Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).

This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.

The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.

This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.

Industrial disasters can have a myriad of repercussions ranging from acute deaths, injuries, and long-term adverse health impacts on nearby populations to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

1,054 industrial disasters were recorded from 1995 to 2021. The majority of these disasters occurred in Asia (720, 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533, 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters and they remain a significant contributor to the healthcare risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve healthcare responses in the future.

A Hazard Definition and Classification Review conducted by the UN Office for Disaster Risk Reduction (UNDRR) and International Science Council (ISC) resulted in publication of Hazard Information Profiles (HIPs). The HIPs provide groundwork for developing a statistical framework enabling better understanding of the true burden of hazards globally. Furthermore, standardized data is critical for effective monitoring of the Sendai Framework, Sustainable Development Goals, and Paris Agreement on Climate Change.

Following the publication of the HIPs, governments and National Statistical Offices (NSOs) have been encouraged to review their systems for classifying, monitoring and reporting on disaster risk reduction with the aim to gradually implement the HIPs in databases and reporting systems.

The aim of the pilot is to provide statistical feedback on the applicability of the reviewed hazard classification and its HIPs.

The DRS pilot utilizes mixed-qualitative methods:

• Global stakeholder workshops

• Literature review to understand the gaps and good practice

• Utilizing snowball methodology to cascade a survey to DRS international experts.

• Country-level expert focus-groups.

• In-country pilots (with Low, Middle, and High-income countries).

• Delphi Methodology with expert stakeholders to hone recommendations

596 responses to the survey from across 38 countries and 90 papers were identified for literature review. Survey initially sent to 120 stakeholders, and snowball methodology increased survey reach, particularly to Global South colleagues. Expert stakeholder and country-level focus groups identified a series of good practices and recommendations enabling step-change towards a standardized global statistical framework. Delphi methodology to refine recommendations is underway.

The DRS pilot has raised global awareness of the importance of using the HIPs in developing a robust statistical framework with usable disaster-related statistics. This will enable greater accuracy of data contributing to Sendai Framework targets A-D. Results of the pilot being used to inform the Office of National Statistics-UKHSA-Wellcome collaboration on developing Standards for Official Statistics on Climate-Health Interactions in Africa.

Strengthening national disaster management legislation and policy is critical for preventing and reducing catastrophic health effects from the growing threat of natural hazard disasters. Although evaluations of the effectiveness of legal and policy instruments are rarely published, similar approaches continue to be applied universally by governments to align their response to disaster impacts. This study analyzed and contrasted the effect of disaster legislation and policy on the emergency health and medical response to six complex natural hazard disasters, including typhoon, earthquake, flood, smoke haze, thunderstorm asthma and the COVID-19 pandemic.

The study applied qualitative multi-case study methodology and used a standardized program logic model to synthesize and analyze the effect of national disaster legislation and policy on emergency health and medical responses. Events were case-bounded by date, more than 9,000 casualties, and local emergency responses provided health and medical care.

Four themes emerged critical to health system response. Where legislation and policy provided clear separation of powers, systems delineated roles and responsibilities, provided clarity and process for assessment, resource acquisition, and operational mandates. Policies that created dedicated local networks and included non-health related organizations, accelerated coordination of crucial health functions for rapid mobilization and prioritization for affected populations. In all but one case, the hazard was closely monitored, already affected communities, and catastrophic risk to life understood, before the declaration and statutory powers were invoked.

Using ‘declarations’ as the legal instrument to initiate ‘whole of government’ resources in disasters requires urgent review, especially where advanced hazard monitoring systems exist. Disaster and emergency health policy should support action orientated toward exposure mitigation, inclusion of non-traditional health actors and partnership building. International policy mechanisms are required to address emerging health threats not locally prioritized and advance regional cooperation agreements when the impact of hazards harm populations outside geographic boundaries.

The Victorian Compendium of Community-Based Resilience Building Case Studies supports place-based disaster risk reduction by promoting strategies to reduce communities’ risk before, during, and after disasters or emergencies and by strengthening community resilience through shared learning. It grew from Community Resilience Forums at Monash University, where community resilience practitioners presented their programs, explained their evolution, how they solved challenges, and shared unforeseen learnings. Forum attendees expressed an urgency for a sharing platform to help build community expertise, save precious community resources, avoid program duplication to prevent communities from reinventing the wheel. These now represent key tenets of the Compendium.

International exemplars inform the structure of the Compendium and a thematic analysis identified critical success factors for underpinning disaster risk reduction and resilience strategies.

As an Australian first, the Compendium gathered 38 programs between 2012 and 2022, which were addressed before (29), during (7), and after (17) events. Programs addressed all hazards (23), bushfires (11), heat (2), fire safety (1), and house fires (1). Twenty programs used a framework. Thirty received funding, with nine receiving less than $20,000 and five receiving more than $100,000. Twenty-nine addressed a whole-of-community perspective.

Critical success factors included: strong governance and Board support; trust, partnerships, commitment, adaptability, stamina, and community leadership; paid facilitator, local government support, external funding; and celebrating often-neglected success.

Offering an innovative contribution to resilience practice and research, the Compendium supports and enables locally-led and owned place-based disaster risk reduction efforts. It supports the Sendai Framework and augments principles in the National Framework for Disaster Risk Reduction by connecting people from diverse sectors to deliver distinct, adaptable actions to help reduce communities’ risk before, during, and after disasters or emergencies. The Compendium enables communities to preserve valuable community resources offering opportunities to extend to a national or international Compendium.

During disasters households may experience lost communication and roads may become impassable; thus a common recommendation is to prepare an emergency supply kit that can be used to shelter-in-place during evacuation. The decision to prepare for disasters becomes more challenging during pandemics because individuals may be hesitant to evacuate to shelters or may be unsure of items to include in emergency supply kits. Because of this, many preparedness estimates before 2020 may no longer reflect current levels of preparedness. The aim of this research was to provide information on what actions people take to prepare for disasters, determine whether households have supply kits, and help guide next steps to better prepare for and respond to disasters during a pandemic.

We conducted descriptive statistics, chi-square analyses, and backward-step regressions on 10 questions collected through Porter Novelli’s ConsumerStyles surveys in Fall 2020 (n=3,625), Spring 2021 (n=6,455), and Fall 2021 (n=3,553) to examine factors that contribute to overall household preparedness levels and supply kit ownership.

Being married, having children in the home, and having a household income of $150,000 or more are all associated with increased preparedness levels. Persons living in mobile homes, recreational vehicles (RVs), boats, or vans are half as likely to have preparedness plans compared to those living in single family homes. While there was a significant association between level of preparedness and supply kit ownership, overall kit ownership is also lacking. While most respondents believed a kit would help their chance of survival, only a third had one. Age, sex, education level, and region of the country were significant predictors of kit ownership.

This study helped close existing knowledge gaps surrounding preparedness and emergency supply kits to guide public health research and prevention strategies, including messaging, to help reduce adverse health impacts during multiple emergencies.

Since 1900, disasters in the Northern Triangle of Central America—Guatemala, Honduras, and El Salvador—have caused over one-hundred-thousand deaths, affected millions of people, and caused billions of dollars of damages. As climate change causes increasingly frequent severe weather events, the catastrophic effects of disasters are likely to contribute to poverty and political and economic instability in the region leading to greater levels of migration out of the Northern Triangle.

This study provides a descriptive analysis of all disasters recorded in the EM-DAT database affecting Guatemala, Honduras, and El Salvador between 1900-2022. Disasters are analyzed by frequency, severity, financial cost, distribution by country, burden of death, affected and financial cost by country, and type of disasters most prevalent in each country. These trends are then graphed over the time period of the database.

EM-DAT records 359 disasters in the Northern Triangle between 1900 and 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62% of total deaths caused by disasters), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.

Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of these coming disasters. Missing data in the EM-DAT dataset limits the conclusions of this study to general trends

The WHO Health Emergency and Disaster Risk Management (H-EDRM) Research Network has identified that health data collection during health emergencies and disasters is a key element to enable proper coordination and timely response, and research priorities of the network.

Focus group discussion was performed to identify key challenges which hinder accomplishment of the data collection.

It was concluded that the issue faces significant challenges including; (1) Access: Logistic issues including safety, transport and communication did not allow experts such as epidemiologists to access onsite and relevant stakeholders. It is also challenging for local public health stakeholders to accept new experts during emergencies. (2) Tools: forms or tools that are concise and operational to be accepted by frontline responders should be provided. (3) Standardization: to set standard forms or tools and its operational mechanism is essential to collect health data, otherwise collected data will be partial and fragmented. (4) Governance: overall governance of procedure and data ownership must be clarified before its implication administratively and legally. These should be endorsed by local health authorities. (5) Ethical procedure: Obtaining informed consent and conducting timely procedures is difficult. Contextually, health data collection during emergencies and disasters in many cases is inappropriate. (6) Operation: Collected data should contribute to ongoing operation in a timely manner. The discussion also found the standard tool of the WHO; the Emergency Medical Teams Minimum Data Set, which has been already used in more than ten countries and has been providing leading examples for this topic.

Further research to fulfill the identified challenges and gaps will facilitate the collection and strengthen the health emergency and disaster risk management.

Managing pandemics is dependent on the adherence of civil societies to directives and recommendations issued by governmental and public health authorities. In the context of the COVID-19 pandemic, hurdles were encountered by authorities regarding public compliance to orders and recommendations of protective health behavior. The objective is to investigate the factors that most powerfully enhance or impede compliance to varied measures–both regulations (i.e. lockdown, mask wearing, social distancing) and recommendations (i.e. vaccination etc.) in Israel.

A longitudinal study, based on structured questionnaires was conducted to investigate factors that enhance or impede the uptake of protective health behavior throughout two years of COVID-19.

Various factors throughout different phases of the pandemic have been identified as playing a significant role in compliance. During the initial phases of the pandemic, the most salient factors for enhanced compliance to non-pharmaceutical interventions (lockdown) were concern for family or self-health, while deterrence played little role. During the fourth wave, findings indicated that pandemic fatigue had begun to have cascading effects on vaccination efforts. Particularly at this stage, trust in authorities and even threat perception components were incapable of predicting uptake, while perceived importance of the vaccine and its effectiveness positively and significantly predicted uptake. Throughout the pandemic, a negative correlation between levels of resilience and distress symptoms and a positive correlation between resilience and enhanced compliance were identified.

Utilizing tools for empowering the population rather than instilling fear or other deterrence measures are more effective approaches to increase compliance with governmental directives. Furthermore, the results highlight the importance of adapting and adjusting risk communication efforts to accommodate specific concerns and hesitations demonstrated by distinct groups during an evolving pandemic. Public health officials and authorities need to engage the public in resilience building activities to promote compliance.

National Veterinary Services of World Organization for Animal Health (WOAH) are responsible for a wide range of activities including animal health, animal welfare and veterinary public health. The WOAH European Region member countries were surveyed to determine and quantify the level of capacity to respond to natural disasters, determine the types of disasters experienced, determine their levels of education and training and identify gaps in capacity and specific needs of Member Countries for disaster response.

A web-based Qualtrics survey on Animal Welfare in Natural Disasters was conducted by Lincoln Memorial University in conjunction with the World Organization for Animal Health (OIE) Platform on Animal Welfare for Europe. The 50 question survey was distributed by email link to Member Countries points of contact provide by OIE. The survey was emailed to 53 OIE European Member Countries with reminder emails to complete. Survey results were compiled and tabulated. Only aggregate data is published and presented.

Forty-nine countries responded to the survey for a 92% completion rate. Floods, earthquakes and fire were the three most commonly encountered disasters. Fifty-two percent indicated they incorporated animal welfare into their disaster planning. Thirty-one percent indicated they had no or limited legal authority to manage animal emergencies in natural disasters. The species covered in the national response plan ranged from laboratory animals at 17% to livestock at 48%. Eighty-two percent had no or limited standard operating procedures and 73% had no training to respond to animal welfare in disasters. Budgets, trained personnel, equipment/supplies and legal authority were the most frequently identified gaps

The survey demonstrated there is a wide range of European Member Countries capacity to respond to animal welfare in natural disasters. This provides the baseline for the OIE Platform for Animal Welfare Europe to provide focused and actionable support to Member Countries

Disasters have adversely affected human life since the beginning of our existence. In response, societies have attempted to improve disaster response & reduce the consequences of disasters by developing standardized organizational arrangements, often known as Incident Command Systems (ICS). These ICS response systems have a military heritage in hierarchical organizational command & control (C2) that is authoritative by nature and fits well with bureaucratic organization. While emergency service agencies have embraced ICS, other agencies often involved in community-level disaster response, such as public health, non-government organizations and community groups, have not. Although ICS have become the backbone of disaster management (DM) policy in Australia and overseas, worldwide debate over the effectiveness of ICS continues. Therefore, this study investigated ICS systems used worldwide to aid in the development of an improved conceptual framework for managing the response to modern-day disasters, for all agencies, at all levels and across all hazard types.

Phase one involved a review and critical analysis of the literature. Phase two used inductive research methods to gain a better understanding of the barriers & facilitators of ICS to the multi-agency disaster response. Two studies were conducted in this phase: Study one used semi-structured interviews with key informants involved in the 2018 Central Queensland Bushfire & 2019 North & Far North Queensland Monsoon Trough Flood & Study two participants from any disaster. Phase three undertook a policy analysis of recent disaster reviews and inquiries. This was triangulated with previous findings and presented to an expert panel by way of a 2-round modified Delphi.

The most significant outcome of this research was the improved understanding of the strengths and weaknesses of ICS within the context of multi-agency engagement in disaster management.

Development of conceptual framework based on modifications to the ICS principles and includes other phases of the DM continuum with psychological aspects taken into consideration.

The Concept of One Health is a cross-sectoral approach that aims at the protection of humans, animals, and the environment acknowledging their interconnection at a global, regional and local level.

The "One Health" approach is officially recognized by the Italian Ministry of Health, and in the Lombardy Region, which has included it as a pillar of the new reform law of the regional health system (LR n.22 of 2021). All international organizations, as a relevant strategy in all sectors, benefit from the collaboration between different disciplines (doctors, veterinarians, environmentalists, economists, sociologists, etc.).

Disseminating basic knowledge of the "One Health" public health approach among the hospital staff of the hospital’s Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location, far from urban Hospital centers and in the Alpine Mountain area.

Promoting the culture of “One Health” through a hospital information and training campaign in recognizing the health of people, animals and ecosystems are interconnected, involving the population in cultural change. To create the basis for networks of collaboration in a multidisciplinary approach, especially at the level of human-animal interface, such as the surveillance of the emerging zoonoses in the light of the climate changes, using models from research to complex networks.

Promoting the application of an approach collaborative, multidisciplinary, inter-sectorial, and coordinated to address potential or existing risks, which originate from the interface between animal-human ecosystems. To disseminate a new public health culture based on “One Health" concepts and on future planning prospects and vision to the population as well.

One Health represents a new paradigm of the vision of public health on a global level, which implies an awareness and a challenge of cultural change for the development of a more sustainable future.

On the night of October 29, 2022, a crowd crush occurred during Halloween festivities in the Itaewon neighborhood of Seoul, Korea. At least 156 people were killed and at least 173 others were injured. In this study, the author tried to learn a lesson by investigating the worldwide crowd crush disaster and analyzing the differences and results.

First, the crowd crush disasters were investigated and summarized through literature and internet searches. Second, based on this, the prevention and management of crowd crush disasters, emergency medical response, and necessary research/development contents were derived through a Delphi survey of experts.

Crowd crush disasters have been experienced from developed countries to developing countries since the 1800s. Commonly the crowd density was high, and the crowds continued to move and then the crowd collapsed above a certain limit. The biggest casualty occurred during a pilgrimage to Mecca in Saudi Arabia in 2015, but the theme of the event, such as concerts, sporting events, and funerals, was varied. Experts survey was that the manager's efforts not to increase the crowd density, and efforts to maintain order and prevent contingencies were important. They said that it is important to comply with the principles of disaster medicine, but it is difficult to access the patient in the crowd crush state, so the management of the crowd may be more important. They said that it is necessary to establish a realistic guideline and a real-time crowd density monitoring system using CCTV or drones.

Crowd crush disasters can occur in any type of crowd gathering events where the crowd density increases, and prevention through crowd management and real-time crowd density monitoring should be implemented.

Triage at mass gathering events (MGEs) has no standard protocol that is widely accepted and applied uniformly across event types and locations. This investigation describes the current state of published literature as it applies specifically to the triage of patient presentations at MGEs, and identifies key roles and important limitations of triage methods in use at events.

A literature review search strategy was employed (previously published, Turris et al, 2021) to search for event case reports published for the period from 2010-2022. Included papers were reviewed and data were extracted for all references to triage; authors were contacted for any missing details. Data extraction looked specifically for the following (if available) : triage mention, triage scale used, triage categories with patient counts, triage training and any information on clinical dispositions subsequent to triage assignment.

A total of 60 papers were included (Data extraction in progress, numbers to be finalized for presentation). Of these papers, a minority even made mention of triage, very few specified the triage scale used, and almost none described any triage training. Only a handful of case reports contained counts of patient presentation by triage categories. A couple of papers mentioned triage scales that were event type specific (sports, etc).

Published literature to date contains limited details and agreement on triage methods in use at MGEs. Methods are largely from the emergency and disaster domains. Triage utility appears generally to be limited to designating location and provider, and for a snapshot of acuity post event. The use of triage scale has not been solely predictive of the need for transfer to hospital.

The lack of planning and coordination by the mass gathering event organizers involving other stakeholders, especially from the health sector, caused mass casualty incidents which could not be managed in a timely manner and resulted in many victims. This was worsened by the fact that the nearest health facilities to the mass gathering event did not have a disaster management plan such as a hospital disaster preparedness plan which, if any, was not operational. No firm regulation forced, monitored, and evaluated the necessity of high-risk mass gathering events to have such a preparedness plan yet in Indonesia.

Using a case study qualitative research method by conducting media observations and listening to webinars on experiences with health workers involved in handling the social disaster of the Kanjuruhan tragedy. Supported by analysis of policy reviews and in-depth interviews with the involved stakeholders on the field.

This is ongoing research, the results have not been finalized. However, from the information that has been obtained so far, it can be concluded that there is no synergy between the plans prepared by the football match organizing committee, police, local government, and nearest referral health facilities. This was identified by the absence of a medical director at the referral health facility, the absence of in and out access for the medical team to the mass gathering event location, and the absence of crowd management at the site of the incident resulted in 720 injured and 135 of them dead. This made the incident the second worst football stampede incident in history.

Specific mass gathering regulation specific to football matches is required as Indonesia has a risk of hooliganism in some areas. This will be mandatory for the organizing committee to comply with and involve relevant stakeholders, especially the local health sector.

The rise of the COVID-19 pandemic caused significant concerns due to the risk of transmission in such mass gatherings. Too many variables for such a critical challenge made it more of a complex situation, with an enormous negative impact on either decision. In this paper, we aimed to summarize the experience of Saudi Arabia in hosting and managing Hajj throughout the pandemic for three seasons, the public health strategies to control the COVID-19 transmission during Hajj, and the policies and regulations that were implemented for the safe return of Hajj.

This is a summary of our experience in managing Hajj seasons throughout the COVID-19 pandemic for the period 2020, 2021, and 2022. A description of the factors, models, and tools used to assess the situation for each year, and the bundles of measures followed to mitigate the events aiming to hold a "Safe Hajj".

2020 was a unique year, with the pandemic at its height with no vaccination available. So, the decision was to hold a symbolic strict Hajj of only 1,000 pilgrims residing within Saudi Arabia. In 2021, as the World was easing restrictions and distributing vaccines, around 60,000 internal pilgrims got to perform Hajj, and 2022 hosted one million international pilgrims. That is still 40% of 2019 Hajj with 2.5 million due to considerations to avoid usual overcrowding and mandating COVID-19 full vaccination status.

Our experience with the COVID-19 pandemic over the past three years has informed us that huge MGs can be conducted safely during the pandemic if adequate measures were implemented. That would include an accurate and reliable risk assessment to inform policymakers about the most effective strategies.

The Birmingham 2022 Commonwealth Games (CWG) met the World Health Organization (WHO) definition of a mass gathering: events attended by sufficient people to strain the planning and response resources of a community, state or nation’. It was a key opportunity for the UK in terms of tourism and economy, but a major challenge in terms of the potential for adverse events e.g. infectious disease outbreaks, terrorist attacks. This increased scrutiny and threatened reputational risk. For UKHSA, as a new organization amidst a rapidly changing public health landscape–continued COVID-19 pandemic and increases in Monekypox, this was a very public test.

In 2021, a small team was established to accelerate preparation including:

• assurance structures

• advice to the Organizing Committee and Government departments

• advice on COVID-19 including testing policy

• staff/stakeholder preparation through exercising/training

• increased staff numbers and skill mix able to adapt

• budget

• operational response structure

• plans in place and tested for a health protection response in the event of an incident

• other mass gatherings reviewed for transferable learning enhanced surveillance systems

Daily epidemiology reporting provided reassurance that there were no significant public health issues requiring escalation. Enhanced surveillance provided reassurance to the community that there were no population ill effects linked to the CWG. Overall, COVID-19 positivity was low. No outbreaks were detected linked to the CWG.

The UKHSA successfully identified, planned and prepared for and mitigated the risks of a mass gathering of 1.5 million people. Early engagement, support, advice and cross- government collaboration has been regarded as exemplary with surveillance data indicating no outbreaks linked to the Games. Despite the breadth of risks visitors were able to attend the event in contrast to the restrictions placed at the Tokyo Olympics. This contributes to the worldwide body of knowledge for planning and delivering mass gatherings – sporting or otherwise.

Mass gatherings have become more frequent since the beginning of the 21st century. In Canada alone, music festival and sporting event industries will each represent yearly revenues over one billion USD by 2025. Such events require adequate medical planning, as they are associated with a greater prevalence of injuries and incidents than daily life, despite most participants having few comorbidities. Most often, the responsibility of medical planning lies with event producers. This study aims to compare the existing legislative requirements for mass gathering medical response in the ten provinces and three territories of Canada.

This study is a cross-sectional descriptive study of legislation. Lists of legislative requirements were obtained by contacting via email or phone the emergency medical services (EMS) directors and Health Ministries of all the provinces and territories of Canada, and asking about any legislation or provision within existing laws regarding mass gatherings. Simple statistics were performed to compare legislation across provinces and territories.

Data collection and analysis are planned to be completed by December 31, 2022. Initial data collection and analysis revealed that none of the seven provinces who answered our emails have provincial legislations. Two referred to specific provisions in the Public Health laws of their province, though nothing specifically refers to mass gatherings. One confirmed that mass gathering medical response was a municipal/local concern to be addressed by the event producers and the locality where the event takes place, and one referred to guidelines published in 2014.

Although some provinces and territories referred to provisions contained in public health legislation, none of the provinces reached to date could list specific legislation on mass gathering medical response. If this trend continues through full data analysis, it will highlight once more the need to provide more standardized guidance to organizers and municipalities in planning medical response.

Uncomplicated acute alcohol intoxication (UAAI) requiring medical management is common at some mass gathering events. Most of the mass gathering literature reporting on medical management involving UAAI are single case studies. The common clinical practice for UAAI at mass gatherings reported in the literature involves intravenous fluids and antiemetics. However, emergency department evidence suggests that administration of intravenous fluids does not enhance patient outcomes, and in some cases extends emergency department length of stay and costs.

Using a retrospective cohort design of routinely collected data over a nine-year period (2010-2013 and 2016-2020), this study was set at an annual end-of-year ‘schoolies’ youth mass gathering event. The primary study aim was to determine the intravenous fluid management practices of UAAI at this event. Secondary study outcomes included patient demographic, clinical characteristics, and patient outcomes. Data were analyzed using time series and descriptive statistics. Ethical approval was obtained.

In total, 378 patients were identified with UAAI at the event over the nine-year period. The median patient age was 17 years (IQR: 17-18), with 47.2% (n=179) being male. Overall, the median length of stay was 74 minutes (IQR: 40 – 144). Only 7.9% (n=30) patients received intravenous cannulation and 6.3% (n=24) patients received intravenous fluids. Proportionately, the use of intravenous fluids for the management of UAAI decreased over the study years [2010, 28.6%; 2011, 32.1%; 2012, 15.6%; 2013, 6.3%; 2016, 2.6%; 2017, 0%; 2018, 1.8%; 2019, 0%; 2020, 0%].

Some mass gathering events have a higher incidence of UAAI presentations. This is particularly true for those mass gathering events with young adults and at music festivals. Knowledge translation from the emergency department context regarding UAAI clinical management could be applied to the mass gathering event setting. This clinical management should include a conservative approach to the management of UAAI.

In recent years, unmanned aerial vehicles (UAVs) have been increasingly used for medical surveillance purposes in mass gathering events. No studies have investigated the reliability of live video transmission from UAVs for accurate identification of distressed race participants in need of medical attention. During the 2022 Montreal marathon, the aim of this study was to determine the proportion of data collection time during which live medical surveillance UAV video feed was successfully transmitted and considered of sufficient quality to identify acute illness.

Four UAVs equipped with high resolution cameras were deployed at two predefined high-risk areas for medical incidents located within the last 800m of the race. The video footage was transmitted in real-time during four consecutive hours to a remote viewing station where four research assistants monitored it on large screens. Interruptions in live feed transmission and moments with inadequate field of view on runners were documented.

On September 25, 2022, 8,577 athletes registered in the Montreal marathon and half marathon. Out of the eight hours of video footage analyzed (four hours per high-risk area), 91.7% represented uninterrupted live video feed with an adequate view of the runners passing through the high-risk areas. The total interruption time was 22 minutes and 19 seconds, and the field of view was considered inadequate for a total of 17 minutes and 33 seconds. Active surveillance of drone-captured footage allowed identification of two race participants in need of medical attention. Appropriate resources were dispatched, and UAV repositioning allowed for real-time viewing of the medical response.

Live video transmission from UAVs for medical surveillance of runners passing through higher-risk segments of a marathon race for four consecutive hours is feasible. Live feed interruptions and segments with an inadequate field of view could be minimized through practice and additional equipment redundancy.