A proposed model for a residency experience in mass gathering medicine: The United States air show[1]
Summary
A proposed model for a residency training experience in mass gathering medicine, based on field experience and retrospective chart review at the US Air Show from 1981 through 1991, an event averaging 223,000 spectators annually. Care was delivered by physicians, nurses and technicians within an organised system, with emergency medicine residents at all three levels evaluating patients appropriate to their responsibility, providing immediate medical control, and integrated into the event disaster plan. Over the study period 2,091 patients were seen. The commonest presenting problems were heat illness (28%), blisters and scrapes (25%), headaches (23%), fractures and lacerations (9%) and eye injuries (5%). One hundred forty-eight patients (7%) required transport to hospital. Approximately 16 residents participated each year, each treating an average of 13.7 patients during a four-hour shift. The proposed training model specifies adequate crowd size to generate useful patient volume, a regularly scheduled event, organised medical and disaster preparations meeting local or published standards, didactic instruction, on-site attending supervision, responsibility matched to training level, participation in planning, and post-event debriefing.
So what
The presentation profile - heat illness, minor skin injury and headache accounting for three quarters of the caseload - is the archetype of the outdoor daytime spectator event, and it argues for shade, water and a large low-acuity throughput capacity rather than for acute-care depth. The 7% transport rate is a useful planning anchor. The paper also remains the clearest published template for building a formal event medicine rotation.
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