Over the past decade, numerous groups of researchers have studied the willingness of health care personnel (HCP) to respond when a disaster threatens the health of a community. Not one of those studies reported that 100% of HCP were willing to work during a public-health event (PHE).

The objective of this study was to explore factors associated with the intent of HCP to respond to a future PHE.

The theory of planned behavior (TPB) framed this cross-sectional study. Data were obtained via a web-based survey from 305 HCP. Linear associations between the TPB-based predictor and outcome variables were examined using Pearson's correlations. Differences between two groups of HCP were calculated using independent t tests. A model-generating approach was used to develop and assess a series of TBP-based observed variable structural equation models for prediction of intent to respond to a future PHE and to explore moderating and mediating effects.

The beginning patterns of relationships identified by the correlation matrix and t tests were evident in the final structural equation model, even though the patterns of prediction differed from those posited by the theory. Outcome beliefs had both a significant, direct effect on intention and an indirect effect on intention that was mediated by perceived behavioral control. Control beliefs appeared to influence intention through perceived behavioral control, as posited by the TPB, and unexpectedly through subjective norm. Subjective norm not only mediated the relationship between control beliefs and intention, but also the relationship between referent beliefs and intention. Additionally, professional affiliation seemed to have a moderating effect on intention.

The intention to respond was influenced primarily by normative and control factors. The intent of nurses to respond to a future PHE was influenced most by the control factors, whereas the intent of other HCP was shaped more by the normative factors. Health care educators can bolster the normative and control factors through education by focusing on team building and knowledge related to accessing supplies and support needed to respond when a disaster occurs.

ConnorSB . Factors Associated with the Intention of Health Care Personnel to Respond to a Disaster. Prehosp Disaster Med. 2014;29(6):1-6.

The catastrophic Great East Japan Earthquake in 2011 created a crisis in a university-affiliated hospital by disrupting the water supply for 10 days. In response, this study was conducted to analyze water use and prioritize water consumption in each department of the hospital by applying a business impact analysis (BIA). Identifying the minimum amount of water necessary for continuing operations during a disaster was an additional goal.

Water is essential for many hospital operations and disaster-ready policies must be in place for the safety and continued care of patients.

A team of doctors, nurses, and office workers in the hospital devised a BIA questionnaire to examine all operations using water. The questionnaire included department name, operation name, suggested substitutes for water, and the estimated daily amount of water consumption. Operations were placed in one of three ranks (S, A, or B) depending on the impact on patients and the need for operational continuity. Recovery time objective (RTO), which is equivalent to the maximum tolerable period of disruption, was determined. Furthermore, the actual use of water and the efficiency of substitute methods, practiced during the water-disrupted periods, were verified in each operation.

There were 24 activities using water in eight departments, and the estimated water consumption in the hospital was 326 (SD = 17) m3 per day: 64 (SD = 3) m3 for S (20%), 167 (SD = 8) m3 for A (51%), and 95 (SD = 5) m3 for B operations (29%). During the disruption, the hospital had about 520 m3 of available water. When the RTO was set to four days, the amount of water available would have been 130 m3 per day. During the crisis, 81% of the substitute methods were used for the S and A operations.

This is the first study to identify and prioritize hospital operations necessary for the efficient continuation of medical treatment during suspension of the water supply by applying a BIA. Understanding the priority of operations and the minimum daily water requirement for each operation is important for a hospital in the event of an unexpected adverse situation, such as a major disaster.

SuginakaH , OkamotoK , HiranoY , FukumotoY , MorikawaM , OodeY , SumiY , InoueY , MatsudaS , TanakaH . Hospital Disaster Response Using Business Impact Analysis. Prehosp Disaster Med. 2014;29(5):1-8.

Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims.

The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims.

A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training.

According to quantitative participant feedback, the disaster exercise enhanced respondents’ perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises.

Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals’ pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster.

BurkeRV, KimTY, BachmanSL, IversonEI, BergBM. Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting. Prehosp Disaster Med. 2014;29(6): 1-7.

The Focused Abdominal Sonography in Trauma (FAST) scan is used to detect free fluid in the peritoneal cavity, or pericardium, to quickly assess for injuries needing immediate surgical intervention. Mass-casualty incidents (MCIs) are settings where paramedics must make triage decisions in minutes. The Simple Triage and Rapid Transport (START) system is used to prioritize transport. The FAST scan can be added to the triage of critical patients, and may aid in triage.

This was a single-blinded, randomized control trial. Ten paramedics with field experience were trained with an ultrasound machine in the performance of the FAST scan. Two weeks were allowed to pass before testing to simulate the time between training of standard procedures and their implementation. On test day, five peritoneal dialysis patients with instilled dialysis fluid and five matched control patients were placed in a room in a random order where the paramedics performed FAST scans on each patient. The paramedics were assessed by declaring positive or negative for each evaluation, as well as being timed for the total exercise.

Of the ninety tests (one paramedic dropped out due to family emergency), the paramedics had a mean accuracy of 60% and median of 62% (range 40%-80%). There was a statistically significant higher false-positive rate of 59% than false-negative rate of 41% (P < .01). Sensitivity was 67% with a specificity of 56%. Average time taken was 1,218 seconds (121.8 seconds per patient) with a range of 735-1,701 seconds and a median of 1,108 seconds.

In this simulation study, paramedics had difficulty performing FAST scans with a high degree of accuracy. However, they were more apt to call a patient positive, limiting the likelihood for false-negative triage.

WestB , CusserJA , EtengoffS , LandsgaardH , LaBondV . The Use of FAST Scan by Paramedics in Mass-casualty Incidents: A Simulation Study. Prehosp Disaster Med. 2014;29(6):1-4.

Prehospital maritime transportation in northern areas sets high demands on hypothermia prevention. To prevent body cooling and hypothermia of seriously-ill or injured casualties during transportation, casualty coverings must provide adequate thermal insulation and protection against cold, wind, moisture, and water splashes.

The aim of this study was to determine the thermal protective properties of different types of casualty coverings and to evaluate which would be adequate for use under difficult maritime conditions (cold, high wind speed, and water splashes). In addition, the study evaluated the need for thermal protection of a casualty and verified the optimum system for maritime casualty transportation.

The study consisted of two parts: (1) the definition and comparison of the thermal protective properties of different casualty coverings in a laboratory; and (2) the evaluation of the chosen optimum protective covering for maritime prehospital transportation. The thermal insulations of ten different casualty coverings were measured according to the European standard for sleeping bags (EN 13537) using a thermal manikin in a climate chamber (-5°C) with wind speeds of 0.3 m/s and 4.0 m/s, and during moisture simulations. The second phase consisted of measurements of skin and core temperatures, air temperature, and relative humidity inside the clothing of four male test subjects during authentic maritime prehospital transportation in a partially-covered motor boat.

Wind (4 m/s) decreased the total thermal insulation of coverings by 11%-45%. The decrement of thermal insulation due to the added moisture inside the coverings was the lowest (approximately 22%-29%) when a waterproof reflective sheet inside blankets or bubble wrap was used, whereas vapor-tight rescue bags and bubble wrap provide the most protection against external water splashes. During authentic maritime transportation lasting 30 minutes, mean skin temperature decreased on average by 0.5°C when a windproof and water-resistant rescue bag was used over layered winter clothing.

The selected optimum rescue bag consisted of insulating and water-resistant layers providing sufficient protection against cold, wind, and water splashes during prehospital transportation lasting 30 minutes in the uncovered portion of a motor boat. The minimum thermal insulation for safe maritime transportation (30 minutes) is 0.46 m2K/W at a temperature of -5°C and a wind speed of 10 m/s.

JussilaK , RissanenS , ParkkolaK , AnttonenH . Evaluating Cold, Wind, and Moisture Protection of Different Coverings for Prehospital Maritime Transportation–A Thermal Manikin and Human Study. Prehosp Disaster Med. 2014;29(6):1-9.

Ambulance staff face complex and sometimes stressful or potentially traumatic situations, not only in disasters but also in their routine daily work. The aim of this study was to survey ambulance managers’ descriptions of crisis support interventions for ambulance staff after potential traumatic events (PTEs).

Semistructured interviews with a qualitative descriptive design were conducted with six ambulance managers in a health care region in central Sweden. The data was analyzed using content analysis.

Five categories were found in the result: (1) description of a PTE; (2) description and performance of crisis support interventions; (3) impact of working in potentially traumatic situations; (4) the ambulance managers’ role in crisis support interventions; and (5) the ambulance managers’ suggestions for improvement. Ambulance managers described crisis support interventions after a PTE as a single, mandatory group meeting with a structure reminiscent of debriefing. The ambulance managers also expressed doubts about the present structures for crisis support and mentioned an alternative approach which is more in line with present evidence-based recommendations.

The results indicated a need for increased understanding of the importance of the managers’ attitudes for ambulance staff; a need for further implementation of evidence-based recommendations for crisis support interventions was also highlighted.

HugeliusK , BergS , WesterbergE , GiffordM , AdolfssonA . Swedish Ambulance Managers’ Descriptions of Crisis Support for Ambulance Staff After Potentially Traumatic Events. Prehosp Disaster Med. 2014;29(6):1-4.

Timely transfer of patients among facilities within a regionalized critical-care system remains a large obstacle to effective patient care. For medical transport systems where dispatchers are responsible for planning these interfacility transfers, accurate estimates of interfacility transfer times play a large role in planning and resource-allocation decisions. However, the impact of adverse weather conditions on transfer times is not well understood.

Precipitation negatively impacts driving conditions and can decrease free-flow speeds and increase travel times. The objective of this research was to quantify and model the effects of different precipitation types on land travel times for interfacility patient transfers. It was hypothesized that the effects of precipitation would accumulate as the distance of the transfer increased, and they would differ based on the type of precipitation.

Urgent and emergent interfacility transfers carried out by the medical transport system in Ontario from 2005 through 2011 were linked to Environment Canada's (Gatineau, Quebec, Canada) climate data. Two linear models were built to estimate travel times based on precipitation type and driving distance: one for transfers between cities (intercity) and another for transfers within a city (intracity).

Precipitation affected both transfer types. For intercity transfers, the magnitude of the delays increased as driving distance increased. For median-distance intercity transfers (48 km), snow produced delays of approximately 9.1% (3.1 minutes), while rain produced delays of 8.4% (2.9 minutes). For intracity transfers, the magnitude of delays attributed to precipitation did not depend on distance driven. Transfers in rain were 8.6% longer (1.7 minutes) compared to no precipitation, whereas only statistically marginal effects were observed for snow.

Precipitation increases the duration of interfacility land ambulance travel times by eight percent to ten percent. For transfers between cities, snow is associated with the longest delays (versus rain), but for transfers within a single city, rain is associated with the longest delays.

GiangWCW , DonmezB , AhghariM , MacDonaldRD . The Impact of Precipitation on Land Interfacility Transport Times. Prehosp Disaster Med. 2014;29(6):1-7.

Disasters create major strain on energy infrastructure in affected communities. Advances in microgrid technology offer the potential to improve “off-grid” mobile disaster medical response capabilities beyond traditional diesel generation. The Carolinas Medical Center's mobile emergency medical unit (MED-1) Green Project (M1G) is a multi-phase project designed to demonstrate the benefits of integrating distributive generation (DG), high-efficiency batteries, and “smart” energy utilization in support of major out-of-hospital medical response operations.

Carolinas MED-1 is a mobile medical facility composed of a fleet of vehicles and trailers that provides comprehensive medical care capacities to support disaster response and special-event operations. The M1G project partnered with local energy companies to deploy energy analytics and an energy microgrid in support of mobile clinical operations for the 2012 Democratic National Convention (DNC) in Charlotte, North Carolina (USA). Energy use data recorded throughout the DNC were analyzed to create energy utilization models that integrate advanced battery technology, solar photovoltaic (PV), and energy conservation measures (ECM) to improve future disaster response operations.

The generators that supply power for MED-1 have a minimum loading ratio (MLR) of 30 kVA. This means that loads below 30 kW lead to diesel fuel consumption at the same rate as a 30 kW load. Data gathered from the two DNC training and support deployments showed the maximum load of MED-1 to be around 20 kW. This discrepancy in MLR versus actual load leads to significant energy waste. The lack of an energy storage system reduces generator efficiency and limits integration of alternative energy generation strategies. A storage system would also allow for alternative generation sources, such as PV, to be incorporated. Modeling with a 450 kWh battery bank and 13.5 kW PV array showed a 2-fold increase in potential deployment times using the same amount of fuel versus the current conventional system.

The M1G Project demonstrated that the incorporation of a microgrid energy management system and a modern battery system maximize the MED-1 generators’ output. Using a 450 kWh battery bank and 13.5 kW PV array, deployment operations time could be more than doubled before refueling. This marks a dramatic increase in patient care capabilities and has significant public health implications. The results highlight the value of smart-microgrid technology in developing energy independent mobile medical capabilities and expanding cost-effective, high-quality medical response.

McCahillPW , NosteEE , RossmanAJ , CallawayDW . Integration of Energy Analytics and Smart Energy Microgrid into Mobile Medicine Operations for the 2012 Democratic National Convention. Prehosp Disaster Med. 2014;29(6):1-8.

Predicting the number of patient encounters and transports during mass gatherings can be challenging. The nature of these events necessitates that proper resources are available to meet the needs that arise. Several prediction models to assist event planners in forecasting medical utilization have been proposed in the literature.

The objective of this study was to determine the accuracy of the Arbon and Hartman models in predicting the number of patient encounters and transportations from the Baltimore Grand Prix (BGP), held in 2011 and 2012. It was hypothesized that the Arbon method, which utilizes regression model-derived equations to estimate, would be more accurate than the Hartman model, which categorizes events into only three discreet severity types.

This retrospective analysis of the BGP utilized data collected from an electronic patient tracker system. The actual number of patients evaluated and transported at the BGP was tabulated and compared to the numbers predicted by the two studied models. Several environmental features including weather, crowd attendance, and presence of alcohol were used in the Arbon and Hartman models.

Approximately 130,000 spectators attended the first event, and approximately 131,000 attended the second. The number of patient encounters per day ranged from 19 to 57 in 2011, and the number of transports from the scene ranged from two to nine. In 2012, the number of patients ranged from 19 to 44 per day, and the number of transports to emergency departments ranged from four to nine. With the exception of one day in 2011, the Arbon model overpredicted the number of encounters. For both events, the Hartman model overpredicted the number of patient encounters. In regard to hospital transports, the Arbon model underpredicted the actual numbers whereas the Hartman model both overpredicted and underpredicted the number of transports from both events, varying by day.

These findings call attention to the need for the development of a versatile and accurate model that can more accurately predict the number of patient encounters and transports associated with mass-gathering events so that medical needs can be anticipated and sufficient resources can be provided.

NableJV , MargolisAM , LawnerBJ , HirshonJM , PerriconeAJ , GalvagnoSM , LeeD , MillinMG , BissellRA , AlcortaRL . Comparison of Prediction Models for Use of Medical Resources at Urban Auto-racing Events. Prehosp Disaster Med. 2014;29(6):1-6.

When disasters that affect a wide area occur, external medical relief teams play a critical role in the affected areas by helping to alleviate the burden caused by surging numbers of individuals requiring health care. Despite this, no system has been established for managing deployed medical relief teams during the subacute phase following a disaster.

After the Great East Japan Earthquake and tsunami, the Ishinomaki Medical Zone was the most severely-affected area. Approximately 6,000 people died or were missing, and the immediate evacuation of approximately 120,000 people to roughly 320 shelters was required. As many as 59 medical teams came to participate in relief activities. Daily coordination of activities and deployment locations became a significant burden to headquarters. The Area-based/Line-linking Support System (Area-Line System) was thus devised to resolve these issues for medical relief and coordinating activities.

A retrospective analysis was performed to examine the effectiveness of the medical relief provided to evacuees using the Area-Line System with regards to the activities of the medical relief teams and the coordinating headquarters. The following were compared before and after establishment of the Area-Line System: (1) time required at the coordinating headquarters to collect and tabulate medical records from shelters visited; (2) time required at headquarters to determine deployment locations and activities of all medical relief teams; and (3) inter-area variation in number of patients per team.

The time required to collect and tabulate medical records was reduced from approximately 300 to 70 minutes/day. The number of teams at headquarters required to sort through data was reduced from 60 to 14. The time required to determine deployment locations and activities of the medical relief teams was reduced from approximately 150 hours/month to approximately 40 hours/month. Immediately prior to establishment of the Area-Line System, the variation of the number of patients per team was highest. Variation among regions did not increase after establishment of the system.

This descriptive analysis indicated that implementation of the Area-Line System, a systematic approach for long-term disaster medical relief across a wide area, can increase the efficiency of relief provision to disaster-stricken areas.

YamanouchiS , IshiiT , MorinoK , FurukawaH , HozawaA , OchiS , KushimotoS . Streamlining of Medical Relief to Areas Affected by the Great East Japan Earthquake with the “Area-based/Line-linking Support System”Prehosp Disaster Med. 2014;29(6):1-9.

Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements.

Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts.

A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report.

The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues (“accreditation”) is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities.

Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts.

KononovasK , BlackG , TaylorJ , RaineR . Improving Olympic Health Services: What are the Common Health Care Planning Issues?Prehosp Disaster Med. 2014;29(6):1-6.

Limited research has focused on the safety and security of First Responders and Receivers, including clinicians, hospital workers, public safety officials, community volunteers, and other lay personnel, during public health emergencies. These providers are, in some cases, at greater peril during large-scale disasters due to their lack of training and inadequate resources to handle major influxes of patients. Exemplified in the 1995 Tokyo sarin gas attacks and the 2008 Wenchuan earthquakes, lack of training results in poor outcomes for both patients and First Receivers.

The improvement of knowledge and comfort level of First Receivers preparing for a medical disaster via an affordable, repeatable emergency preparedness training (EPT) curriculum.

A 5-hour EPT curriculum was developed including nine learning objectives, 18 competencies, and 34 performance objectives. Following brief didactic and small group sessions, interprofessional teams of four to six trainees were observed in a large patient simulator designed to recreate environmentally challenging (ie, flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors. Trained observers assessed successful completion of 16 individual and 18 team performance objectives. Prior to training, team members completed a 24-question knowledge assessment, a demographic survey, and a comfort level self-assessment. Following training, trainees repeated the 24 questions, self-assessment, and course assessment.

One hundred ninety-five participants completed the course between November 2012 and August 2013. One hundred ninety-one (98.5%), 150 (76.9%), and 66 (33.8%) participants completed the pretest, post-test, and course assessment, respectively. The mean (SD) percentage of correct answers between the pretest and post-test increased from 46.3 (13.4) to 75.3 (12.2), P < .0001. Thirty-eight participants (19.5%) reported more than three hours of disaster EPT each year while 157 participants (80.5%) reported three hours or less of yearly EPT. Sixty-six (100%) reported the course relevant to care providers and 61 (92.4%) highly recommended the course. Comfort level increased from 37.0/100 (n = 192) before training to 76.3/100 (n = 145) after training.

The Center for Health Professional Training and Emergency Response's (CHPTER's) 5-hour EPT curriculum for patient care providers recreates simultaneous multi-actor disasters, measures EPT performance, and improves trainee knowledge and comfort level to save patient and provider lives during a disaster, via an affordable, repeatable EPT curriculum. A larger-scale study, or preferably a multi-center trial, is needed to further study the impact of this curriculum and its potential to enhance the safety and security of the “Second Front.”

JonesJ, StaubJ, SeymoreA, ScottLA. Securing the Second Front: Achieving First Receiver Safety and Security through Competency-based Tools. Prehosp Disaster Med. 2014;29(6):1-5.

The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events.

A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings.

Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event.

A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.

Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.

LundA , TurrisSA , BowlesR , SteenkampM , HuttonA , RanseJ , ArbonP . Mass-gathering Health Research Foundational Theory: Part 1 - Population Models for Mass Gatherings. Prehosp Disaster Med. 2014;29(6):1-7.

Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning “MG event model,” complimenting the “MG population model” reported elsewhere.

Existing descriptions of “MGs” were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.

Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.

The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.

TurrisSA , LundA , HuttonA , BowlesR , EllersonE , SteenkampM , RanseJ , ArbonP . Mass-gathering Health Research Foundational Theory: Part 2 - Event Modeling for Mass Gatherings. Prehosp Disaster Med. 2014;29(6):1-9.