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Mass gathering events: a retrospective analysis of the triage categories, type of injury or medical complaint and medical usage rates
  1. Hans Van Remoortel1,2,
  2. Hans Scheers1,2,
  3. Karen Lauwers3,
  4. Johan Gillebeert4,5,
  5. Stijn Stroobants3,
  6. Pascal Vranckx4,6,7,
  7. Emmy De Buck1,2,8,
  8. Philippe Vandekerckhove2,4,9
  1. 1 Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
  2. 2 Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven Institute for Healthcare Policy, Leuven, Belgium
  3. 3 Humanitarian Services, Belgian Red Cross, Mechelen, Belgium
  4. 4 Belgian Red Cross, Mechelen, Belgium
  5. 5 Emergency Department, ZNA Stuivenberg, Antwerpen, Belgium
  6. 6 Department of Cardiology and Intensive Care, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Belgium
  7. 7 Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
  8. 8 Cochrane First Aid, Mechelen, Belgium
  9. 9 Centre for Evidence-Based Health Care, University of Stellenbosch, Cape Town, South Africa
  1. Correspondence to Dr Hans Van Remoortel, Centre for Evidence-Based Practice, Belgian Red Cross, 2800 Mechelen, Belgium; hans.vanremoortel{at}


Background Adequate on-site first aid delivery at mass gatherings (MGs) is one of the cornerstones to ensure safe and healthy MGs. We investigated medical usage rates, frequency of triage categories and type of injury or medical complaint, among attendees at MGs in Belgium.

Methods We analysed the Medical Triage and Registration Informatics System database, which includes prospectively collected person-level data regarding individuals visiting on-site posts at MGs in Belgium. MGs attended by >10 000 people and organised ≥5 times between 2009 and 2018 were included. We determined the proportion of patients in each triage category (‘first aid’ vs ‘medical condition’ vs ‘medical emergency’ vs ‘no treatment’) and each type of injury or medical complaint, and we calculated patient presentation rate (PPR) and transfer to hospital rate (TTHR).

Results Twenty-eight MGs, totalling 194 events, were included involving 148 265 patient visits. ‘First aid’ was the most common triage category (80%, n=118 514). The need for a nurse/physician (‘medical condition’), and for the treatment of life-threatening conditions (‘medical emergency’) was rare (8.9%, n=13 052, and 0.6%, n=860, of all patient presentations, respectively), but remarkably higher during indoor electronic dance music (EDM) events (17.8% (n=26 391) and 4.0% (n=5930), of all patient presentations, respectively). ‘Skin wounds’ were the most common injury category (42.4%, n=62 275). ‘Respiratory problems’, ‘neurological problems’, ‘intoxication’, ‘heart complaints’ and ‘gastrointestinal complaints’ were more frequent during indoor (electronic) dance, whereas ‘burns’, ‘fracture/contusion’ and ‘skin wounds’ were higher during outdoor music, sports events and city festivals, respectively. PPR (per 10 000 attendees) was highest for outdoor EDM and outdoor music (median 130 (IQR 79) and 129 (IQR 104), respectively). TTHR (per 10 000 attendees) was highest for indoor EDM (median 4.4 (IQR 8.5)).

Conclusion Medical usage rates, proportion of patients in triage and injury or medical complaint categories varied across different MG categories, suggesting opportunities for planning medical coverage at these events.

  • mass casualty incidents
  • triage

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  • Handling editor Kirsty Challen

  • Contributors HVR, KL, EDeB and PV planned the study. HVR and HS were involved in analysing the data. HVR drafted the manuscript and all authors contributed to the interpretation of the data, and critically revised and approved the overall content of the manuscript.

  • Funding This work was made possible through funding from the Foundation for Scientific Research of the Belgian Red Cross.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.