title: Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event.
abstract: BACKGROUND
  Emergency medical services (EMS) responses to mass gatherings have been described frequently, but there are few reports describing the response to a single-day gathering of large magnitude.
  
  
  OBJECTIVE
  This report describes the EMS response to the largest single-day, ticketed concert held in North America: the 2003 "Toronto Rocks!" Rolling Stones Concert.
  
  
  METHODS
  Medical care was provided by paramedics, physicians, and nurses. Care sites included ambulances, medically equipped, all-terrain vehicles, bicycle paramedic units, first-aid tents, and a 124-bed medical facility that included a field hospital and a rehydration unit. Records from the first-aid tents, ambulances, paramedic teams, and rehydration unit were obtained. Data abstracted included patient demographics, chief complaint, time of incident, treatment, and disposition.
  
  
  RESULTS
  More than 450,000 people attended the concert and 1,870 sought medical care (42/10,000 attendees). No record was kept for the 665 attendees simply requesting water, sunscreen, or bandages. Of the remaining 1,205 patients, the average of the ages was 28 +/- 11 years, and 61% were female. Seven-hundred, ninety-five patients (66%) were cared for at one of the first-aid tents. Physicians at the tents assisted in patient management and disposition when crowds restricted ambulance movement. Common complaints included headache (321 patients; 27%), heat-related complaints (148; 12%), nausea or vomiting (91; 7.6%), musculoskeletal complaints (83; 6.9%), and breathing problems (79; 6.6%). Peak activity occurred between 14:00 and 19:00 hours, when 102 patients per hour sought medical attention. Twenty-four patients (0.5/10,000) were transferred to off-site hospitals.
  
  
  CONCLUSIONS
  This report on the EMS response, outcomes, and role of the physicians at a large single-day mass gathering may assist EMS planners at future events.
authors.affiliation: Division of Prehospital Care, Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Feldman
authors.forename: Jane L
authors.initials: JL
authors.lastname: Lukins
authors.forename: Richard P
authors.initials: RP
authors.lastname: Verbeek
authors.forename: Russell D
authors.initials: RD
authors.lastname: MacDonald
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Burgess
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances; D000846:Anniversaries and Special Events; D003441:Crowding; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005392:First Aid; D006302:Health Services Research; D006801:Humans; D008297:Male; D008399:Mass Behavior; D009864:Ontario; D011787:Quality of Health Care; D011998:Recreation; D018570:Risk Assessment; D014187:Transportation of Patients / Q000458:organization & administration