Skip to main content Accessibility help

Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery

  • Amy N. B. Johnston (a1) (a2) (a3), Jasmine Wadham (a1), Josea Polong-Brown (a1), Michael Aitken (a1) (a2), Jamie Ranse (a4), Alison Hutton (a5), Brent Richards (a6) and Julia Crilly (a1) (a2)...



Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.


The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).


A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.


Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.


This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.

JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery. Prehosp Disaster Med. 2019;34(1):62–71.


Corresponding author

Correspondence: Amy Johnston, PhD Department of Emergency Medicine Princess Alexandra Hospital Metro South, 199 Ipswich Road Woolloongabba 4102 QLD Australia E-mail:


Hide All

Conflicts of interest/funding: Funding for the full-scale exercise was provided by the Central Massachusetts Homeland Security Advisory Council (Worcester, Massachusetts USA). Funding for the research aspect of the project was provided by the University of Massachusetts Medical School (Worcester, Massachusetts USA). The authors declare no conflicts of interest.



Hide All
1. Hutton, A, Savage, C, Ranse, J, Finnell, D, Kub, J. The use of Haddon’s matrix to plan for injury and illness prevention at outdoor music festivals. Prehosp Disaster Med. 2015;30(2):175-183.
2. Hutton, A, Ranse, J, Verdonk, N, Ullah, S, Arbon, P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehosp Disaster Med. 2014;29(2):160-166.
3. Lund, A, Turris, SA. Mass-gathering medicine: risks and patient presentations at a 2-day electronic dance music event. Prehosp Disaster Med. 2015;30(3):271-278.
4. Arbon, P. Planning medical coverage for mass gatherings in Australia: what we currently know. J Emerg Nurs. 2005;31(4):346-350.
5. Forero, R, McCarthy, S, Hillman, K. Access block and emergency department overcrowding. Critical Care. 2011;15(2):216.
6. Doherty, L. Going the extra mile: health care for marathon runners. Emergency Nurse. 2010;18(2):18-20.
7. Events Queensland. Gold Coast Airport Marathon. Events Queensland. Accessed August 2017.
8. Jena, AB, Mann, NC, Wedlund, LN, Olenski, A. Delays in emergency care and mortality during major US marathons. New Eng J Med. 2017;376(15):1441-1450.
9. Roberts. 12-yr profile of medical injury and illness for the Twin Cities Marathon. Med Sci Sports Exer. 2000;32(9):1549-1555.
10. Hutton, A, Cusack, L, Zannettino, L. Building public policy to support young people in reducing alcohol-related harm when partying at Schoolies Festivals. Aust J Primary Health. 2012;18(2):96-100.
11. Barnes, C, Henrickson, KE. Economic development generated by investment in participation sports. J Bus Econ Policy. 2017;4(1):156-162.
12. Saayman, M, Saayman, A. Appraisal of measuring economic impact of sport events. South African J Res Sport, Phys Ed Rec. 2014;36(3):151-181.
13. Hutton, A, Roderick, A, Munt, R. Lessons learned at World Youth Day: collecting data and using postcards at mass gatherings. Prehosp Disaster Med. 2010;25(3):273-277.
14. Khorram-Manesh, A, Berner, A, Hedelin, A, Ortenwall, P. Estimation of healthcare resources at sporting events. Prehosp Disaster Med. 2010;25(5):449-455.
15. Enock, KE, Jacobs, J. The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health. Public Health. 2008;122(11):1229-1238.
16. Gannon, DM, Derse, AR, Bronkema, PJ, Primley, DM. The emergency care network of a ski marathon. Am J Sports Med. 1985;13(5):316-320.
17. Agar, C, Pickard, L, Bhangu, A. The Tough Guy prehospital experience: patterns of injury at a major UK endurance event. Brit Assoc Accid Emerg Med. 2009;26(11):826-830.
18. Herbenick, MA, King, JS, Altobelli, G, Nguyen, B, Podesta, L. Injury patterns in professional arena football. Am J Sports Med. 2008;36(1):91-98.
19. Nguyen, RB, Milsten, AM, Cushman, JT. Injury patterns and levels of care at a marathon. Prehosp Disaster Med. 2008;23(6):519-525.
20. Videbæk, S, Bueno, AM, Nielsen, RO, Rasmussen, S. Incidence of running-related injuries per 1000 h of running in different types of runners: a systematic review and meta-analysis. Sports Med. 2015;45(7):1017-1026.
21. Tang, N, Kraus, CK, Brill, JD, Shahan, JB, Ness, C, Scheulen, JJ. Hospital-based event medical support for the Baltimore Marathon, 2002-2005. Prehosp Emerg Care. 2008;12(3):320-326.
22. Jaworski, CA. Medical concerns of marathons. Curr Sports Med Reports. 2005;4(3):137-143.
23. Fredericson, M, Misra, AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007;37(4-5):437-439.
24. Glick, J, Rixe, JA, Spurkeland, N, Brady, J, Silvis, M, Olympia, RP. Medical and disaster preparedness of US marathons. Prehosp Disaster Med. 2015;30(4):344-350.
25. Donabedian, A. The quality of care: how can it be assessed? J Am Med Assoc. 1988;260(12):1743-1748.
26. Irvine, D, Sidani, S, Hall, LM. Finding value in nursing care: a framework for quality improvement and clinical evaluation. Nurs Econ. 1998;16(3):110-131.
27. Baxter, P, Jack, S. Qualitative case study methodology: study design and implementation for novice researchers. Qual Report. 2008;13(4):544-559.
28. Queensland Health. Gold Coast Hospital and Health Service Annual Report 2015–2016. Published 2016. Accessed August 2017.
29. About the Gold Coast Airport Marathon. Accessed July 2017.
30. Elo, S, Kyngäs, H. The qualitative content analysis process. J Advanced Nurs. 2008;62(1):107-115.
31. Petty, NJ, Thomson, OP, Stew, G. Ready for a paradigm shift? Part 2: introducing qualitative research methodologies and methods. Manual Therapy. 2012;17(5):378.
32. Bogdon, R, Biklen, S. Research for Education. An Introduction to Theories and Methods. London, United Kingdom: Pearson Education; 2007.
33. Lincoln, YS, Guba, EG. Naturalistic Inquiry. Beverly Hills, California USA: Sage Publications; 1985.
34. Tracy, SJ. Qualitative quality: eight “Big-Tent” criteria for excellent qualitative research. Qual Inquiry. 2010;16(10):837-851.
35. Campbell, JL, Quincy, C, Osserman, J, Pedersen, OK. Coding in-depth semi-structured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294-320.
36. Popping, R. Some views on agreement to be used in content analysis studies. Quality & Quantity. 2010;44(6):1067-1078.
37. AusRunning. Australian Marathon Statistics. Accessed October 2017.
38. Schwellnus, M, Derman, W. The quest to reduce the risk of adverse medical events in exercising individuals: introducing the SAFER (Strategies to reduce Adverse medical events For the ExerciseR) studies. Brit J Sports Med. 2014;48(11):869.
39. Zeitz, KM, Zeitz, CJ, Arbon, P. Forecasting medical work at mass-gathering events: predictive model versus retrospective review. Prehosp Disaster Med. 2005;20(3):164-168.
40. Woodall, J, Watt, K, Walker, D, et al. Planning volunteer responses to low-volume mass gatherings: do event characteristics predict patient workload? Prehosp Disaster Med. 2010;25(5):442-448.
41. Burton, JO, Corry, SJ, Lewis, G, Priestman, WS. Differences in medical care usage between two mass-gathering sporting events. Prehosp Disaster Med. 2012;27(5):458-462.
42. Grange, JT, Baumann, GW, Vaezazizi, R. On-site physicians reduce ambulance transports at mass gatherings. Prehosp Emerg Care. 2003;7(3):322-326.
43. Zeitz, K, Zeitz, C, Arbon, P, Cheney, F, Johnston, R, Hennekam, J. Practical solutions for injury surveillance at mass gatherings. Prehosp Disaster Med. 2008;23(1):76-81.
44. Arbon, P, Bridgewater, FH, Smith, C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disaster Med. 2001;16(3):150-158.
45. Turris, SA, Lund, A, Hutton, A, et al. Mass-gathering health research foundational theory: part 2 - event modeling for mass gatherings. Prehosp Disaster Med. 2014;29(6):655-663.
46. Ranse, J, Hutton, A, Keene, T, et al. Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):1-7.
47. Daniel, J. Sampling Essentials: Practical Guidelines for Making Sampling Choices. Los Angeles, California USA: Sage; 2011.


Related content

Powered by UNSILO

Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery

  • Amy N. B. Johnston (a1) (a2) (a3), Jasmine Wadham (a1), Josea Polong-Brown (a1), Michael Aitken (a1) (a2), Jamie Ranse (a4), Alison Hutton (a5), Brent Richards (a6) and Julia Crilly (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.