How to Get Involved in Mass Gatherings

Special Events Special
• Part 2

To execute a large event requiring medical support, one must go beyond generic written plans and protocols. The steps taken at the beginning of the planning process can mean the difference between success and failure, which translates directly to the overall safety and care of participants, spectators, medical providers, and staff. Because of their expertise and training, emergency physicians are well-suited to assist in planning for and operating at these types of gatherings as subject-matter experts and senior members of the incident command team.

Residents and medical students interested in emergency medicine often want to get involved in the various aspects of special event operations. EMS medical directors, EMS fellows, and experienced emergency physicians with an interest in prehospital or event medicine can be great mentors for newcomers wanting to learn more about what it takes to run large events.

With a mentor identified, oftentimes the best way to learn about how special events are organized is to jump right in and observe the process of planning and executing a real event from beginning to end. To help you get started, here is an introduction to some techniques frequently used to lay the foundation for a successful event, whether it is a road race like the Baltimore Grand Prix, a concert, cultural festival, or common sports competition. While every jurisdiction is different, understanding these planning principles will help you learn as you work together with a mentor or members of the planning team.

Get to Know the Team

As a resident or medical student, you will most likely be part of a larger planning organization with many players. Depending on the size of the event, this may include the event organizers as well as representatives from law enforcement, fire/rescue, emergency medical services, public works, emergency management, and even local government executive leadership.

It may go without saying, but it is important to meet the other members of the group early and in person, if possible, to build working relationships and learn about the capabilities and experiences that individuals will bring to the planning process. This will help you later, not only when roles and responsibilities are documented in the plan, but also when working together to execute the plan during the event itself.

Ask and Gather, Then Write

It can be tempting to start with a search for standard templates and begin entering information, but most event planners spend time gathering information to ascertain all of the details needed to draft the plan. This includes an analysis of venue conditions, hazards, and resources (see “Challenges to Mass Gathering Medical Care” in Special Event Special Part 1 – Treating the Masses).

For example:

—     What type of crowd will be present and are there special populations to consider?
—     What will the weather be like?
—     What are the venue's characteristics with regard to attendance, facilities, supplies, and transportation access?
—     What kinds of problems have been encountered with similar events in the past?
—     What is necessary to ensure the safety and welfare of those staffing the event?

Along with information gathering, individuals in charge of drafting the plan often reach out to other members of the planning team or colleagues who have served in similar roles for past events, especially other physicians with experience managing patient care, protocol development, and health record reporting. Similarly, numerous published case reports are available for historical events, such as the Boston Marathon bombing, SuperBowl XLVIII, Chicago Shamrock Shuffle, and Chicago Marathon that provide insight and lessons learned.1-4

The next step is to start writing. This is the best time to use preformatted incident management templates, if applicable. Free online publications, such as the Federal Emergency Management Agency's Operational Templates and Guidance for EMS Mass Incident Deployment, provide examples. The FEMA Incident Command System Resource Center ( also provides relevant planning guidance and forms.

Updating old planning documents that worked well in the past can also save time and provide a familiar format for local responders who are routinely involved in supporting these types of incidents. Fire departments, police departments, hospital emergency preparedness offices, and emergency management agencies can often provide copies of previous plans.


Prior to the event, the medical team (or full incident team) will often schedule time for a “tabletop” exercise or walk-through using different patient care, mass casualty, and emergency response scenarios where the plan is applied. Representative team members at all levels may be invited to participate, including those in command roles as well as medical providers and other responders who will be working at the event. Both seasoned and less experienced personnel provide valuable insight into the types of problems that can be anticipated. It is helpful if everyone has a copy of the draft plan so that specific comments and feedback can be provided in real time during the review.

After the leadership team has worked to incorporate revisions from the practice session and secure any necessary approvals, the last step is to distribute the medical plan (as part of the larger operational plan, if applicable) and then put it into action on the day of the event.

Perform a “Hot Wash”

Emergency physicians, residents, and medical students work with other members of the hospital team as well as prehospital fire/rescue personnel and emergency medical providers daily. Debriefing after a challenging patient case in the emergency department or critical fire/rescue event in the prehospital setting is a routine method of identifying things that went well and things that could have gone better. Special events are no different. A good after-action assessment generates valuable lessons to carry forward to the next event.


The myriad planning considerations and operational decisions that need to be made can be overwhelming at first, especially for anyone new to special event planning. However, by understanding these basic concepts and pairing with a mentor to learn more about the planning process, you can work as part of the team to help ensure that any event, large or small, is executed safely and efficiently for participants, attendees, and providers, including quality medical care when it is needed. Remember, there is no one better suited for the task than you!



  1. Gates G, Arabian S, Biddinger P, et al: The Initial Response to the Boston Marathon Bombing: Lessons Learned to Prepare for the Next Disaster. Annals of Surgery 260(6): 960-966, 2014.
  2. Clancy T, Cortacans H: Super Ready: How a Regional Approach to Super Bowl EMS Paid Off. EMS World 43(7): 30-37, 2014.
  3. Basdere M, Ross C, Chan J, et al: Acute Incident Rapid Response at a Mass-Gathering Event Through Comprehensive Planning Systems: A Case Report from the 2013 Shamrock Shuffle. Prehospital and Disaster Medicine 29(3): 320-325, 2014.
  4. Chiampas G, Jaworski C: Preparing for the Surge: Perspectives on Marathon Medical Preparedness. Current Sports Medicine Reports 8(3): 131-135, 2009.