Medical care at long duration mass gatherings: is the Seville 92 Expo a useful model for Saragossa ’08?

Moreno Millán E, Raposo Triano MF, Álvarez Leiva C

Introduction: Long duration mass gatherings involve possible risks. To avoid negative

consequences to the local health care system an inclusive medical attention model

should be established in this setting. We present the planning, management and results

obtained from the emergency medical system developed for the coverage of the

Universal Exhibition of Seville (EXPO’92).

Methodology: after analyzing the data of previous exhibitions we forecasted that the

complexity of the demand for health care would be low. The prediction was for a

young and healthy crowd of spectators, a frequentation ratio between 1.8-2.4 consultations

per 1,000 visitors with a 97% problem solving capacity, and a 2% hospital remission

rate. Considering those circumstances a primary care center (PCC), including

stabilization and observation areas, and five peripheral units located strategically near

the pavilions or more dangerous areas were built.

Results: During the 176 days of the EXPO’92 82,748 people received medical attention

(470 people/day [range 211-760]) and the frequentation ratio was 1.98/1,000.

Among the cases assisted 92.5% were mild, 82.1% of patients were 10-49 years old,

only 6.8% were > 60 years old, and 56.9% were women. The cause of seeking attention

was significant disease in 64.7%, and accidental injury in 30.4%. Among all cases

68.5% were visitors, 30.7% workers, and 82% Spaniards. Saturdays were the days with

the highest level of work intensity and the most frequent pathology was mild trauma

(32.7%). 1,726 patients were assisted at the PCC (9.8 per day, 2.08% of all the people

who needed assistance); mean length of stay was 91 minutes and 30.8% were older

than 50 years. Among the 552 patients evacuated 222 were hospitalized and 61 admitted

to the ICU. Two patients died in the EXPO’92 area and 6 more at the hospital.

Discussion and conclusions: The specific location of the emergency care system made

immediate attention of patients possible. Different management of the most seriously

ill at the different PPC areas facilitated specific treatment. The number of consultations,

their low complexity, the solving capacity and the amount of people remitted to hospitals

met our expectations, in conjunction with a very low frequentation (0.2%). The

existence of critical pathology, however, required constant presence of Emergency Medicine

experts. This model is perfectly exportable to other events, such as the next Saragossa

EXPO’08.

Moreno Millán E, Raposo Triano MF, Álvarez Leiva C