title: Level of medical care required for mass gatherings: the XV Winter Olympic Games in Calgary, Canada.
abstract: OBJECTIVE
  To determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a major winter event.
  
  
  METHODS
  Standard charts were available for 3,395 encounters. Interviews with medical staff showed that the few unrecorded encounters were for very minor medical problems. A four-tiered triage system (low, moderate, urgent, and emergent) developed before the Games was applied to each chart retrospectively by a single emergency physician. Chi-squared tests were used to test significant differences.
  
  
  METHODS
  This winter sporting and entertainment event had 12 urban and rural venues. Medical staff (98 physicians, 161 nurses, and 337 first-aid attendants) were based in 28 advanced life support (ALS) clinics. The medical service operated for four weeks.
  
  
  METHODS
  There were 1.8 million spectator-days. Patients included spectators, athletes, and support staff.
  
  
  METHODS
  First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue, or more rarely, to local hospital emergency departments. Paramedic ambulances were stationed at the venues. The triage system was not used for patient management.
  
  
  RESULTS
  Only 40 urgent and one emergent medical problems were encountered. The majority of patients could have been managed by trained nurses working alone under standing orders. Fifty patients were transported to the hospital by ground ambulance and three by helicopter. No significant differences were found in the low acuity levels experienced at indoor urban venues, outdoor urban venues, and the rural cross-country ski venue. The Alpine ski venue was characterized by significantly higher acuity and a long prehospital transfer phase.
  
  
  CONCLUSIONS
  Owing to the low acuity encountered and the availability of Calgary's ALS ambulance service, we concluded that physician-based ALS teams were not required for patient management at the urban venues. Such teams were found to be required at the rural Alpine ski venue. Other reasons for using physicians are discussed, as is development of a standard triage system for mass gatherings.
authors.affiliation: Division of Emergency Medicine, Foothills Hospital, Calgary, Alberta, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Thompson
authors.forename: G
authors.initials: G
authors.lastname: Savoia
authors.forename: G
authors.initials: G
authors.lastname: Powell
authors.forename: E B
authors.initials: EB
authors.lastname: Challis
authors.forename: P
authors.initials: P
authors.lastname: Law
mesh_terms: D000416:Alberta; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D013177:Sports; D014187:Transportation of Patients; D000078329:Workforce