COMPREHENSIVE REVIEW
Enhancing the Minimum Data Set for Mass-Gathering Research and Evaluation: An Integrative Literature Review Jamie Ranse, RN, FACN, FCENA, BN, GCertClinEd, GCertClinEpi, MCritCarNurs;1,2 Alison Hutton, RN, MACN, BN, Paed Cert., DipApSci(Nsg), MN, PhD;2 Sheila A. Turris, RN NP, BHSc, Emergency Cert., MSN, PhD;3 Adam Lund, FRCPC(Emergency), BSc, MD, MEd3
1. Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia 2. Flinders University, Adelaide, South Australia, Australia 3. Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, British Columbia, Canada Correspondence: Jamie Ranse, RN, FACN, FCENA, BN, GCertClinEd, GCertClinEpi, McritCarNurs University of Canberra, Faculty of Health Canberra Australian Capital Territory, Australia E-mail: [email protected] Conflicts of interest: The authors have no disclosures or conflicts of interest to report. Keywords: events; health; mass gathering; minimum data set; research Abbreviations: MDS: minimum data set PDM: prehospital and disaster medicine PPR: patient presentation rate RTHR: referral to hospital rate TTHR: transport to hospital rate Received: December 11, 2013 Revised: February 2, 2014 Accepted: February 8, 2014 Online publication: May 23, 2014 doi:10.1017/S1049023X14000429
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Abstract Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required. Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework. Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS. Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature. Ranse J, Hutton A, Turris SA, Lund A. Enhancing the minimum data set for massgathering research and evaluation: an integrative literature review. Prehosp Disaster Med. 2014;29(3):280-289.
Introduction A mass gathering can be defined as an event where a group of people come together for a common purpose within a particular space or venue. Further, a mass gathering is an event ‘‘where there is the potential for a delayed response to [health] emergencies.’’1 A number of challenges in providing adequate health care exist at a mass gathering, primarily related to the environment and patient egress.2 Health providers aim to maximize their efficiency in responding to health emergencies within the mass-gathering environment, while minimizing the disruption to the normal operational capacity of the health service in the surrounding community or region. As such, a detailed health plan for mass gatherings is vital to ensure adequate health outcomes for participants, spectators, and the broader host community. As the science underpinning mass-gathering health is developing, so are specific ways of measuring and evaluating care at these events. In 2012, a minimum data set (MDS) was proposed to facilitate the systematic data collection across events,3 leading to international dialogue on this issue.4 However, this data set was developed by the authors with an Australian focus and without significant contribution from the existing literature. Others have highlighted the need for consistency in the collection and reporting
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of data from mass gatherings.5 Given this, the purpose of this paper is to continue the discussion regarding the development of the biomedical aspects of an MDS, with contributions from the literature and applications in international settings. To assist in planning the medical support for mass gatherings, a predictive model of patient presentations that estimates the health workload has previously been reported in the literature.6 However, this model originated from one country and applies to events with $ 25,000 participants or attendees. The model has not yet been extensively tested and is now more than a decade old. Arguably, a predictive model is one way to build situational awareness of the health needs at a mass gathering, particularly when historical information pertaining to an event is not available.7 However, a predictive model needs to be refined to ensure a narrow confidence interval that will enhance accuracy and reliability. When validated, the predictive model could be used by event planners and health providers to increase their situational awareness of health needs when planning for a massgathering event. The multitude of factors that may influence health outcomes at mass gatherings should be considered in a comprehensive, allfactors approach to a larger, more comprehensive MDS. Biomedical characteristics of participants and attendees, as well as environmental, psychosocial, and health resources/support, are the broad categories that should be included. Within the abovementioned categories, it is important to explore each in detail to ensure that the larger, more comprehensive MDS is inclusive. Such data will ultimately support the development of a sophisticated, reliable, and accurate predictive model. In 2012, an MDS clearly defined for the collection of specifically biomedical data for mass-gathering health research and evaluation was proposed.3 Since this publication, the international mass-gathering community, led by members of the World Association for Disaster and Emergency Medicine, have continued a dialogue to create a comprehensive data set.4,8 This research aims to enhance the existing biomedical aspects of the Ranse and Hutton MDS proposed for mass-gathering research and evaluation in the international context.3 The desired outcome of this work is to arrive at a common language for reporting on events in order to enable data pooling which will permit analysis that crosses national boundaries, event types, and event sizes. Variability in the reporting of mass-gathering patient level characteristics is currently an impediment to meta-analysis. The prospective convergence in data variables collected through an MDS approach, or similar consensus document, would be a valuable step forward in the development of mass-gathering theory, predictive models and risk assessment, and clinical support tools. These concepts are important, but are beyond the scope of this research. Instead, this research provides a valuable step in the bigger agenda of mass-gathering theory development and understanding. Methods Design This research used an integrated literature review methodology which aims to construct new knowledge about a given topic or issue from existing literature.9 Data Collection To conduct the integrative review, manuscripts were obtained from the journal Prehospital and Disaster Medicine (PDM), June 2014
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Inclusion Criteria > >
Patient-level data Categorization of biomedical information from patient presentations at mass gatherings
Exclusion Criteria Editorials Discussion papers > Collection of biomedical information that only highlights PPR and/or TTHR > >
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Table 1. Inclusion and Exclusion Criteria Abbreviations: PPR, patient presentation rate; TTHR, transport to hospital rate.
inclusive of the period 2003 through 2013. Prehospital and Disaster Medicine is the premier journal for publications relating to mass-gathering health. A search of PDM using keywords such as ‘‘event’’ and ‘‘mass gathering’’ was conducted in the first instance. However, it was evident early in the data collection process that using these keywords did not capture relevant manuscripts regarding the reporting of biomedical patient data to support the development of an MDS. As such, the search strategy evolved to include a review of the table of contents for each issue of PDM during the review period. This step yielded 41 manuscripts suitable for review. Each manuscript was read in full, while specific inclusion and exclusion criteria were applied to determine the appropriateness of each manuscript (Table 1). Using these criteria, 22 manuscripts were excluded. A total of 19 manuscripts were deemed suitable for data analysis. Data Analysis Information from each manuscript identified was entered into a Microsoft Word 2010 table (Microsoft Corporation, Redmond, Washington USA). This information included: author(s), year of publication, country where the mass gathering took place, specific type of mass-gathering event, reported patient presentation rate (PPR), reported transfer to hospital rate (TTHR), and the number of categories or variables used to describe the presenting chief complaint of primary presenting problem. The manuscripts were further classified as using ‘‘low,’’ ‘‘medium,’’ or ‘‘high’’ levels of categorization. Ranse and Hutton3 argued that categorization exists on a continuum ranging from high (ie, very detailed) to low level (ie, general). Specifically, they proposed that high-level patient data is specific and detailed in nature (eg, ‘‘chest pain’’). In contrast, low-level patient is nonspecific and not of a detailed nature (eg, ‘‘major illness’’). Data from the 19 manuscripts were compared with the Ranse and Hutton MDS.3 The ‘‘addition’’ column of the Microsoft Word 2010 table included any identifiable differences in the biomedical patient-level categorization between the manuscripts included in this research and the MDS previously proposed by Ranse and Hutton.3 Results The findings from the first phase of data collection and analysis are highlighted in Table 2. In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the massgathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS. Prehospital and Disaster Medicine
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Discussion This review highlights that research pertaining to mass gatherings is being reported internationally, by a number of different researchers and research groups, at a variety of event types. It is reasonable to argue that if an author has included a patient-level category in the literature, it could be assumed that it is included because of clinical or medico-legal significance for that particular event or jurisdiction, and as such, may be applicable to other events. Categorization Patient-level information reported at a high level of detail provides insight into the types of patient presentations.3 High-level categorizations reduce nonspecific categories such as ‘‘other,’’ ‘‘minor,’’ or ‘‘major,’’ which have limited usefulness to the planning of health workload. A number of manuscripts reviewed in this research incorporated categories not previously outlined in the Ranse and Hutton MDS;3 these are highlighted in the ‘‘additions’’ column of Table 2. As such, the authors of this research propose to enhance the original Ranse and Hutton MDS3 by including these additions. However, it should be noted that when authors included descriptors or categories such as ‘‘dehydration’’10 or ‘‘panic attack,’’11 they were omitted from the study as these focus on diagnostic-related classification rather than a presenting problem. Similarly, categories such as ‘‘assault’’12 are not included, as this relates to a mechanism of injury rather than an injury itself. Interestingly, the diagnosis and underlying mechanism of injury or illness at mass gatherings is scantly reported in the literature. From the reviewed literature, amendments to the category of ‘‘illness’’ can include: ‘‘abdominal pain,’’13,14 ‘‘allergic reaction,’’15–18 ‘‘epistaxis,’’10,11,13,19 and ‘‘toothache (not resulting from injury).’’16,19 Additionally, a number of manuscripts included categories related to obstetric and/or gynecologicalrelated presentations. As such, obstetric and/or gynecologicalrelated presentations ought to be included as an additional medium-level classification, with higher level data including ‘‘vaginal bleeding’’16 and ‘‘other,’’13,19,20 as obstetric categories have not been included before. ‘‘Agitation’’14 and ‘‘disorientation’’14 should be added within the mental health categories. Mental health-related presentations are infrequently reported in the literature from mass-gathering events. However, the inclusion of these categories is important as on occasion, appropriate patient management requires a specific response from specific health professionals, and this should be considered in health planning for mass gatherings. Furthermore, the more specific categories relating to mental health presentations at mass gatherings will enhance the understanding of the patrons with mental health care needs. The Ranse and Hutton MDS3 does not include information pertaining to requests for ‘‘self-treatment’’ items. Self-treatment items that existed in the reviewed literature included: adhesive bandage strip/bandaids,10,14 emergency contraception,11 hearing protection,14 simple analgesia and over the counter medications,10,11,14,19 and feminine hygiene products (such as tampons and sanitary napkins).14 Additionally, from clinical experience, the authors of this review suggest the addition of sun cream/sun protection and the provision of water to be added to the list of self-treatment items. While these items seem trivial at first, they constitute a large part of the work of clinicians at mass gatherings.21 Additionally, the provisions of self-treatment items Prehospital and Disaster Medicine
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provide insight into the event participants’ own health preparedness. Prospectively, it would be reasonable to develop and evaluate strategies targeted at event participants who request items for health promotion and self-treatment. As such, the inclusion of this data would assist in the planning of these health promotion strategies and evaluation of the promotional strategy effectiveness. Referral Of the literature reviewed, the referral to hospital rate (RTHR) had been included in one previous study.22 This rate was previously proposed by Ranse and Hutton3 as an indicator for hospital workload, in addition to the frequently reported PPR and TTHR which reflect onsite and ambulance/prehospital workload, respectively. Additionally, a number of categories should be added to the referral section of the MDS that were identified in this literature review, such as: ‘‘referral to dentist’’23 and ‘‘death/deceased at the event.’’23 Minimum Data Set The newly proposed components of the MDS for mass-gathering research and evaluation (Table 3) should form the biomedical parameters within a larger, broader, and comprehensive MDS. The comprehensive MDS will include, in detail, the other factors predicting health workload and requirements at mass gatherings, such as the psychosocial, environmental, and health workforce/ resources. However, this integrative literature review has highlighted several issues for future consideration. For example, how might the current categories and classification evolve to address acuity and reduce subjectivity? Perhaps a burn might be classified in the ‘‘minor’’ category, or might belong in the ‘‘major’’ category if involving 20% of body surface area. Additionally, how might the MDS evolve to encompass mechanism of injury? The authors of this review acknowledge that moving forward, illness prevention and health promotion will continue to be highly relevant considerations for both event planners and health providers. As such, information regarding mechanism of injury may be an invaluable addition to the MDS. Limitations This research reports on the literature that was published in PDM during the review period. Other journals were considered for inclusion; however, any search strategy resulted in a hap-hazard discovery of papers. In the future, further strategies, including a broader search of the literature, should be considered to enhance this revised MDS. This may be more appropriate to the larger, broader, more comprehensive MDS. Finally, the literature reviewed is written primarily by researchers in developed nations (n 5 13). Commonly, developing nations do not have equivalencies in health infrastructure, economic resources, or trained health professionals when compared with developed nations. As such, this MDS might not apply in the context of developing nations. Conclusion This manuscript reviews the Ranse and Hutton MDS3 for biomedical data collection for mass-gathering health research and evaluation, to ensure it is contemporary, comprehensive, and complete. As a result of this literature review, 16 high-level additional patient categories have been added to the original data set. As a result, this new proposed MDS is more comprehensive and is recommended as the new standard as a MDS for Vol. 29, No. 3
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biomedical research and evaluation at mass gatherings. It is emphasized that this MDS forms one factor within a larger, broader, more comprehensive MDS, to predict health workload
at mass-gathering events. The other factors of this more comprehensive MDS should include psychosocial, environmental, and health workforce/resources.
References 1. Arbon P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131-135. 2. Ranse J, Zeitz K. Chain of survival at mass gatherings: a case series of resuscitation events. Prehosp Disaster Med. 2010;25(5):457-463. 3. Ranse J, Hutton A. Minimum data set for mass-gathering health research and evaluation: a discussion paper. Prehosp Disaster Med. 2012;27(6):543-550. 4. Ranse J, Hutton A. Author reply: minimum data set for mass-gatherings health research and evaluation: the beginning of an international dialogue. Prehosp Disaster Med. 2013;28(2):3. 5. Lund A, Turris SA, Amiri N, et al. Mass-gathering medicine: creation of an online event and patient registry. Prehosp Disaster Med. 2012;27(6):601-611. 6. Arbon P, Bridgewater H, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disaster Med. 2001;16(3): 109-116. 7. 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. 8. Turris SA, Lund A. Minimum data set for mass-gatherings health research and evaluation: a response. Prehosp Disaster Med. 2013;28(2):1-3. 9. Torraco RJ. Writing integrative literature reviews: guidelines and examples. Human Res Dev Rev. 2005;4(3):356-367. 10. Nguyen RB, Milsten AM, Cushman JT. Injury patterns and levels of care at a marathon. Prehosp Disaster Med. 2008;23(6):519-525. 11. McQueen CP. Care of children at a large outdoor music festival in the United Kingdom. Prehosp Disaster Med. 2010;25(3):223-226. 12. Hiltunen T, Kuisma M, Ma¨a¨tta¨ T, et al. Prehospital emergency care and medical preparedness for the 2005 World Championship Games in Athletics in Helsinki. Prehosp Disaster Med. 2007;22(4):304-311. 13. Milsten AM, Seaman KG, Liu P, et al. Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings. Prehosp Disaster Med. 2003;18(4):334-346. 14. Krul J, Sanou B, Swart EL, Girbes ARJ. Medical care at mass gatherings: emergency medical services at large-scale rave events. Prehosp Disaster Med. 2012;27(1):71-74. 15. Thierbach AR, Wolcke BB, Piepho T, et al. Medical support for children’s mass gatherings. Prehosp Disaster Med. 2003;18(1):14-19.
16. Grant WD, Nacca NE, Prince LA, Scott JM. Mass-gathering medical care: retrospective analysis of patient presentations over five years at a multi-day mass gathering. Prehosp Disaster Med. 2010;25(2):183-187. 17. Hardcastle TC, Samlal S, Naidoo R, et al. A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 stadium in Durban. Prehosp Disaster Med. 2012;27(5):409-415. 18. Pakravan AH, West RJ, Hodgkinson DW. Suffolk Show 2011: prehospital medical coverage in a mass-gathering event. Prehosp Disaster Med. 2013;28(5):529-532. 19. Tyner SE, Hennessy L, Coombs LJ, Fizzell J. Analysis of presentations to on-site medical units during World Youth Day 2008. Prehosp Disaster Med. 2012;27(6): 595-600. 20. Morimura N, Katsumi A, Koido Y, et al. Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan. Prehosp Disaster Med. 2004;19(3):278-284. 21. Turris SA, Lund A. Triage during mass gatherings. Prehosp Disaster Med. 2012; 27(6):531-535. 22. Gutman SJ, Lund A, Turris SA. Medical support for the 2009 World Police and Fire Games: a descriptive analysis of a large-scale participation event and its impact. Prehosp Disaster Med. 2011;26(1):33-40. 23. Krul J, Girbes ARJ. Experience of health-related problems during house parties in the Netherlands: nine years of experience and three million visitors. Prehosp Disaster Med. 2009;24(2):133-139. 24. Feldman MJ, Lukins JL, Verbeek PR, et al. Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event. Prehosp Disaster Med. 2004;19(4):287-296. 25. Olapade-Olaopa EO, Alonge TO, Amanor-Boadu SD, et al. On-site physicians at a major sporting event in Nigeria. Prehosp Disaster Med. 2006;21(1):40-44. 26. Yazawa K, Kamijo Y, Sakai R, et al. Medical care for a mass gathering: the Suwa Onbashira Festival. Prehosp Disaster Med. 2007;22(5):431-435. 27. Burton JO, Corry S, Lewis G, Priestman WS. Differences in medical care usage between two mass-gathering sporting events. Prehosp Disaster Med. 2012;27(5): 458-462. 28. Bortolin M, Ulla M, Bono A, et al. Holy shroud exhibition 2010: health services during a mass-gathering event. Prehosp Disaster Med. 2013;28(3):239-244. 29. Smith WP, Tuffin H, Stratton SJ, Wallis LA. Validation of a modified medical resource model for mass gatherings. Prehosp Disaster Med. 2013;1(1):1-7.
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Author/s Milsten et al
13
Event Type
PPR
TTHR
Categorization
Additions
United States of America
Various: baseball, football, rock concerts
6.1/1,000
Not reported
High 33 categories
Epistaxsis Gastrointestinal complaints Obstetrics/gynecology
Germany
Fun fair
19.2/10,000
Not reported
Low – Medium 7 categories
Allergic reaction
Canada
Rock concert
4.2/10,000
0.5/10,000
Low – Medium 9 categories
Korea/Japan
Soccer World Cup
1.21/1,000
0.05/1,000
Medium – High 18 categories
Nigeria
Major sporting event
2.1/1,000
Not reported
Low 3 categories
–
(2007)
Finland
World championship games in athletics
16.0/10,000
0.52/10,000
Medium – High 16 categories
–
(2007)
Japan
Log rolling festival
1.32/10,000
0.035/10,000
Low 5 categories
–
(2008)
United States of America
Marathon
Not reported
15.0/10,000
Medium – High 19 categories
Epistaxis Request for self-treatment: - Bandage request - Medication request
Netherlands
Rave party
59.0-170.0/10,000
Not reported
High 32 categories
Death Referral to dentist
United States of America
Fair
4.8/10,000
2.7/10,000
High 36 categories
Allergic reaction Toothache Vaginal bleeding
United Kingdom
Outdoor music festival
Not reported
Not reported
Medium – High 24 categories
Emergency contraception Epistaxis Paracetamol request
Canada
World police and fire games
109.4/1,000
0.52/1,000
Medium 8 categories
–
Netherlands
Rave party
Not reported
Not reported
Low 6 categories
Agitation Disorientation Gastric/stomach ache Request for self-treatment: - Analgesia - Band_aids - Hearing protection - Sanitary napkins - Tampons
(2003)
Thierbach et al
Feldman et al
Nation
15
24
Morimura et al
(2003)
(2004)
20
(2004)
Olapade-Olaopa et al
Hiltunen et al
Yazawa et al
Nguyen et al
12
26
10
Krul & Girbes 16
Grant et al
McQueen
11
23
(2010)
22
(2011)
(2012)
(2006)
Obstetrics/gynecology
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Table 2. Review of the Literature (continued)
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14
(2009)
(2010)
Gutman et al
Krul et al
25
–
17
Hardcastle et al
Burton et al
Tyner et al
27
19
Bortolin et al
(2012)
(2012)
28
Pakravan et al
Smith et al
29
(2012)
(2013) 18
(2013)
(2013)
Nation
Event Type
PPR
TTHR
Categorization
Additions
South Africa
Soccer World Cup
0.48/10,000
0.09/10,000
Low – Medium 14 categories
Allergic reaction
United Kingdom
Rugby and horse races
1.9-4.7/10,000
Not reported
Low – Medium 13 categories
Australia
World Youth Day 2008
Not reported
Not reported
High 34 categories
Italy
The Holy Shroud Exhibition 2010
0.27/1,000
0.039/1,000
Low 8 categories
England
Suffolk Show – agricultural show
2.0/1,000
0.1/1,000
Low – Medium 8 categories
England and South Africa
Various
Not reported
Not reported
Low 3 categories
–
Epistaxis Gynecological Medication request Toothache
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Author/s
–
Allergic reaction
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Table 2 (continued). Review of the Literature Abbreviations: PPR, patient presentation rate; TTHR, transport to hospital rate.
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DEMOGRAPHICS Individual
Date of Birth Gender
Reason at Event
Presentation
yyyy/mm/dd 1
Male
2
Female
1
Participant
2
Spectator
3
Official
4
Other
Date
yyyy/mm/dd
Time
24-hour clock
Discharge/Referral Time
24-hour clock
PRESENTATION TYPE 1
Injury
2
Illness
3
Environmental
4
Mental Health
5
Self-treatment
1
Fracture
2
Dislocation
3
Crushing Injury
4
Traumatic Amputation
5
Intracranial Injury (including concussion)
6
Injury to Internal Organ
7
Drowning, Immersion
8
Asphyxia (or other threat to breathing)
9
Burn or Corrosion
10
Electrical Injury
Soft Tissue
11
Sprain or Strain
Wound
12
Blister
13
Abrasion
14
Superficial Laceration
15
Open Wound
16
Other Minor Wound
17
Eye Injury
18
Dental Injury
INJURY Major Injury
Minor Injury
Face Specific
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Table 3. Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review (continued) Prehospital and Disaster Medicine
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287 Foreign Body
Review of Injury Multiple Injuries
19
Foreign Body (in external eye)
20
Foreign Body (in ear canal)
21
Foreign Body (in nose)
22
Foreign Body (in respiratory tract)
23
Foreign Body (in alimentary tract)
24
Foreign Body (in genitourinary tract)
25
Foreign Body (in soft tissue)
26
Foreign Body, Other/Unspecified
27
Review of Injury
28
Injuries of More than One ‘‘Nature’’
1
Head
2
Face
3
Neck
4
Spine
5
Back
6
Thorax
7
Abdomen
8
Pelvis
9
Shoulder
10
Upper Arm
11
Elbow
12
Forearm
13
Wrist
14
Hand
15
Thigh
16
Knee
17
Lower Leg
18
Ankle
19
Foot
20
Multiple Locations
1
Cardiac Arrest
2
Chest Pain
3
Other
INJURY LOCATION Location
Limb
ILLNESS Major
Cardiac
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review. June 2014
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Mass-gathering Data Collection Respiratory
Neurological
Gastrointestinal
Obstetrics Gynaecology
Minor
4
Respiratory Arrest
5
Asthma
6
Other
7
Seizure
8
Collapse, Unspecified
9
Nausea/Vomiting
10
Diarrhoea
11
Abdominal Pain
12
Diabetes related
13
Vaginal Bleeding
14
Other
15
Headache
16
Skin/Rash
17
Allergic Reaction
18
Fever
19
Pain
20
Epistaxis
21
Eye
22
Ear
23
Toothache (not from trauma)
24
Faint
25
Other
1
Sunburn
2
Exhaustion
3
Stroke
4
Hypothermia
5
Frostbite
6
Bite or Sting
7
Envenomation
8
Alcohol Related
9
Substance Related
10
Both Substance and Alcohol Related
ENVIRONMENTAL Heat Related
Cold Related
Bites and Stings
Drug Related
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review.
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MENTAL HEALTH 1
Agitation
2
Anxiety
3
Disorientation
4
Panic Attack
5
Other Psychiatric Disorder
1
Adhesive Bandage Strip/Bandaid
2
Emergency Contraception
3
Hearing Protection
4
Simple Analgesia
5
Sun Protection/Sun Cream
6
Tampons/Sanitary Napkins
7
Water
1
Hospital by Ambulance
2
Hospital by Own Arrangements
3
Referred to Doctor
4
Referred to Dentist
5
Not Referred (returned to event/returned to work)
6
Refused Treatment
7
Death /Deceased at the Event
SELF TREATMENT
OUTCOME Referred to Further Health Treatment
Not Referred
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review.
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Prehospital and Disaster Medicine
Enhancing the Minimum Data Set for Mass-Gathering Research and Evaluation: An Integrative Literature Review Jamie Ranse, RN, FACN, FCENA, BN, GCertClinEd, GCertClinEpi, MCritCarNurs;1,2 Alison Hutton, RN, MACN, BN, Paed Cert., DipApSci(Nsg), MN, PhD;2 Sheila A. Turris, RN NP, BHSc, Emergency Cert., MSN, PhD;3 Adam Lund, FRCPC(Emergency), BSc, MD, MEd3
1. Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia 2. Flinders University, Adelaide, South Australia, Australia 3. Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, British Columbia, Canada Correspondence: Jamie Ranse, RN, FACN, FCENA, BN, GCertClinEd, GCertClinEpi, McritCarNurs University of Canberra, Faculty of Health Canberra Australian Capital Territory, Australia E-mail: [email protected] Conflicts of interest: The authors have no disclosures or conflicts of interest to report. Keywords: events; health; mass gathering; minimum data set; research Abbreviations: MDS: minimum data set PDM: prehospital and disaster medicine PPR: patient presentation rate RTHR: referral to hospital rate TTHR: transport to hospital rate Received: December 11, 2013 Revised: February 2, 2014 Accepted: February 8, 2014 Online publication: May 23, 2014 doi:10.1017/S1049023X14000429
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Abstract Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required. Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework. Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS. Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature. Ranse J, Hutton A, Turris SA, Lund A. Enhancing the minimum data set for massgathering research and evaluation: an integrative literature review. Prehosp Disaster Med. 2014;29(3):280-289.
Introduction A mass gathering can be defined as an event where a group of people come together for a common purpose within a particular space or venue. Further, a mass gathering is an event ‘‘where there is the potential for a delayed response to [health] emergencies.’’1 A number of challenges in providing adequate health care exist at a mass gathering, primarily related to the environment and patient egress.2 Health providers aim to maximize their efficiency in responding to health emergencies within the mass-gathering environment, while minimizing the disruption to the normal operational capacity of the health service in the surrounding community or region. As such, a detailed health plan for mass gatherings is vital to ensure adequate health outcomes for participants, spectators, and the broader host community. As the science underpinning mass-gathering health is developing, so are specific ways of measuring and evaluating care at these events. In 2012, a minimum data set (MDS) was proposed to facilitate the systematic data collection across events,3 leading to international dialogue on this issue.4 However, this data set was developed by the authors with an Australian focus and without significant contribution from the existing literature. Others have highlighted the need for consistency in the collection and reporting
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of data from mass gatherings.5 Given this, the purpose of this paper is to continue the discussion regarding the development of the biomedical aspects of an MDS, with contributions from the literature and applications in international settings. To assist in planning the medical support for mass gatherings, a predictive model of patient presentations that estimates the health workload has previously been reported in the literature.6 However, this model originated from one country and applies to events with $ 25,000 participants or attendees. The model has not yet been extensively tested and is now more than a decade old. Arguably, a predictive model is one way to build situational awareness of the health needs at a mass gathering, particularly when historical information pertaining to an event is not available.7 However, a predictive model needs to be refined to ensure a narrow confidence interval that will enhance accuracy and reliability. When validated, the predictive model could be used by event planners and health providers to increase their situational awareness of health needs when planning for a massgathering event. The multitude of factors that may influence health outcomes at mass gatherings should be considered in a comprehensive, allfactors approach to a larger, more comprehensive MDS. Biomedical characteristics of participants and attendees, as well as environmental, psychosocial, and health resources/support, are the broad categories that should be included. Within the abovementioned categories, it is important to explore each in detail to ensure that the larger, more comprehensive MDS is inclusive. Such data will ultimately support the development of a sophisticated, reliable, and accurate predictive model. In 2012, an MDS clearly defined for the collection of specifically biomedical data for mass-gathering health research and evaluation was proposed.3 Since this publication, the international mass-gathering community, led by members of the World Association for Disaster and Emergency Medicine, have continued a dialogue to create a comprehensive data set.4,8 This research aims to enhance the existing biomedical aspects of the Ranse and Hutton MDS proposed for mass-gathering research and evaluation in the international context.3 The desired outcome of this work is to arrive at a common language for reporting on events in order to enable data pooling which will permit analysis that crosses national boundaries, event types, and event sizes. Variability in the reporting of mass-gathering patient level characteristics is currently an impediment to meta-analysis. The prospective convergence in data variables collected through an MDS approach, or similar consensus document, would be a valuable step forward in the development of mass-gathering theory, predictive models and risk assessment, and clinical support tools. These concepts are important, but are beyond the scope of this research. Instead, this research provides a valuable step in the bigger agenda of mass-gathering theory development and understanding. Methods Design This research used an integrated literature review methodology which aims to construct new knowledge about a given topic or issue from existing literature.9 Data Collection To conduct the integrative review, manuscripts were obtained from the journal Prehospital and Disaster Medicine (PDM), June 2014
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Inclusion Criteria > >
Patient-level data Categorization of biomedical information from patient presentations at mass gatherings
Exclusion Criteria Editorials Discussion papers > Collection of biomedical information that only highlights PPR and/or TTHR > >
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Table 1. Inclusion and Exclusion Criteria Abbreviations: PPR, patient presentation rate; TTHR, transport to hospital rate.
inclusive of the period 2003 through 2013. Prehospital and Disaster Medicine is the premier journal for publications relating to mass-gathering health. A search of PDM using keywords such as ‘‘event’’ and ‘‘mass gathering’’ was conducted in the first instance. However, it was evident early in the data collection process that using these keywords did not capture relevant manuscripts regarding the reporting of biomedical patient data to support the development of an MDS. As such, the search strategy evolved to include a review of the table of contents for each issue of PDM during the review period. This step yielded 41 manuscripts suitable for review. Each manuscript was read in full, while specific inclusion and exclusion criteria were applied to determine the appropriateness of each manuscript (Table 1). Using these criteria, 22 manuscripts were excluded. A total of 19 manuscripts were deemed suitable for data analysis. Data Analysis Information from each manuscript identified was entered into a Microsoft Word 2010 table (Microsoft Corporation, Redmond, Washington USA). This information included: author(s), year of publication, country where the mass gathering took place, specific type of mass-gathering event, reported patient presentation rate (PPR), reported transfer to hospital rate (TTHR), and the number of categories or variables used to describe the presenting chief complaint of primary presenting problem. The manuscripts were further classified as using ‘‘low,’’ ‘‘medium,’’ or ‘‘high’’ levels of categorization. Ranse and Hutton3 argued that categorization exists on a continuum ranging from high (ie, very detailed) to low level (ie, general). Specifically, they proposed that high-level patient data is specific and detailed in nature (eg, ‘‘chest pain’’). In contrast, low-level patient is nonspecific and not of a detailed nature (eg, ‘‘major illness’’). Data from the 19 manuscripts were compared with the Ranse and Hutton MDS.3 The ‘‘addition’’ column of the Microsoft Word 2010 table included any identifiable differences in the biomedical patient-level categorization between the manuscripts included in this research and the MDS previously proposed by Ranse and Hutton.3 Results The findings from the first phase of data collection and analysis are highlighted in Table 2. In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the massgathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS. Prehospital and Disaster Medicine
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Discussion This review highlights that research pertaining to mass gatherings is being reported internationally, by a number of different researchers and research groups, at a variety of event types. It is reasonable to argue that if an author has included a patient-level category in the literature, it could be assumed that it is included because of clinical or medico-legal significance for that particular event or jurisdiction, and as such, may be applicable to other events. Categorization Patient-level information reported at a high level of detail provides insight into the types of patient presentations.3 High-level categorizations reduce nonspecific categories such as ‘‘other,’’ ‘‘minor,’’ or ‘‘major,’’ which have limited usefulness to the planning of health workload. A number of manuscripts reviewed in this research incorporated categories not previously outlined in the Ranse and Hutton MDS;3 these are highlighted in the ‘‘additions’’ column of Table 2. As such, the authors of this research propose to enhance the original Ranse and Hutton MDS3 by including these additions. However, it should be noted that when authors included descriptors or categories such as ‘‘dehydration’’10 or ‘‘panic attack,’’11 they were omitted from the study as these focus on diagnostic-related classification rather than a presenting problem. Similarly, categories such as ‘‘assault’’12 are not included, as this relates to a mechanism of injury rather than an injury itself. Interestingly, the diagnosis and underlying mechanism of injury or illness at mass gatherings is scantly reported in the literature. From the reviewed literature, amendments to the category of ‘‘illness’’ can include: ‘‘abdominal pain,’’13,14 ‘‘allergic reaction,’’15–18 ‘‘epistaxis,’’10,11,13,19 and ‘‘toothache (not resulting from injury).’’16,19 Additionally, a number of manuscripts included categories related to obstetric and/or gynecologicalrelated presentations. As such, obstetric and/or gynecologicalrelated presentations ought to be included as an additional medium-level classification, with higher level data including ‘‘vaginal bleeding’’16 and ‘‘other,’’13,19,20 as obstetric categories have not been included before. ‘‘Agitation’’14 and ‘‘disorientation’’14 should be added within the mental health categories. Mental health-related presentations are infrequently reported in the literature from mass-gathering events. However, the inclusion of these categories is important as on occasion, appropriate patient management requires a specific response from specific health professionals, and this should be considered in health planning for mass gatherings. Furthermore, the more specific categories relating to mental health presentations at mass gatherings will enhance the understanding of the patrons with mental health care needs. The Ranse and Hutton MDS3 does not include information pertaining to requests for ‘‘self-treatment’’ items. Self-treatment items that existed in the reviewed literature included: adhesive bandage strip/bandaids,10,14 emergency contraception,11 hearing protection,14 simple analgesia and over the counter medications,10,11,14,19 and feminine hygiene products (such as tampons and sanitary napkins).14 Additionally, from clinical experience, the authors of this review suggest the addition of sun cream/sun protection and the provision of water to be added to the list of self-treatment items. While these items seem trivial at first, they constitute a large part of the work of clinicians at mass gatherings.21 Additionally, the provisions of self-treatment items Prehospital and Disaster Medicine
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provide insight into the event participants’ own health preparedness. Prospectively, it would be reasonable to develop and evaluate strategies targeted at event participants who request items for health promotion and self-treatment. As such, the inclusion of this data would assist in the planning of these health promotion strategies and evaluation of the promotional strategy effectiveness. Referral Of the literature reviewed, the referral to hospital rate (RTHR) had been included in one previous study.22 This rate was previously proposed by Ranse and Hutton3 as an indicator for hospital workload, in addition to the frequently reported PPR and TTHR which reflect onsite and ambulance/prehospital workload, respectively. Additionally, a number of categories should be added to the referral section of the MDS that were identified in this literature review, such as: ‘‘referral to dentist’’23 and ‘‘death/deceased at the event.’’23 Minimum Data Set The newly proposed components of the MDS for mass-gathering research and evaluation (Table 3) should form the biomedical parameters within a larger, broader, and comprehensive MDS. The comprehensive MDS will include, in detail, the other factors predicting health workload and requirements at mass gatherings, such as the psychosocial, environmental, and health workforce/ resources. However, this integrative literature review has highlighted several issues for future consideration. For example, how might the current categories and classification evolve to address acuity and reduce subjectivity? Perhaps a burn might be classified in the ‘‘minor’’ category, or might belong in the ‘‘major’’ category if involving 20% of body surface area. Additionally, how might the MDS evolve to encompass mechanism of injury? The authors of this review acknowledge that moving forward, illness prevention and health promotion will continue to be highly relevant considerations for both event planners and health providers. As such, information regarding mechanism of injury may be an invaluable addition to the MDS. Limitations This research reports on the literature that was published in PDM during the review period. Other journals were considered for inclusion; however, any search strategy resulted in a hap-hazard discovery of papers. In the future, further strategies, including a broader search of the literature, should be considered to enhance this revised MDS. This may be more appropriate to the larger, broader, more comprehensive MDS. Finally, the literature reviewed is written primarily by researchers in developed nations (n 5 13). Commonly, developing nations do not have equivalencies in health infrastructure, economic resources, or trained health professionals when compared with developed nations. As such, this MDS might not apply in the context of developing nations. Conclusion This manuscript reviews the Ranse and Hutton MDS3 for biomedical data collection for mass-gathering health research and evaluation, to ensure it is contemporary, comprehensive, and complete. As a result of this literature review, 16 high-level additional patient categories have been added to the original data set. As a result, this new proposed MDS is more comprehensive and is recommended as the new standard as a MDS for Vol. 29, No. 3
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biomedical research and evaluation at mass gatherings. It is emphasized that this MDS forms one factor within a larger, broader, more comprehensive MDS, to predict health workload
at mass-gathering events. The other factors of this more comprehensive MDS should include psychosocial, environmental, and health workforce/resources.
References 1. Arbon P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131-135. 2. Ranse J, Zeitz K. Chain of survival at mass gatherings: a case series of resuscitation events. Prehosp Disaster Med. 2010;25(5):457-463. 3. Ranse J, Hutton A. Minimum data set for mass-gathering health research and evaluation: a discussion paper. Prehosp Disaster Med. 2012;27(6):543-550. 4. Ranse J, Hutton A. Author reply: minimum data set for mass-gatherings health research and evaluation: the beginning of an international dialogue. Prehosp Disaster Med. 2013;28(2):3. 5. Lund A, Turris SA, Amiri N, et al. Mass-gathering medicine: creation of an online event and patient registry. Prehosp Disaster Med. 2012;27(6):601-611. 6. Arbon P, Bridgewater H, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disaster Med. 2001;16(3): 109-116. 7. 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. 8. Turris SA, Lund A. Minimum data set for mass-gatherings health research and evaluation: a response. Prehosp Disaster Med. 2013;28(2):1-3. 9. Torraco RJ. Writing integrative literature reviews: guidelines and examples. Human Res Dev Rev. 2005;4(3):356-367. 10. Nguyen RB, Milsten AM, Cushman JT. Injury patterns and levels of care at a marathon. Prehosp Disaster Med. 2008;23(6):519-525. 11. McQueen CP. Care of children at a large outdoor music festival in the United Kingdom. Prehosp Disaster Med. 2010;25(3):223-226. 12. Hiltunen T, Kuisma M, Ma¨a¨tta¨ T, et al. Prehospital emergency care and medical preparedness for the 2005 World Championship Games in Athletics in Helsinki. Prehosp Disaster Med. 2007;22(4):304-311. 13. Milsten AM, Seaman KG, Liu P, et al. Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings. Prehosp Disaster Med. 2003;18(4):334-346. 14. Krul J, Sanou B, Swart EL, Girbes ARJ. Medical care at mass gatherings: emergency medical services at large-scale rave events. Prehosp Disaster Med. 2012;27(1):71-74. 15. Thierbach AR, Wolcke BB, Piepho T, et al. Medical support for children’s mass gatherings. Prehosp Disaster Med. 2003;18(1):14-19.
16. Grant WD, Nacca NE, Prince LA, Scott JM. Mass-gathering medical care: retrospective analysis of patient presentations over five years at a multi-day mass gathering. Prehosp Disaster Med. 2010;25(2):183-187. 17. Hardcastle TC, Samlal S, Naidoo R, et al. A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 stadium in Durban. Prehosp Disaster Med. 2012;27(5):409-415. 18. Pakravan AH, West RJ, Hodgkinson DW. Suffolk Show 2011: prehospital medical coverage in a mass-gathering event. Prehosp Disaster Med. 2013;28(5):529-532. 19. Tyner SE, Hennessy L, Coombs LJ, Fizzell J. Analysis of presentations to on-site medical units during World Youth Day 2008. Prehosp Disaster Med. 2012;27(6): 595-600. 20. Morimura N, Katsumi A, Koido Y, et al. Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan. Prehosp Disaster Med. 2004;19(3):278-284. 21. Turris SA, Lund A. Triage during mass gatherings. Prehosp Disaster Med. 2012; 27(6):531-535. 22. Gutman SJ, Lund A, Turris SA. Medical support for the 2009 World Police and Fire Games: a descriptive analysis of a large-scale participation event and its impact. Prehosp Disaster Med. 2011;26(1):33-40. 23. Krul J, Girbes ARJ. Experience of health-related problems during house parties in the Netherlands: nine years of experience and three million visitors. Prehosp Disaster Med. 2009;24(2):133-139. 24. Feldman MJ, Lukins JL, Verbeek PR, et al. Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event. Prehosp Disaster Med. 2004;19(4):287-296. 25. Olapade-Olaopa EO, Alonge TO, Amanor-Boadu SD, et al. On-site physicians at a major sporting event in Nigeria. Prehosp Disaster Med. 2006;21(1):40-44. 26. Yazawa K, Kamijo Y, Sakai R, et al. Medical care for a mass gathering: the Suwa Onbashira Festival. Prehosp Disaster Med. 2007;22(5):431-435. 27. Burton JO, Corry S, Lewis G, Priestman WS. Differences in medical care usage between two mass-gathering sporting events. Prehosp Disaster Med. 2012;27(5): 458-462. 28. Bortolin M, Ulla M, Bono A, et al. Holy shroud exhibition 2010: health services during a mass-gathering event. Prehosp Disaster Med. 2013;28(3):239-244. 29. Smith WP, Tuffin H, Stratton SJ, Wallis LA. Validation of a modified medical resource model for mass gatherings. Prehosp Disaster Med. 2013;1(1):1-7.
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Author/s Milsten et al
13
Event Type
PPR
TTHR
Categorization
Additions
United States of America
Various: baseball, football, rock concerts
6.1/1,000
Not reported
High 33 categories
Epistaxsis Gastrointestinal complaints Obstetrics/gynecology
Germany
Fun fair
19.2/10,000
Not reported
Low – Medium 7 categories
Allergic reaction
Canada
Rock concert
4.2/10,000
0.5/10,000
Low – Medium 9 categories
Korea/Japan
Soccer World Cup
1.21/1,000
0.05/1,000
Medium – High 18 categories
Nigeria
Major sporting event
2.1/1,000
Not reported
Low 3 categories
–
(2007)
Finland
World championship games in athletics
16.0/10,000
0.52/10,000
Medium – High 16 categories
–
(2007)
Japan
Log rolling festival
1.32/10,000
0.035/10,000
Low 5 categories
–
(2008)
United States of America
Marathon
Not reported
15.0/10,000
Medium – High 19 categories
Epistaxis Request for self-treatment: - Bandage request - Medication request
Netherlands
Rave party
59.0-170.0/10,000
Not reported
High 32 categories
Death Referral to dentist
United States of America
Fair
4.8/10,000
2.7/10,000
High 36 categories
Allergic reaction Toothache Vaginal bleeding
United Kingdom
Outdoor music festival
Not reported
Not reported
Medium – High 24 categories
Emergency contraception Epistaxis Paracetamol request
Canada
World police and fire games
109.4/1,000
0.52/1,000
Medium 8 categories
–
Netherlands
Rave party
Not reported
Not reported
Low 6 categories
Agitation Disorientation Gastric/stomach ache Request for self-treatment: - Analgesia - Band_aids - Hearing protection - Sanitary napkins - Tampons
(2003)
Thierbach et al
Feldman et al
Nation
15
24
Morimura et al
(2003)
(2004)
20
(2004)
Olapade-Olaopa et al
Hiltunen et al
Yazawa et al
Nguyen et al
12
26
10
Krul & Girbes 16
Grant et al
McQueen
11
23
(2010)
22
(2011)
(2012)
(2006)
Obstetrics/gynecology
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Table 2. Review of the Literature (continued)
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14
(2009)
(2010)
Gutman et al
Krul et al
25
–
17
Hardcastle et al
Burton et al
Tyner et al
27
19
Bortolin et al
(2012)
(2012)
28
Pakravan et al
Smith et al
29
(2012)
(2013) 18
(2013)
(2013)
Nation
Event Type
PPR
TTHR
Categorization
Additions
South Africa
Soccer World Cup
0.48/10,000
0.09/10,000
Low – Medium 14 categories
Allergic reaction
United Kingdom
Rugby and horse races
1.9-4.7/10,000
Not reported
Low – Medium 13 categories
Australia
World Youth Day 2008
Not reported
Not reported
High 34 categories
Italy
The Holy Shroud Exhibition 2010
0.27/1,000
0.039/1,000
Low 8 categories
England
Suffolk Show – agricultural show
2.0/1,000
0.1/1,000
Low – Medium 8 categories
England and South Africa
Various
Not reported
Not reported
Low 3 categories
–
Epistaxis Gynecological Medication request Toothache
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Author/s
–
Allergic reaction
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Table 2 (continued). Review of the Literature Abbreviations: PPR, patient presentation rate; TTHR, transport to hospital rate.
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DEMOGRAPHICS Individual
Date of Birth Gender
Reason at Event
Presentation
yyyy/mm/dd 1
Male
2
Female
1
Participant
2
Spectator
3
Official
4
Other
Date
yyyy/mm/dd
Time
24-hour clock
Discharge/Referral Time
24-hour clock
PRESENTATION TYPE 1
Injury
2
Illness
3
Environmental
4
Mental Health
5
Self-treatment
1
Fracture
2
Dislocation
3
Crushing Injury
4
Traumatic Amputation
5
Intracranial Injury (including concussion)
6
Injury to Internal Organ
7
Drowning, Immersion
8
Asphyxia (or other threat to breathing)
9
Burn or Corrosion
10
Electrical Injury
Soft Tissue
11
Sprain or Strain
Wound
12
Blister
13
Abrasion
14
Superficial Laceration
15
Open Wound
16
Other Minor Wound
17
Eye Injury
18
Dental Injury
INJURY Major Injury
Minor Injury
Face Specific
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Table 3. Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review (continued) Prehospital and Disaster Medicine
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287 Foreign Body
Review of Injury Multiple Injuries
19
Foreign Body (in external eye)
20
Foreign Body (in ear canal)
21
Foreign Body (in nose)
22
Foreign Body (in respiratory tract)
23
Foreign Body (in alimentary tract)
24
Foreign Body (in genitourinary tract)
25
Foreign Body (in soft tissue)
26
Foreign Body, Other/Unspecified
27
Review of Injury
28
Injuries of More than One ‘‘Nature’’
1
Head
2
Face
3
Neck
4
Spine
5
Back
6
Thorax
7
Abdomen
8
Pelvis
9
Shoulder
10
Upper Arm
11
Elbow
12
Forearm
13
Wrist
14
Hand
15
Thigh
16
Knee
17
Lower Leg
18
Ankle
19
Foot
20
Multiple Locations
1
Cardiac Arrest
2
Chest Pain
3
Other
INJURY LOCATION Location
Limb
ILLNESS Major
Cardiac
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review. June 2014
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Mass-gathering Data Collection Respiratory
Neurological
Gastrointestinal
Obstetrics Gynaecology
Minor
4
Respiratory Arrest
5
Asthma
6
Other
7
Seizure
8
Collapse, Unspecified
9
Nausea/Vomiting
10
Diarrhoea
11
Abdominal Pain
12
Diabetes related
13
Vaginal Bleeding
14
Other
15
Headache
16
Skin/Rash
17
Allergic Reaction
18
Fever
19
Pain
20
Epistaxis
21
Eye
22
Ear
23
Toothache (not from trauma)
24
Faint
25
Other
1
Sunburn
2
Exhaustion
3
Stroke
4
Hypothermia
5
Frostbite
6
Bite or Sting
7
Envenomation
8
Alcohol Related
9
Substance Related
10
Both Substance and Alcohol Related
ENVIRONMENTAL Heat Related
Cold Related
Bites and Stings
Drug Related
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review.
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MENTAL HEALTH 1
Agitation
2
Anxiety
3
Disorientation
4
Panic Attack
5
Other Psychiatric Disorder
1
Adhesive Bandage Strip/Bandaid
2
Emergency Contraception
3
Hearing Protection
4
Simple Analgesia
5
Sun Protection/Sun Cream
6
Tampons/Sanitary Napkins
7
Water
1
Hospital by Ambulance
2
Hospital by Own Arrangements
3
Referred to Doctor
4
Referred to Dentist
5
Not Referred (returned to event/returned to work)
6
Refused Treatment
7
Death /Deceased at the Event
SELF TREATMENT
OUTCOME Referred to Further Health Treatment
Not Referred
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Table 3 (continued). Patient data set and entry codes. Items in italic relate to items that have been added as a result of this literature review.
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