Skip to main content Accessibility help

Ambulance Need at Mass Gatherings

  • Elissa Meites (a1) and John F. Brown (a1) (a2)



Scant evidence exists to guide policy-making around public health needs during mass gatherings. In 2006, the City and County of San Francisco began requiring standby ambulances at all mass gatherings with attendance of >15,500 people. The objectives were to evaluate needs for ambulances at mass gatherings, and to make evidence-based recommendations for public health policy-makers. The hypothesis was that the needs for ambulances at mass gatherings can be estimated using community baseline data.


Emergency medical services plans were reviewed for all public events with an anticipated attendance of >1,000 people in San Francisco County during the 12-month period 01 August 2006 through 31 July 2007. Ambulance transport data were confirmed by event coordinators and ambulance company records, and the rate was calculated by dividing ambulance transports by event attendance. Baseline ambulance transport rate was calculated by dividing the annual ambulance transports in the county's computer-aided dispatch system by the census population estimate. The risk ratio was calculated using the risk of transport from a mass gathering compared with the baseline risk of ambulance transport for the local community. Significance testing and confidence intervals were calculated.


Descriptive information was available for 100% of events and ambulance transport data available for 97% of events. The majority of the mass gatherings (47 unique events; 59 event days) were outdoor, weekend festivals, parades, or concerts, though a large proportion were athletic events. The ambulance transport rate from mass gatherings was 1 per 59,000 people every six hours. Baseline ambulance transport rate in San Francisco was 1 per 20,000 people every six hours. The transport rate from mass gatherings was significantly lower than the community baseline (risk ratio [RR] = 0.15, 95% CI = 0.10–0.22, p <0.001). At events reserving a standby ambulance, 46% of ambulances were unused.


San Francisco mass gatherings appear to present a lower risk of ambulance transports compared to the community baseline, suggesting that the community baseline sets an appropriate standard for requiring standby ambulances at mass gatherings. The initial ambulance requirement policy in San Francisco may have been overly conservative.


Local baseline data is a recommended starting point when setting policy for public health needs at mass gatherings.


Corresponding author

San Francisco EMS Agency, 30 Van Ness Avenue, Suite 3300, San Francisco, California 94102, USA E-mail:


Hide All
1.Characteristics of state legislation governing medical care at mass gatherings. Prehosp Emerg Care 1999;3(4):316320.
2.Chan, SB, Quinn, JE: Outcomes in EMS-transported attendees from events at a large indoor arena. Prehosp Emerg Care 2003;7(3):332335.
3.Parillo, SJ: Medical care at mass gatherings: Considerations for physician involvement. Prehosp Disaster Med 1995;10(4):273275.
4.Lukins, JL, Feldman, MJ, Summers, JA, Verbeek, PR: A paramedic-staffed medical rehydration unit at a mass gathering. Prehosp Emerg Care 2004;8(4):411416.
5.Zeitz, KM, Zeitz, CJ, Arbon, P: Forecasting medical work at mass-gathering events: Predictive model versus retrospective review. Prehosp Disaster Med 2005;20(3):164168.
6.The City of San Diego: Planning the Medical Services for Your Special Event. 1999. Available from Accessed 14 October 2010.
7.Varon, J, Fromm, RE, Chanin, K, Filbin, M, Vatpakdi, K: Critical illness at mass gatherings is uncommon. J Emerg Med 2003;25(4):409413.
8.Binder, LS, Willoughby, PJ, Matkaitis, L: Development of a unique decentralized rapid-response capability and contingency mass-casualty field hospital for the 1996 Democratic National Convention. Prehosp Emerg Care 1997;1(4):238245.
9.Flabouris, A, Bridgewater, F: An analysis of demand for first-aid care at a major public event. Prehosp Disaster Med 1996;11(1):4854.
10.Friedman, LJ, Rodi, SW, Krueger, MA, Votey, SR: Medical care at the California AIDS Ride 3: Experiences in event medicine. Ann Emerg Med 1998;31(2):219223.
11.Arbon, P, Bridgewater, FH, Smith, C. Mass gathering medicine: A predictive model for patient presentation and transport rates. Prehosp Disaster Med 2001;16(3):150158.
12.Grange, JT, Green, SM, Downs, W: Concert medicine: Spectrum of medical problems encountered at 405 major concerts. Acad Emerg Med 1999;6(3):202207.


Related content

Powered by UNSILO

Ambulance Need at Mass Gatherings

  • Elissa Meites (a1) and John F. Brown (a1) (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.