Our approach

Published patient presentation rates at mass gatherings range from about 0.7 to 72 per 1,000 attendees.⁴ With that much variation, no single staffing formula suits every event. A headcount alone says little about who is attending, what they are doing or how far they are from a hospital.

We therefore start with the factors that are likely to affect demand and the difficulty of reaching a patient:

• Who is attending, and whether they are watching or taking part
• Expected heat, and the shade and water available
• Alcohol, contact sport, animals and other specific hazards
• The size of the site, and how a patient would leave it
• The distance to a hospital

Trained clinicians on site can recognize a problem, begin treatment and stay with a patient until the next stage of care. Many of the concerns seen at events can also be assessed on the spot, so that a person gets advice or treatment and a clear recommendation about what to do next.

Standby care has limits. It does not prevent every emergency, it cannot guarantee an outcome, and it does not replace 911 or a hospital. We would rather explain those limits at the start than have an organizer assume otherwise.

Heat deserves particular attention in the Central Valley, where the average July high in Madera is 96°F.³ For exertional heat stroke, the National Athletic Trainers' Association states that when medical staff are on site, patients should be cooled first and transported second. It names cold-water immersion up to the neck as the most effective cooling method.²

Cooling of that kind is hard to improvise. For an event at risk, planning means deciding in advance where ice, water and a place to treat will come from, and who will be responsible for them.

For every minute without CPR, survival from a witnessed ventricular fibrillation cardiac arrest falls by 7 to 10 percent.¹ Early recognition, CPR and defibrillation matter, wherever the arrest occurs.

California requires schools that offer interscholastic athletics to acquire an AED and keep it available to athletic trainers, coaches and authorized persons at on-campus athletic events, and encourages making it available within a recommended three to five minutes.¹⁰ On-site clinicians add to that readiness. They do not replace it.

Standby care treats what can be treated on site and helps stabilize those who need more. Anyone who needs a hospital still needs a route to one, so we work with you to agree how 911 will be called, where an ambulance would enter the site and how a patient would reach it.

In California, local EMS agencies oversee emergency medical services within their areas. In Madera, Fresno, Kings and Tulare counties, the Central California EMS Agency carries out those functions, and the Fresno County Department of Public Health is the designated local EMS agency.⁹ Other counties have their own. Madera Event Medical Services is a private company and is not part of any of these agencies.

The National Association of EMS Physicians recommends that a physician medical director take an active role in developing an event's medical plan, and that care at mass gatherings be at least commensurate with local standards.⁵ It also notes the value of on-site care in reducing the burden on local EMS and healthcare resources.

Medical direction is one of the questions we address in planning for each event, along with what the local EMS agency requires.