title: Health Service Impact from Mass Gatherings: A Systematic Literature Review.
abstract: BACKGROUND
  During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review. Aim This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.
  
  
  METHODS
  This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.
  
  
  RESULTS
  Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.
  
  
  CONCLUSIONS
  There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum. Ranse J , Hutton A , Keene T , Lenson S , Luther M , Bost N , Johnston ANB , Crilly J , Cannon M , Jones N , Hayes C , Burke B . Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):71-77.
authors.affiliation: 1University of Canberra, Faculty of Health,Canberra,Australian Capital Territory,Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Ranse
authors.affiliation: 2Flinders University,School of Nursing and Midwifery,Adelaide,South Australia,Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Hutton
authors.affiliation: 4Australian Catholic University,Canberra,Australian Capital Territory,Australia.
authors.forename: Toby
authors.initials: T
authors.lastname: Keene
authors.affiliation: 4Australian Catholic University,Canberra,Australian Capital Territory,Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Lenson
authors.affiliation: 6Calvary Health Care ACT,Canberra,Australian Capital Territory,Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Luther
authors.affiliation: 7Department of Emergency Medicine,Gold Coast Health,Southport,Queensland,Australia.
authors.forename: Nerolie
authors.initials: N
authors.lastname: Bost
authors.affiliation: 7Department of Emergency Medicine,Gold Coast Health,Southport,Queensland,Australia.
authors.forename: Amy N B
authors.initials: AN
authors.lastname: Johnston
authors.affiliation: 7Department of Emergency Medicine,Gold Coast Health,Southport,Queensland,Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
authors.affiliation: 3St John Ambulance Australia (New South Wales),Event Health Services,Sydney,New South Wales,Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Cannon
authors.affiliation: 1University of Canberra, Faculty of Health,Canberra,Australian Capital Territory,Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jones
authors.affiliation: 1University of Canberra, Faculty of Health,Canberra,Australian Capital Territory,Australia.
authors.forename: Courtney
authors.initials: C
authors.lastname: Hayes
authors.affiliation: 9Canberra Hospital,Intensive Care Unit,Canberra,Australian Capital Territory,Australia.
authors.forename: Brandon
authors.initials: B
authors.lastname: Burke
mesh_terms: D000846:Anniversaries and Special Events; D003441:Crowding; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D014187:Transportation of Patients / Q000458:organization & administration; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy
keywords:  EMS Emergency Medical Services;  ER emergency room;  PDM Prehospital and Disaster Medicine;  PPR patient presentation rate;  RTHR referral to hospital rate;  TTHR transport to hospital rate; Emergency Medical Services; emergency rooms; hospitals; mass gathering; paramedic; planned event