title: Use of treat-and-release medical directives for paramedics at a mass gathering.
abstract: BACKGROUND
  Paramedics provide a substantial proportion of care at mass gatherings but do not typically release patients without physician assessment.
  
  
  OBJECTIVE
  To evaluate treat-and-release medical directives implemented at a large single-day summer rock concert.
  
  
  METHODS
  Medical directives allowed paramedics to administer acetaminophen, dimenhydrinate, diphenhydramine, or polymyxin B ointment for common complaints without evidence of serious illness on history or examination. After treatment, patients were released or transferred to a medical facility according to predefined criteria. Patient demographics, chief complaint, treatment, and disposition were obtained from paramedic records. To determine whether any patients released by paramedic subsequently required ambulance transport, all ambulance records were searched for a period of eight hours before to 24 hours after the event.
  
  
  RESULTS
  More than 450,000 people attended the concert, with 1,870 presenting for medical attention. Four hundred seven patients received medications under the directives. No disposition was recorded in 13 cases. Two hundred ninety-nine patients were treated with acetaminophen, of whom 269 (90.0%) were released and 23 (7.7%) required additional care. Sixty-two patients received dimenhydrinate, 44 (71%) were released, and 14 (23%) required transport. Thirty-six patients received diphenhydramine, and 34 (94%) were released. Ten patients received polymyxin B and were released. No patient released by paramedics was found to have later required ambulance transport.
  
  
  CONCLUSIONS
  Treat-and-release medical directives for paramedics at mass gatherings may help divert patients from requiring care at a medical facility. Future research is needed to determine the safety (morbidity and mortality) of these directives.
authors.affiliation: 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: P Richard
authors.initials: PR
authors.lastname: Verbeek
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; D000488:Allied Health Personnel / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D002648:Child; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008399:Mass Behavior; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D017009:Professional Autonomy