11 Feb On-Site Physicians Reduce Ambulance Transports at Mass Gatherings

Objectives.
To prospectively determine if on-site physicians at a mass gathering reduced the number of ambulance transports to local medical facilities. The authors also wished to determine the level of care provider (emergency medical technician, EMT-P, registered nurse, or medical doctor) required to treat and disposition each patient. Methods. This study determined whether each patient presenting to on-site first aid stations at California Speedway during a large motorsports event would require ambulance transport to the hospital per the local emergency medical services (EMS) protocols. Whether the on-site physician prevented certain ambulance transports also was determined. Additionally, the minimum level of provider that could treat and disposition each patient was determined. Results. On-site physicians significantly reduced (p < 0.001) the number of ambulance transports at this mass gathering. Ambulance transports to local hospitals were reduced by 89% (from 116 to 13). Fiftytwo percent of the patients were able to be treated and dispositioned (cardiac arrests, minor first aid, etc.) by a paramedic. Registered nurses were able to treat and disposition another 39% of the patients with pre-established protocols written by the track medical director. These patients had abrasions requiring tetanus shots, mild to moderate heat exhaustion that resolved with intravenous hydration, and other minor complaints. Finally, about 9% of the patients required physician-level care (suturing, prescriptions, etc.) to treat and disposition them. Conclusion. On-site physicianlevel medical care at large mass gatherings significantly reduces the number of patients requiring transport to hospitals, thus reducing the impact on the local EMS system and surrounding medical facilities. Key words: mass gatherings; emergency medical services; auto racing; motorsports.

Emergency.
physicians increasingly are called on to organize medical support for mass gatherings such as professional and amateur sports venues, large commercial concerts, conventions, and motorsports events. Over the past 20 years numerous investigators have described various levels of physician staffing for such events.1–12 The role of physicians for routine onsite care at mass gatherings, however, continues to be

Controversial.
Several investigators have provided arguments supporting physician involvement in such settings. Boyle et al.2 have noted that on-site physician participation is crucial in certain events such as air shows, boat races, and auto races where higher risk for major traumatic injuries exists. They also argue that on-site physicians enhanced overall care, reduced liability, and allowed safe disposition of certain patients back to the event without transport to a local medical facility. Chapman et al.3 reported a significant number of patients presenting during a concert required hospital treatment who might have benefited from the services of on-site physicians.

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