venue Seated or unseated Spectator profile Past history of similar events Expected number of spectators Event duration Seasonal considerations Proximity to hospitals Profile of hospitals Additional hazard Mass Gatherings MedicineRisk Assessment

11. TEMPERATURE

12. AGE GROUP

13. PRESENCE OF ALCOHOL

14. Queuing Procedures and Duration

15. Patient Severity Distribution

16. South African Medical Resource Model

17. Resource Model Validation • > 92% Prediction Rate • where under predicted was for ILS at small events (< 5000)

18. Sunday 9 July 2000 • South Africa vs Zimbabwe – National Sports Stadium Harare • 8 min from full time South Africa scored to take a 2-1 lead • Glass bottle thrown onto the field hitting the goal scorer • Matched halted – Police respond with tear gas • In ensuing stampede 13 persons killed many injured A Hospital Response to a soccer stadium stampede in Zimbabwe FD Madzimbamuto Emerg. Med. J. 2003;20;556-559

22. Educate staff on heat-related illness if appropriate • Ensure that Hospital Disaster Plan is a “living” document • ? Additional staffing for duration of the event • Most importantly establish reliable communications between EMS providers, other hospital etc • Be part of a holistic health response – break down the Silos and don’t shift the site of the disaster • Do what we do daily and do it well – then can easily escalate when required Hospital Preparedness

23. Mass Gatherings shown to have higher rate of illness and injuries than general population • Wherever large number of people gather in one area there is an increased risk of a major incident. • Risk not just a function of number of persons attending • Mass gathering Medicine new and dynamic discipline • South Africa can become a leader CONCLUSION

24. Thank You