title: On-site physicians reduce ambulance transports at mass gatherings.
abstract: OBJECTIVE
  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). Fifty-two 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.
  
  
  CONCLUSIONS
  On-site physician-level 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.
authors.affiliation: Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, California 92354, USA. jgrange@pol.net
authors.forename: Jeff T
authors.initials: JT
authors.lastname: Grange
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Baumann
authors.forename: Reza
authors.initials: R
authors.lastname: Vaezazizi
mesh_terms: D002140:California / Q000453:epidemiology; D003441:Crowding; D003657:Decision Making; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006801:Humans; D018986:Motor Vehicles; D010348:Patient Care Team; D010819:Physician's Role; D010820:Physicians / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011446:Prospective Studies; D011787:Quality of Health Care; D013177:Sports; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D000078329:Workforce; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology