Emergency management and planning for mass gatherings, including concerts, religious events and sports events.

1. Planning and Management
of Mass Gatherings
David Alexander
University College London

2. Mass gatherings:-
• large concentrations of people
[in the open air]
• events with more than 1000 people?
• where there are crowds there is a
risk of incidents caused by crushes,
stampedes, disorder or fighting.

3. Events with young people
(rock concerts, sporting events, etc.):-
• crushes or fires in stadiums
• fighting and violence
• overcrowding
• mass vandalism
• intoxication with drugs and alcohol.

5. Mass healings and religious events
• exhaustion or illness
of elderly people
Car racing, air shows
• risk that vehicles or aircraft
will crash into the crowd
Other
• hostage-taking and terrorism
• spontaneous structural collapse.

6. Civil protection and emergency response
services should be involved in all phases
of the event from planning to clean-up.

7. Is there a potential choice of sites?
• to minimise hazards and risks
• to ensure ease of access
• to facilitate the work of
the emergency services.

8. Relevant issues:-
• logistics
• safety and reliability of equipment
• crowd control
• public health
• medical assistance.

9. Closure and clearance of sites and
access roads to guarantee access to
emergency services (local ordinance)?
• with analysis of possible
crowding effects
Control of movement and accommodation
to avoid crushes and entrapment
• work out in advance the number of
people due to enter a particular area.
Ticketing involves restriction of access
and therefore restriction of egress.

10. Avoid flying over crowds
Ramstein, Germany, airshow, 1988:
70 dead and 400 injured when two
fighter planes practising acrobatics crashed
into each other and fell onto the crowd.

13. For open-air events, prior estimates
of the number of people expected
are usually unreliable.

14. To sit on the ground: 0.25 m² per
person (less for events with seating)
Crowds in movement:-
• 2.5 m² per person for walking
• 1.0 m² per person – restricted movement
• 0.2 m² per person – severely restricted
movement, potentially uncontrollable
and dangerous.

15. Narrow passageways and gates:
maximum capacity 25 people per minute
Steps (single file):
maximum 16 people per minute
Escalators:
maximum 100 people per minute.

16. To control crowd movement use:-
• barriers that can resist minor pressure
without collapsing dangerously or
contributing to crushes (do not
allow people to climb upon them)
• personnel (with training
and visible identification).

17. Exits:-
• clearly illuminated and signed
• can always be opened from inside
• gates, doors and stairs that
are not exits must have signs
to that effect.

18. Health hazards:-
• collapse of overstressed scaffolding
• snakes or rodents at the site?
• public health considerations (hygiene).
• heat syncope, heatstroke,
sunburn, dehydration

19. Hygiene:-
• at least 1 toilet per 100 people?
• three female toilets for each two
male ones, or two to one?
• manage the storage, preparation
and sale of food to the crowd.

20. Medical assistance:-
• usually, during a large open-air
event, not more than 1.5% of the
public will need medical attention
• the most common kind of medical
intervention is "treat and release"
without taking the patient to hospital.

21. Patient Presentation Rate (PPR)
Rate of arrival of patients
per 1000 spectators:-
• minimum 0.14
• maximum 90
• means 0.5-2.6 (~0.99)
Transport-to-Hospital Rate (TTHR)
Rate of transport to hospital
per 1000 spectators:-
• minimum 0.01
• maximum 0.55
• mean 0.027.

22. Factors that affect the
incidence of medical cases:-
• type of event (dominant factors:
mobility of crowd, duration of event)
• weather at the time
• type of person involved
(age, male or female, etc.)
• size of the crowd.

23. Medical care needs to be offered at the
mass gathering but local care needs to
be maintained as usual:
• rapid access to patients
• on-site triage
• stabilisation of the patient's
medical condition on site
• transport to hospital
• ability to respond to cardiac
emergencies with Advanced
Cardiopulmonary Life Support (ACLS).

24. Medical and health-related organisation:-
• set up triage area, assembly
area for emergency vehicles
• a large enough advance
medical post (first-aid post)
• design site to facilitate access
from every side for rescuers
• open-air events may require
off-road vehicles in order to
reach injured or sick people.

25. • be in constant contact
with the local hospital
• ensure access to the
site for ambulances
• logo and identifying signs medical post
• capacity, personnel and farmaceutical
suppies of the advance medical post
• running water for medical personnel.
Medical and health-related organisation:-

26. Assuming
the worst:-
using a plan
of the site,
let's create
disaster
scenarios
resources
need to be
enough to
sustain
emergency opps.

27. Psychosocial questions Biomedical questions Environmental questions
Morale and
behaviour of crowds
Health status of the crowd
and its individual members
Size and density
of the crowd
Motivation and behaviour
of single individuals
Predictable pattern of
injuries and disease
Site: fenced off or not?;
extended or concentrated;
nature of land and soil
Interests and culture of
the crowd members
Predominant age and
sex of crowd members
Type and nature of event
Reasons for being present
at the mass gathering
Active or passive
participation
Standing, sitting or
moving around
Duration of the
mass gathering
Pathologies related
to cold or heat
Temperature
and humidity
Consumption of
alcohol and drugs
Physiology of
alcohol and drugs
Availability of
alcohol and drugs
Risk of injury or illness:
Patient Presentation Rate (PPR)
Transport-to-Hospital Rate (TTHR)
Response:
stockpiling of
medical services

28. Nec audiendi sunt qui solent dicere,
"Vox populi, vox dei"; cum tumultiositas
vulgi semper insaniæ proxima est
"Do not listen to those who say "the
voice of the people is the voice of God",
because the voice of the people is
always the nearest thing to madness.
[Alcuin, Epistolæ]

29. [FINE]