This is a companion blog post that will enrich the presentation by Deanna Dahl-Grove, MD and Joelle Simpson, MD that will be delivered Friday, October 25th at the AAP National Conference and Exhibition Section on Emergency Medicine Program during the Committee for the Future Sessions. It focuses on preparing for disasters in your local area and institution and we hope that it will enrich your understanding of the subject material and help you prepare for an interactive presentation.

Objectives

Understand the application of the four phases of disaster planning in preparing for a mass gathering event
Assess hazards and vulnerabilities in the community in planning a mass gathering event
Review sample frameworks for mass gathering planning
Access resources for disaster planning for children

When thinking about delivering care, conventional medicine relates to the individual patient whereas disaster medicine relates to large populations.

The 4 Phases of Disaster Planning

Mitigation

The steps taken to preventa disaster before it occurs. Examples include vaccines, safety procedures, and security planning.

Planning

Creating and practicing a disaster plan. The key aspects are to:

Identify key roles and stakeholders
Perform a Hazard & Vulnerability Risk assessment
Deliver Education and training
Establish logistics such as evacuation routes, surge staff, space & supplies, etc.

Response

The activation and implementation of a disaster plan. Key parts to ensure success include:

Exercise! Exercise! Exercise!
Test response of all involved
Patient triage
Patient surge management

Recovery

Includes returning to normal, rebuilding efforts, and reunifying.

When thinking about mass gatherings, it’s important to consider planning, frequency and location. Several examples are below, but you can likely think of many more.

When planning a Special Event, several variables can be used to determine a classification system to assess risk. One such system is shared below.

Higher risk: Score >5, or scores of 2 in two different categories
Intermediate Risk: Total score 3 or 4, or a score of 2 in any category
Lower Risk: Total score <3 and no single category with a score of 2

Based on that risk assessment, on-site resources can be allocated appropriately. For example:

Higher Risk

ALS on-site medical aid station,
ALS on-site ambulance and roaming teams.
An on-site physician

Intermediate Risk

BLS on-site medical aid station + on-site ALS ambulance
Staffing levels, number of aid stations
Mobile teams at event

Lower Risk

BLS on-site care
On-site BLS ambulance

There are many variables to consider in planning mass gatherings. These are descriptions of the above variables.

Weather– extremes of temperature and humidity correlate with volume/severity of patient encounters
Intoxication risks – Alcohol availability, potential for recreational drug use
Demographics of attendees – Anticipated age of spectators and participants
Crowd dynamics – varies with type of event, from calm to rowdy/aggressive
Transport time to the hospital –distance, traffic conditions, air ambulance (helicopter) assets

In addition to these variables, other considerations in planning mass gathering events include:

Venue location – indoors vs. outdoors, availability of shelter/shade or other climate control methods
Nature of event – spectator event, athletic competition, concert, parade (or other linear distribution of spectators/participants)
Public utilities – Reasonable availability of free and unlimited drinking water
Ingress/egress– for emergency vehicles and access to the medical tent
Transportation– All-terrain vehicles or other intra-venue patient transport methods
Security– Liability insurance and security considerations

Considering these variables, you can create a Special Events Planning Guide. Below is an example from the DC Department of Health – Health Emergency Preparedness & Response Administration.