STATES & MUNICIPALITIES · RESEARCHED FROM OFFICIAL LEGAL SOURCES · SURVEY COMPLETE — ALL 51 JURISDICTIONS
The 50-State Regulatory Atlas
In 1999, Jaslow surveyed the nation and found six states with mass-gathering statutes. This atlas is the replication, a generation later — every state and the District, statute by statute, rule by rule, quoted verbatim from official sources. The finding: Twenty-two of the 51 jurisdictions surveyed carry an enforceable event-medical requirement in state law — 13 that put clinicians into law by ratio, band, or named physician of record; 7 that mandate medical content without clinician ratios; and 2 that license the medical team itself. The District of Columbia is counted separately: it operates a tiered administrative framework (a BLS station below 2,500 attendees, rising to multiple ALS units and mobile teams above 50,000, with DOH plan review) enforced through permits rather than statute, following repeal of its special-events license statute in October 2025. That row is now verified against three primary sources. The hardest ratio in America is Connecticut's: one physician per 1,000 attendees. US requirements are a patchwork, not a void.
These states put physicians, nurses, or paramedics into law — by ratio, by band, or by named physician of record.
| State | Trigger | Medical requirement (summary) | Key cite |
|---|---|---|---|
| Connecticut | 3,000+ / 18+ hrs (regs); 2,000 avg / 12+ hrs (statute) | 1 CT-licensed physician per 1,000 or fraction thereof + 1 nurse per 1,500 on site; treatment room per physician; dedicated ambulance; hospital MOU with promoter liability; prescription-drug custody by a CT-licensed physician or pharmacist with an administration log; patient records (name, address, tentative diagnosis); telephone service to the medical director in the first aid area | Regs. §19-13-B87; CGS ch. 368s |
| Oregon | >3,000 / >24 hrs, open-air | 1 OR physician per 10,000 day (1/20,000 night); 1 nurse per 7,500; 1 ambulance per 10,000; 1 cot per 1,000; enclosed facility | ORS 433.735–.770; OAR 333-039-0040 |
| Indiana | Mass Gathering Act events (1973; permanent venues exempt) | 1 physician per 10,000 + 1 nurse per 5,000 anticipated, half on site; treatment structure with room per physician; ambulance at all times | IC 16-41-22-10 |
| Tennessee | Mass gatherings per TCA 68-112 (18-hour trigger) | 1 TN physician per 10,000 + 1 nurse per 5,000; treatment facilities; emergency transportation | TCA §68-112-104 |
| Mississippi | 1,000+ / 18+ hrs, musical, private property | Physicians and nurses "on duty at all times"; stocked treatment facility; dedicated ambulance; sheriff's permit + health certification | Miss. Code §45-21; 15 MAC Pt.14 |
| New York | ≥5,000 (state permit) | EMT-staffed facilities + ambulances by attendance band; physician within 15 min ≤30,000; physician on site >30,000; +20% surge clause | 10 NYCRR Part 18, §18.4 |
| North Carolina | >5,000 / >24 hrs | Notarized NC-licensed physician of record who sets staffing; 450 sq ft treatment center; licensed ambulance; hospital notification | G.S. 130A-251 et seq.; 15A NCAC 18A .1415 |
| Maryland | Ticketed outdoor music festivals (county thresholds 500/1,000) | Tiered: 2 first responders <5,000; +2 ALS at 5,000; +1 physician and ALS ambulance on site >10,000; EMS-program-approved plan | Bus. Reg. §§17-1401–07; COMAR 10.16.05.06 |
| Louisiana | 500+ / 4+ hrs, non-stadium | EMS "under the supervision of a licensed physician"; enclosed covered treatment structure; emergency vehicles; health-unit permit 30 days out | LAC 51:XXV.505 |
| Colorado | >500 persons | Physician-supervised EMS; enclosed treatment structure; emergency vehicles and communications (1972 rule, in force) | 6 CCR 1010-10 |
| Pennsylvania | Special events per EMS plan tiers | Special-event EMS medical director; DOH-approved plan 90 days out; ambulances staged at 5,000 / 25,000 / 55,000 | 28 Pa. Code Ch. 1033 |
| Washington | ≥2,000 predicted / ≥5 hrs, outdoor music | Health-officer approval of emergency medical facilities, attendant physicians, and emergency air evacuation; no codified ratios | RCW 70.108.040 |
| Arkansas | >1,000 / 24+ hrs | Aid station (≥100 sq ft) staffed by AR-licensed paramedic (or RN + physician on call); ambulances scaled 1/10k, 2/50k, +1 per 25k; 90-day notice | 20 CAR §137-111 (ADH Outdoor Mass Gatherings) |
| State | Trigger | Medical requirement (summary) | Key cite |
|---|---|---|---|
| Texas | Mass Gatherings Act permit events | "Adequate medical and nursing care"; 1 emergency aid station per 10,000 with 2 first-aid staff; physician arrangements; ambulance; hospital evacuation listing | H&S ch. 751; 25 TAC §§265.1–.3 |
| Utah | 1,000+ / 2+ hrs per day | First aid station(s); the EMS operations plan controls staffing; site maps with landing zones; health officer may require stand-by ambulances | Utah Admin. Code R392-400-11 |
| Iowa | >1,000 / >12 hrs, outdoor | "Adequately staffed first aid station"; ambulance arrangements; 30-day notice to state director; closure is the enforcement lever | 641 IAC ch. 19 |
| Maine | 2,000+ / 12+ hrs, outdoor | Mandatory medical plan in the permit application (named, credentialed personnel); guideline baseline: physician-supervised EMS, first-aid facility, on-site vehicles | 22 M.R.S. ch. 265; 10-144 CMR ch. 214 |
| Vermont | 2,000+ paying, outdoor, for-profit | State-police Commercial Assembly Permit statutorily conditioned on adequate "emergency medical facilities"; 30-day filing; free events fall outside the act | 20 V.S.A. §§4501–4511 (§4507) |
| Nevada | ≥1,000 (county license); 500+/20 hr/3+ days (state rule) | County license conditioned on "adequate medical facilities, including doctors and supplies"; state mass-gathering rule is sanitation-only | NRS 244.3545(6); NAC 444.547–.5498 |
| Missouri | 5,000+ / 12+ hrs, ticketed music | County festival license requires a medical facilities and services plan; content at county discretion | RSMo ch. 316 |
Oklahoma has no gathering statute but a dedicated Event Stand-by EMRA license (OAC 310:641) — on-site event medical teams are themselves state-licensed, with treatment protocols and documented local-EMS coordination. Kentucky classifies event medicine as its own EMS license class (Class VIII, 202 KAR 7:545, per 2024 HB 57). In both, the state regulates the providers, not the events — a direct attachment point for practice standards.
Dedicated but medically silent, vestigial, or enabling-only: Delaware (festival permits at 1,000+ paying, $50k bond, no medical content), New Hampshire (local open-air licenses + 1972 promoter cost-recovery), Minnesota (sanitation authority that expressly bars a state permit), North Dakota (permit scheme repealed 1983), Georgia (statute survives, staffing rules repealed April 2025), Wisconsin and Virginia (county-enabling — real requirements live in county ordinances, e.g., Price County, WI: 1 EMT per 2,000 attendees). New Jersey's 1971 act appears defunct (confirmation pending).
The District of Columbia has no statute but guidance with teeth, now verified against three primary sources: the Mayor's Special Events Task Group framework requires a physician-staffed aid station by event type and crowd size — from ≥15,001 attendees for athletic events and ≥50,001 for concerts, parades and conventions — with ALS aid stations and mobile medical teams at higher bands, a BLS ambulance at the smallest tier and ALS above, and a Health, Medical and Safety Plan approved by DC Health's Special Operations Division (a formal DOH planning meeting is required at 100,000+). It is enforced through interlocking permits rather than a promulgated rule. The matrix distinguishes required from recommended with a glyph that plain-text extraction destroys; the thresholds above are the cells marked required. A separate DC DOH medical-planning guide referenced by the MSETG guide could not be retrieved and is not relied on here.
Clean negatives (20): Alabama, Alaska, Arizona, California, Florida, Hawaii, Idaho, Illinois, Kansas, Massachusetts, Michigan, Montana, Nebraska, New Mexico, Ohio, Rhode Island, South Carolina, South Dakota, West Virginia, Wyoming. In each, event medicine is governed by EMS licensure, local permits, and the organizer's standard of care — and counties are actively filling the vacuum (Boise County, Idaho: permit required at just 150 attendees, adopted August 2025 — the lowest trigger found anywhere in this survey).
SURVEY COMPLETE: all 50 states + DC mapped, waves 1–9, 2026-08-07 to 2026-08-09. Full verification trails, verbatim quotes, and per-state memos in the source compilation. Manuscript in preparation.
Where state law is silent, cities are not. Ten major event markets, from published staffing matrices to striking silences.
| City | Dedicated requirement? | Trigger | Key content |
|---|---|---|---|
| San Francisco | Yes — EMS Agency policy | Peak crowd >1,000 | Five-level unit matrix, from >4 ALS/BLS units down to event EMTs (Policy 7010, eff. 4/1/2025) |
| Chicago | Yes — DCASE/CFD standards | 1,000+ attendance | Tiered coverage; MD-staffed medical tent at 5,001–7,500 |
| Houston | Yes — ordinance | >500 expected (outdoor music) | Must meet ESA Event Safety Guide medical tables (Code ch. 25, §25-164) |
| Boston | Yes — BPHC EMS regulation | Any of 6 criteria incl. >5,000 | Boston EMS sets minimums; published unit types and rates |
| Austin | Yes — ATCEMS program | Permit tiers | ≥1 staffed BLS first-aid station at ~5,000+; matrix discretionary |
| Las Vegas / Clark Co. | Yes — health district | 2,500+ projected | Tiered coverage 2,500 → 50,000+; plan approval (SNHD EMS Regs §1150) |
| Washington, DC | MSETG framework — permit-conditioned | Tiered by event type and crowd size | Physician-staffed aid station required at ≥15,001 (athletic) and ≥50,001 (concerts, parades, conferences); ALS aid station and mobile medical teams at mid and upper tiers; BLS ambulance at the smallest tier, ALS above; Health, Medical & Safety Plan approved by DC Health's Special Operations Division; formal DOH planning meeting required at ≥100,000. Enforced through MSETG permit approval. Cite: 2026 MSETG Special Events Planning Guide p.31; DC Health HSPA Special Events service page. Former licensing statute D.C. Code §47-2826 repealed eff. 10/1/2025; §1-325.81 is a FEMS fee fund, not a medical authority. |
| New York City | State backstop only | >5,000 (NYS Part 18) | City permitting medically silent; state bands govern |
| Miami / Miami-Dade | Partial — discretionary | Fire life-safety review | MDFR Special Events Bureau staffing; no public matrix |
| Los Angeles | none_found | LAFD special-event permit | No published medical matrix — the nation's largest event economy runs case-by-case |
Each jurisdiction was researched from official sources — legislature sites, revisors of statutes, secretary-of-state administrative codes — with triggers and medical requirements quoted verbatim. Where an official host blocked retrieval, mirror text was used and flagged for confirmation. Negative findings were verified against full chapter indexes, not assumed; several folklore leads were affirmatively disproven along the way. Every memo carries its verification trail and remains draft until physician review. Four regulatory models emerged: hard-ratio 1970s relics, modern tiered schemes, license-the-team states, and mandatory-plan / advisory-standard regimes. Methodology: how content earns publication.
Retrieval note — Connecticut §19-13-B87. The section was read verbatim from the Connecticut eRegulations portal (Office of the Secretary of the State, the official publisher of record). One portal defect is worth recording: the portal's "Quick Search — Exact" field returns "Unable to find section 19-13-B87" for that exact string, although the section is served normally through Content Search ("mass gathering") and the Browse tree. A reader who checks this citation through the portal's obvious front door and hits that error should not conclude the section — or our citation of it — does not exist.