A paramedic-staffed medical rehydration unit at a mass gathering

Heat-related illness is reported to be a significant cause of morbidity at outdoor mass gatherings during warm weather. Paramedics are traditionally present at mass gatherings to provide prehospital care for people in need.

To describe a paramedic-staffed medical rehydration unit and a new role for paramedics at a mass gathering attended by more than 450,000 people.

A 48-bed medical rehydration unit was deployed adjacent to the main field hospital. Paramedics admitted patients to the unit if they met predetermined criteria for mild to moderate heat-related illness. Each paramedic was responsible for four beds. Paramedics initiated oral and intravenous rehydration therapy by following medical directives. Emergency medical services (EMS) physicians reviewed patients before discharge.

The medical rehydration unit managed 143 patients (3/10,000 attendees). The mean number of patients admitted per hour was nine. The average age was 24 years; 103 (72%) were female. The main presenting complaint was syncope, presyncope, or dizziness in 43 (30%). Forty-four (31%) patients received parenteral and oral fluids; the remainder received oral fluids alone. The average length of stay was 94 minutes (95% CI 82-106). One hundred seven (75%) patients were discharged, 17 (12%) were transferred to the main field hospital, four (3%) left against medical advice, and two (1%) required transfer to a hospital off site. In 13 (9%) cases, records of patient disposition were incomplete.

This article defines a new role for paramedics and describes the operation of a medical rehydration unit at a large, single-day mass gathering in summer.