title: Disasters at mass gatherings: lessons from history.
abstract: IntroductionReviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type of medical care needed. Crowd disasters at mass gathering events have not been fully researched and this review examines these aiming to provide future suggestions for event organisers, medical resource planners, and emergency services, including local hospital emergency departments.MethodsA review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and reviewed. Disasters occurring in extreme weather events, and environmental leading to participant illness were not included. These articles were read, analysed, abstracted and summarised.Results156 articles from literature search were found detailing mass gathering disasters identified from 1971 - 2011. With only 21 cases found within peer-review literature. Twelve events were further documented as a case reports. Five events were examined as review articles while four events underwent commissioned inquiries. Analysis of cases were categorised in to crowd control, event access, fire safety, medical preparedness and emergency response.ConclusionsMass gathering events have an enormous potential to place a severe strain on the local health care system, and a mixture of high crowd density, restricted points of access, poor fire safety, minimum crowd control and lack of on-site medical care can lead to problems that end in disaster.
authors.affiliation: Emergency Specialist Registrar in the UK, and member of the World Health Organisation/Health Protection Agency UK, Collaboration of Mass Gathering Emergency Medicine and  Head of Extreme Events and Health Protection Centre for Radiation, Chemicals and Environmental Hazards, Health Protection Agency, London UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Soomaroo
authors.forename: Virginia
authors.initials: V
authors.lastname: Murray