Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Mass gatherings can be religious, political, socio-cultural, or sporting events, and vary in the form of processions, car races, conferences, fairs, etc. New Delhi hosted the 2010 Commonwealth Games, a mass gathering spread over a duration of 10 days with different venues and a high density of participants, spectators, security personnel, volunteers, and high-profile guests. Various organizations were involved in the planning and implementation of the games which called for a collaborative and coordinated effort to make the event a success. Security coverage was required for 23 sporting, 32 training, and seven non-sporting venues. Security arrangements were of utmost importance and required training, mobilization, and deployment of army, police, and other emergency workers, as well as establishing Standard Operating Procedures for responses to chemical, biological, radioactive, and nuclear events and availing specialized equipment. Areas of public health interventions in mass gathering include mass-casualty preparedness, disease surveillance and outbreak response, safety of water, food, and venues, health promotion, public health preparedness and response, pest and vector control, coordination and communication, healthcare facility capacity, and medical supplies. Methods adopted for the study included interviews with the stakeholders of the Commonwealth Games and use of secondary data to cite examples and support arguments. Existing knowledge must be documented and made available for use in planning for future mass gatherings. The size, duration, and interest of such events demands special attention toward preparedness and mitigation strategies to prevent or minimize the risk of ill health and maximizing the safety of people involved.

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Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15005245 ◽

2015 ◽

Vol 30 (6) ◽

pp. 621-624 ◽

Cited By ~ 4

Author(s):

Suresh Dwivedi ◽

Mudera P. Cariappa

Keyword(s):

Public Health ◽

Low Cost ◽

Health Planning ◽

Sporting Events ◽

Mass Gathering ◽

Publication Type ◽

Health Security ◽

The Public ◽

Health Challenge ◽

Public Health Challenge

AbstractMass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of insanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.DwivediS, CariappaMP. Mass-gathering events: the public health challenge of the Kumbh Mela 2013. Prehosp Disaster Med. 2015;30(6):621–624.

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(P2-39) Public Health Safety for Traditional Mass Gatherings in India: A 10-Year Analysis

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11004833 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s148-s148 ◽

Cited By ~ 1

Author(s):

S. Sanyal ◽

A. Madan

Keyword(s):

Violent Behavior ◽

Healthcare Services ◽

Mass Casualty ◽

Sporting Events ◽

Mass Gathering ◽

Health Safety ◽

Crowd Management ◽

Mass Gatherings ◽

Indian Context ◽

The Times

IntroductionIn the past decade, India has witnessed many lapses in crowd safety during mass gatherings. The high casualty rate in stampedes during traditional mass gatherings has prompted the study of these events. Wide variations exist in casualty rates for similar events, and key issues in healthcare services in these special situations were addressed in the Indian context.MethodsFrom 2001–2010, Mass gathering data were collected from news items reported in the archives of newspapers, “The Times of India”, “The Hindu” and “The Indian Express”. The keywords used were: “stampede”, “mass gathering”, “mass-gathering events”, “mass-gathering incidents”, “crowd”, and “crowd management”. The study included triggers for the incident and the number of casualties (dead and injured) in each incident.ResultsIn 27 separate mass gatherings in India, there were 936 dead and 540 injured casualties. The unique characteristics of mass gatherings in India included a predominance of old and vulnerable people in traditional mass gatherings, in contrast to the young and middle-aged groups who gather for music and sporting events elsewhere. Further, alcohol/substance abuse, brawls, and violent behavior were absent at traditional Indian mass gatherings. Non-traditional mass gatherings accounted for a lesser number of incidents in India, and were located in movie theatres and railway stations.ConclusionsIn a populous country like India, traditional mass gatherings predominate, and ensuring the health, safety, and security of the public at such events will require an understanding of crowd behavior, critical crowd densities, and crowd capacities in the Indian context. However, planning for mass gatherings can be developed using the existing body of knowledge of mass-casualty preparedness, food safety, and health promotion.

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What did Syndromic Surveillance Show During London 2012? Lessons for Mass Gatherings

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v7i1.5835 ◽

2015 ◽

Vol 7 (1) ◽

Author(s):

Dan Todkill ◽

Helen Hughes ◽

Alex Elliot ◽

Roger Morbey ◽

Obaghe Edeghere ◽

...

Keyword(s):

Public Health ◽

General Practitioner ◽

Syndromic Surveillance ◽

Lessons Learned ◽

Surveillance Systems ◽

Mass Gathering ◽

Daily Number ◽

Mass Gatherings ◽

London 2012 ◽

The Impact

This paper investigates the impact of the London 2012 Olympic and Paralympic Games on syndromic surveillance systems coordinated by Public Health England. The Games had very little obvious impact on the daily number of ED attendances and general practitioner consultations both nationally, and within London. These results provide valuable lessons learned for future mass gathering events.

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Proposing a Minimum Data Set for Mass Gathering Health

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19000980 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s40-s41

Author(s):

Malinda Steenkamp ◽

Paul Arbon ◽

Adam Lund ◽

Sheila Turris ◽

Jamie Ranse ◽

...

Keyword(s):

Public Health ◽

Minimum Data Set ◽

Data Repository ◽

Mass Gathering ◽

Data Set ◽

Mass Gatherings ◽

Modified Delphi ◽

Minimum Data ◽

Safety Considerations ◽

Data Elements

Introduction:There is currently no standardized approach to collecting mass gathering health data, which makes comparisons across or between events challenging. From 2013 onward, an international team of researchers from Australia and Canada collaborated to develop a Minimum Data Set (MDS) for Mass Gathering Health (MGH).Aim:The process of developing the MDS has been reported on previously at the 2015 and 2017 World Congresses on Disaster and Emergency Medicine, and this presentation will present a final MDS on MGH.Methods:This study drew from literature, including the 2015 Public Health for Mass Gatherings key considerations, previous event/patient registry development, expert input, and the results of the team’s work. The authors developed an MDS framework with the aim to create an online MGH data repository. The framework was populated with an initial list of data elements using a modified Delphi technique.Results:The MDS includes the 41 data elements in the following domains: community characteristics, event characteristics, venue characteristics, crowd characteristics, event safety considerations, public health considerations, and health services. Also included are definitions and preliminary metadata.Discussion:The development of an MGH-MDS can grow the science underpinning this emerging field. Future input from the international community is essential to ensure that the proposed MDS is fit-for-purpose, i.e., systematic, comprehensive, and rigorous, while remaining fluid and relevant for various users and contexts.

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Public Health Threats in Mass Gatherings: A Systematic Review

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.161 ◽

2019 ◽

Vol 13 (5-6) ◽

pp. 1035-1046

Author(s):

Manoochehr Karami ◽

Amin Doosti-Irani ◽

Ali Ardalan ◽

Fathemeh Gohari-Ensaf ◽

Zainab Berangi ◽

...

Keyword(s):

Public Health ◽

Infectious Diseases ◽

Environmental Health ◽

Health Care Services ◽

Traffic Accidents ◽

Road Traffic ◽

Health Problems ◽

Sporting Events ◽

Mass Gatherings ◽

Health Threats

ABSTRACTMass gatherings (MGs) are held throughout the world. The aim of this review was to assess and identify the health threats based on the type of the MG, type of diseases, and injuries. Research platforms such as Web of Science, Medline, and Scopus were searched through June 2017. All epidemiologic studies that investigated the health threats during the MGs, such as communicable diseases, injuries, high-risk behaviors, and environmental health problems, were included in this review. Out of 1264 references, 45 articles were included in the review.Three main types of MGs include religious, festival, and sporting event; and fairs such as trade, book, and agricultural types were also reported in the selected studies. In the religious MGs, infectious diseases were the most common health threat. Road traffic accidents and environmental health problems were additional health threats. At MG sporting events, injuries were the most common health problems. Infectious diseases and alcohol and drug-related disorders were other reported public health concerns. In the festival MGs, alcohol and drug-related problems were commonly reported. This review showed that health threats vary, based on the type of mass gathering. The health organizers of MGs should consider the type of the MG and the health needs and safety of the participants to help them plan their action and provide the needed health care services.

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Assessment of Temporary Medical Clinics During the Arbaeenia Mass Gathering at Al-Karkh, Baghdad, Iraq, in 2014: Cross-Sectional Study

JMIR Public Health and Surveillance ◽

10.2196/10903 ◽

2019 ◽

Vol 5 (3) ◽

pp. e10903 ◽

Cited By ~ 1

Author(s):

Faris Lami ◽

Ali Abdalkader Ali ◽

Kareem Fathullah ◽

Hana Abdullatif

Keyword(s):

Public Health ◽

Health Care ◽

Health Workforce ◽

Mass Gathering ◽

Mass Gatherings ◽

Medical Supplies ◽

Set Up ◽

Almost All ◽

Basic Medical ◽

Equipment And Instruments

Background During mass gatherings, public health services and other medical services should be planned to protect attendees and people living around the venue to minimize the risk of disease transmission. These services are essential components of adequate planning for mass gatherings. The Arbaeenia mass gathering signifies the remembrance of the death of Imam Hussain, celebrated by Shiite Muslims, and takes place in Karbala, which is a city in southern Iraq. This annual mass gathering is attended by millions of people from within and outside Iraq. Objective This study aimed to map the availability of medical supplies, equipment, and instruments and the health workforce at the temporary clinics located in Al-Karkh, Baghdad, Iraq, in 2014. Methods This assessment was conducted on the temporary clinics that served the masses walking from Baghdad to Karbala. These clinics were set up by governmental and nongovernmental organizations (NGOs) and some faith-based civil society organizations, locally known as mawakib. We developed a checklist to collect information on clinic location, affiliation, availability of safe water and electricity, health personnel, availability of basic medical equipment and instruments, drugs and other supplies, and average daily number of patients seen by the clinic. Results A total of 30 temporary clinics were assessed: 18 clinics were set up by the Ministry of Health of Iraq and 12 by other governmental organizations and NGOs. The clinics were staffed by a total of 44 health care workers. The health workers served 16,205 persons per day, an average of 540 persons per clinic, and 368 persons per health care worker per day. The majority of clinics (63% [19/30]-100% [30/30]) had basic medical diagnostic equipment. Almost all clinics had symptom relief medications (87% [26/30]-100% [30/30]). Drugs for diabetes and hypertension were available in almost half of the clinics. The majority of clinics had personal hygiene supplies and environmental sanitation detergents (78%-90%), and approximately half of the clinics had medical waste disposal supplies. Instruments for cleansing and dressing wounds and injuries were available in almost all clinics (97%), but only 4 clinics had surgical sterilization instruments. Conclusions Although temporary clinics were relatively equipped with basic medical supplies, equipment, and instruments for personal medical services, the health workforce was insufficient, given the number of individuals seeking care, and only limited public health service, personal infection control, and supplies were available at the clinics.

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Using State and National Surveillance Systems during World Equestrian Games in NC

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9691 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Lana Deyneka ◽

Zachary Faigen ◽

Anne Hakenwerth ◽

Nicole Lee ◽

Amy Ising ◽

...

Keyword(s):

Public Health ◽

Syndromic Surveillance ◽

Urgent Care ◽

Poison Center ◽

Surveillance Systems ◽

Mass Gathering ◽

Mass Gatherings ◽

Epidemic Intelligence ◽

Polk County ◽

Ed Visits

ObjectiveTo describe surveillance activities and use of existing state (NC DETECT) and national (NSSP) syndromic surveillance systems during the International Federation for Equestrian Sports (FEI) World Equestrian Games (WEG), in Mill Spring, NC from September 11 to September 23, 2018MethodsNC DETECT collects statewide data from hospital emergency department (ED) visits and Carolinas Poison Center (CPC) calls. NC DETECT also collects data from select Urgent Care Centers (UCC) in the Charlotte area. CPC data are updated hourly, while ED data are updated twice a day. NC DETECT data were monitored daily for census (total ED visits), communicable disease syndromes, injury syndromes, and other occurrences of public health significance related to the event. The geographic areas monitored were Polk County (the location of the main event), the counties where the guests were lodging in the Western NC Region (Henderson, Transylvania, Buncombe, Rutherford, McDowell, and Cleveland), the Charlotte Metropolitan area, and statewide. Because of the large number of people from other states and countries who attended, ED surveillance was mainly conducted by hospitals so that visits were captured for all patients and not just NC residents. WEG dashboards containing ED data were created prior to the event using NC DETECT and NSSP ESSENCE systems, and were accessible to epidemiologists at the state level. NSSP syndrome queries were shared with the neighboring state (SC) public health agency. Surveillance began two weeks prior to the event to establish baseline levels for all ED visits for hospitals in Polk County and the Western NC Region. Surveillance occurred daily before the event, during the event, and for two weeks following the event to account for incubation periods of potential diseases.ResultsThe 2018 Equestrian games in Western NC were affected by heavy rain and heat. The weather led to low attendance and cancellation of a few competitions. During the observation period, ED admissions and most of the mass gathering related syndromes in both NC DETECT and NSSP systems were at baseline. ED admissions for motor vehicle collisions and dehydration syndromes were above baseline for 09/19 and 09/21/18 (Figures 3-4). CPC calls and UC admissions for selected UC centers in the Charlotte area were also monitored, and were at baseline.ConclusionsNC DETECT and NSSP Dashboards provided effective and timely surveillance for the WEG event to assist local public health in the rural NC area with epidemiologic investigations and appropriate response. NC DETECT’s CPC and UC data provided additional valuable information, and complemented ED surveillance during the mass gathering event. Syndromic surveillance became essential during WEG, as NC DPH deployment plans and resource availability changed when Hurricane Florence bore down on the region.References1. Joseph S. Lombardo, Carol A. Sniegoski, Wayne A. Loschen, Matthew Westercamp, Michael Wade, Shandy Dearth, and Guoyan Zhang Public Health Surveillance for Mass Gatherings Johns Hopkins APL Technical Digest , Volume 27, Number 4 (2008)2. Kaiser R, Coulombier D. Epidemic intelligence during mass gatherings. Euro Surveill. 2006;113. Ising A, Li M, Deyneka L, Vaughan-Batten H, Waller A. Improving syndromic surveillance for nonpower users: NC DETECT dashboards. Emerging Health Threats Journal 2011, 4: 11702 - DOI: 10.3402/ehtj.v4i0.11702

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Risk Assessment tool for Religious Mass Gathering Events of India

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9929 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Upasana Sharma ◽

Sankara Sarma

Keyword(s):

Public Health ◽

Risk Assessment ◽

Content Validity ◽

Tamil Nadu ◽

Assessment Tool ◽

Risk Assessment Tool ◽

Mass Gathering ◽

Planning Stage ◽

Mass Gatherings ◽

Special Events

ObjectiveTo develop a risk assessment tool to assess the public health and environmental risks associated with religious mass gathering events of Tamil Nadu, a state in the southern part of IndiaIntroductionIn spite of the fact that mass gatherings are an undeniably regular element of our society attended by huge crowds yet such occasions are not very well understood. Even though such gatherings are accumulations of "well people", vast number of people associated with mass gatherings can put a serious strain on the entire health care system1.The public health implications of mass gathering events include a potential increased risk for disease transmission because of the variability and mobility of those attending the event and increased media attention. Risk assessment for mass gathering events is crucial to identify the potential health hazards which aids in planning and response activities specific to the event2. Preparing for mass gatherings offer an opportunity to improve health service delivery, enhance health promotion and strengthen public health systems3.In India, many of the religious festivals are observed with mass gatherings and prayers. Large crowd participate in such festivals as participants to observe the unique rituals and also as spectators. Literature indicates that in India, we might be well equipped for response activities but the scientific concept of risk assessment i.e., to understand the existing risks, identify the risks, characterize the risks and plan for risk reduction strategies accordingly are at an infant stage .The little that has been done in the field of mass gatherings has generally focused on description of preparedness activities of single event, crowd control, prevention of stampedes with little attention to public health preparedness. The present project is an attempt to systemize the process of risk assessment by developing a risk assessment tool consisting of characteristics peculiar to planned religious mass gatherings of Indian context.MethodsQualitative approach was followed to identify the risks associated with mass gathering events and to identify the domains and items to be included in the risk assessment tool. Firstly, an extensive review of literature about the risks associated with the mass gathering events was done. Secondly, Key Informants (n=20) involved in planning and management of religious mass gathering events in the State of Tamil Nadu, India were purposively identified and interviewed using a semi structured interview guide. Principle of redundancy was followed. Content/Thematic analysis was done using Atlas.ti software. Currently, the project is in the phase of obtaining content validity of the developed tool. Followed by this, a mobile application based upon the validated tool will be developed which will be further field tested for feasibility in a selected mass gathering event in Tamil Nadu. Using a self administered content validity questionnaire, the experts will be asked to assess the relevance of the items of the tool. Agreement proportions between the experts will be calculated. S-CVI (Scale Content Validity Index), index for inter-rater agreement (agreement proportion) and Kappa agreement coefficient will be calculated.ResultsA sum total of 48 unique health risks have been identified. Stampedes, fire accidents, structural collapse, drowning, outbreak of communicable diseases, exacerbation of existing medical illnesses (like cardiac diseases, asthma etc) etc are the some of the health risks identified. Six domains (characteristics related to event, participant, environment, disaster preparedness, medical service preparedness and pre event planning activities) and 21 items have been generated from the content analysis of key informant interviews and literature review.ConclusionsSome special events and unforeseen events occur in places of mass gatherings besides fixed places of worshipping .Such events cause more damage to human beings and property. Special events like idol procession, chariot pulling, fire walking, animal sacrificing happen pulling larger crowds within the mass gatherings. In order to inform all planning and delivery activities it is essential to understand the mass gathering context and risk assessments. This tool can be used by public health managers to identify key public health and environmental risks at the planning stage before the event takes off. At the planning stage, use of this tool will help in putting the required measures in place in order to address the potential risks identified. The tool can be used as a guiding instrument during and after the event as well. The investigators further plan to develop a mobile based app from this risk assessment tool and test it out in a selected mass gathering event of the state of Tamil Nadu located in southern part of India. Feedback from public health managers about the mobile based risk assessment tool can be instrumental in further modifying the tool. By contributing to public health preparedness activities during mass gathering events in a country with poor resources like India, this research activity is an initiative that is expected to lead to health systems strengthening.References1. Arbon P. The development of conceptual models for mass-gathering health. Prehospital and Disaster Medicine. 2004 Sep;19(3):208-12.2. World Health Organization. Public health for mass gatherings: Key considerations. Geneva: WHO; 2015.3. Tam JS, Barbeschi M, Shapovalova N, Briand S, Memish ZA, Kieny MP. Research agenda for mass gatherings: a call to action. The Lancet infectious diseases. 2012 Mar 31; 12(3):231-9.

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A Systematic Review of Noncommunicable Health Issues in Mass Gatherings

Prehospital and Disaster Medicine ◽

10.1017/s1049023x14000144 ◽

2014 ◽

Vol 29 (2) ◽

pp. 167-175 ◽

Cited By ~ 15

Author(s):

Ahmed H. Alquthami ◽

Jesse M. Pines

Keyword(s):

Systematic Review ◽

Presentation Rate ◽

Healthcare Research ◽

Mass Gathering ◽

Health Issues ◽

Publication Type ◽

Mass Gatherings ◽

Mass Gathering Medicine ◽

Ambulance Transports ◽

Patient Presentation

AbstractIntroductionThe review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.MethodsA systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.ResultsAcross all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.ConclusionsThe rate of noncommunicable health issues varies across events and very serious emergencies are rare.AlquthamiAH, PinesJM. A systematic review of noncommunicable health issues in mass gatherings. Prehosp Disaster Med. 2014;29(2):1-9.

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