Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.

To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.

A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.

One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.

A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.

The main objective was to study different clinical presentations and outcomes of patients after acute industrial chlorine gas exposure in Oman with evaluation of overall incident management to help develop a chemical exposure incident protocol.

This was a retrospective observational study of 15 patients exposed to chlorine gas after an accidental chlorine gas leak in a metal melting factory in Oman.

Six (40%) patients were admitted and nine (60%) patients were discharged from the emergency department (ED) after initial management. The important post-chlorine gas exposure clinical symptoms were eye irritation (66.6%), cough (73.3%), shortness of breath (40.0%), chest discomfort (66.6%), rhinorrhea (66.6%), dizziness (40.0%), vomiting (46.6%), sore throat (13.3%), and stridor (53.3%). Important signs included tachycardia (40.0%), tachypnea (40.0%), wheeze (20.0%), and use of accessory muscles for breathing (20.0%). Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles for breathing have shown significant correlation with outcome (admission) having P value of <.05.

In the presented acute chlorine gas exposure incidence, 15 exposed persons were brought to the ED, out of which six were admitted and nine were discharged after symptomatic treatment. Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles of breathing show significant relation with the outcome of admission.

There are 60 Poison Centers in the United States that manage over 2.5 million poison exposure calls each year. A poison center can be reached 24 hours a day by dialing a national 800 hotline. Poison Centers are staffed by Specialists in Poison Information who are highly trained in clinical toxicology and are very skilled in telephone triage.

ATSDR and the Poison Centers in HHS/FEMA Region 6 developed draft guidance for incorporating Poison Centers into the National Response Plan. That framework was used to incorporate Poison Centers into the gulf oil spill response of 2010. The National Poison hotline was promoted to provide medical support for those with health effects or health questions related to the spill. During the response the surveillance capabilities of the National Poison Data System (NPDS) were highlighted. The Louisiana Poison Center (LPC) and the other gulf states Poison Centers provided information on health effects related to the spill. Information was provided by the LPC to the Louisiana Department of Health and Hospitals, Office of Public Health Section of Epidemiology and Environmental Toxicology, public information officer to assist in briefing the Governor, the Louisiana Governors Office of Homeland Security and Emergency Preparedness to post to the Virtual Louisiana website, as well as ATSDR, CDC, EPA, and other agencies participating in the gulf response unified command. Poison Centers, for the first time, participated in a response on a national level, providing medical support for those with symptoms or medical questions related to the spill. In addition to assisting in the medical care of those exposed to substances related to the oil spill and the response efforts, Poison Centers also responded to questions about air and water quality and seafood safety.

Poison Centers are a valuable resource to assist in emergency response plans.

To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium’s largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model.

Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test.

A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = −5.566, P <.001, r = −.61; Hartman: Z = −4.245, P <.001, r = .47).

When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.

There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.

The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.

A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.

There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 – 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 – 1.802) and 1.376 (0.987 – 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 – 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.

The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.

In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.

To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.

This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).

A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.

Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.