Health service impact from mass-gatherings: A systematic literature review

Mr Jamie Ranse1,2,8, A/Prof Alison Hutton2, Mr Toby Keene3,4, Mr Shane Lenson3, Mr Matt Luther5, Ms Nerolie Bost6,7, Dr Amy Johnston,6,7 A/Prof Julia Crilly6,7, Mr Matt Cannon8, Ms Nicole Jones1, Ms Courtney Hayes1, Dr Brandon Burke9

1 University of Canberra, University Drive, Bruce ACT 2617
2 Flinders University, Sturt Road, Bedford Park SA 5042
3 Australian Catholic University, Antill Street, Watson ACT 2602
4 Australian Capital Territory Ambulance Service, Amberley Avenue, Majura ACT 2609
5 Calvary Health Care ACT, Mary Potter Circuit, Bruce ACT 2617
6 Emergency Department, Gold Coast Hospital and Health Services, Hospital Boulevard, Southport QLD 4215
7 Menzies Health Institute Queensland, Griffith University, QLD 4222
8 St John Ambulance Australia (New South Wales), Burwood NSW 2134
9 Canberra Hospital, Yamba Dr, Garran ACT 2605

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass-gathering events was the focus of this literature review.

Aim: This literature review aims to develop an understanding of the impact of mass gatherings on local health services.

Method: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation and hospital utilisation.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass-gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusions: There is minimal research focusing on the impact of mass-gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass-gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass-gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum.


Jamie is currently employed as the Discipline Lead for Nursing at the University of Canberra. His research interests are in the area of disaster and mass gathering health. Jamie is currently completing a Doctor of Philosophy at Flinders University, where he is research the experience of Australian nurses who assist in the out-of-hospital disaster environment. Jamie has over 40 publications in the area of disaster and mass gathering health. Jamie is an active member of a number of national and international nursing associations. He is a Fellow of the Australian College of Nursing and College of Emergency Nursing Australasia. He is currently the chair-elect of the WADEM Mass Gathering Section.