Related Experiment Videos
Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in
W D Weaver1, K Sutherland, M J Wirkus
1Division of Cardiology, Harborview Medical Center, Seattle.
Insights
Approximately 4 in 1,000 attendees at the 1986 Vancouver World
Area of Science:
- Emergency medicine
- Public health
- Event medical services
Background:
- Assessing emergency medical needs at large public gatherings is crucial for resource allocation and public safety.
- The 1986 World's Exposition in Vancouver provided a unique setting to study medical issues in a high-attendance event.
- Evaluating the effectiveness of lay responders and automated external defibrillators (AEDs) in mass casualty events is important.
Purpose of the Study:
- To determine the types and frequency of emergency medical problems encountered during the 1986 Vancouver World's Exposition.
- To assess the correlation between event attendance and patient load.
- To evaluate the role and effectiveness of lay personnel trained in using automated external defibrillators (AEDs).
Main Methods:
- Conducted a retrospective analysis of emergency medical cases during the exposition.
- Collected data on patient numbers, types of complaints, and referral rates.
- Documented cardiac arrest incidents and the use of AEDs by trained security personnel.
Main Results:
- An average of 3.93 emergency medical problems per 1,000 visitors were recorded, showing a linear relationship with gate attendance.
- Minor ailments constituted 95% of cases, with only 4.4% requiring further medical evaluation.
- Trained lay responders successfully used AEDs in two out of six cardiac arrest cases, resulting in survival.
Conclusions:
- The majority of medical issues at the exposition were minor and manageable by on-site medical staff.
- Automated external defibrillators are suitable for use by lay responders in event settings, improving survival rates for certain cardiac arrests.
- Effective planning and training of lay personnel can significantly enhance emergency medical response during large public events.
Abstract:
During the 1986 World's Exposition held in Vancouver, British Columbia, the types and frequencies of emergency medical problems were assessed. The average number of patients seeking care was 3.93 +/- 0.95 per 1,000 visitors (daily range, 1.94 to 6.8). Patient loads were linearly related to gate attendance, but the correlation was imperfect (P less than .001, r = .63). Only 4.4% of patients evaluated on site by nurses and paramedics were referred for additional testing and treatment: of these patients, 30% had suspected serious musculoskeletal injury, 16% had abdominal pain, and 25% had complaints of chest pain, dizziness, or loss of consciousness. Lay employees (security personnel) were trained to use automatic external defibrillators. There were six cardiac arrests (0.3 per million visitors). Two patients collapsed with ventricular fibrillation, were defibrillated by lay personnel, quickly regained consciousness, and survived. The other arrests were associated with asystole or electromechanical dissociation; no shocks were inappropriately given, and all four died. We conclude that four of every 1,000 persons at this assembly sought emergency medical care, that 95% of the problems seen were minor with few requiring physician skills, and that the automatic external defibrillator was suited for this setting and could be used by lay responders to provide early definitive treatment.