Hospital-based healthcare provider (nurse and physician) integration into an EMS-managed mass-gathering event[1]
Summary
Four-year review of a coordinated EMS + hospital-based nurse-physician team at a college football stadium: 1,681 patients across 26 events (1,544,244 attendance; 1.09 patients per thousand). 87.6% were minor complaints; 12.4% received full physician evaluations (most with pulse oximetry and ECG monitoring), led by altered mental status (52.7%) and chest pain (12.7%). 109 patients were transported (6.48% of patients) — but 57.6% of fully evaluated patients were discharged on site by a physician, avoiding transport. Event-day ED census ran significantly higher than non-event days (176.2 vs 161.2, P<.001) with only minor system impact. Concludes physician integration may increase absolute census while DECREASING the percentage transported.
So what
The key quantitative case for physician-level care on site: on-site physicians converted more than half of full evaluations into safe discharges, keeping transports down even as total census rose. This is the evidence behind treat-and-release event medicine — the difference between a first-aid post that forwards everything and a clinical operation that closes cases — and the altered-mental-status-dominant case mix defines what those physicians actually manage at a stadium. Pairs with the ED-impact SLR (PoshtMashhadi) on the hospital side.
Key findings
- 1,681 patients, 26 college football events, 1.09 per 1,000 attendees
- 87.6% minor; full evaluations led by AMS (52.7%) and chest pain (12.7%)
- 57.6% of fully evaluated patients discharged on site by physicians - transports avoided
- Event-day ED census up (176.2 vs 161.2, P<.001) but system impact minor
- Physician integration: higher census captured, lower percent transported
Read the paper
- Publisher (DOI) ↗may be paywalled
- PubMed ↗abstract · free