Special Events and Mass Gatherings: A Preparedness Perspective

By Steven Alles, MD, MS, MFA, Bioterrorism and Public Health Preparedness Manager, Philadelphia Department of Public Health, and Sarah Getachew, NACCHO Program Analyst

OLYMPUS DIGITAL CAMERAThousands of special events and mass gatherings (e.g. conventions, sporting events, community based festivals, and parades) take place throughout the year in the U.S. These events can bring hundreds of thousands of people into one place, and therefore present significant challenges for preparedness planning and emergency response. High concentrations of people may overwhelm local resources and staff capacity, and magnify the effects of natural disasters and diseases outbreaks. Events designated as National Special Security Events (NSSEs) by the President or Secretary of Homeland Security as nationally or internationally significant ― with the potential to be a target for terrorism ― present especially substantial nuances in ensuring the public’s safety.

Successful pre-incident planning and emergency response where local, state, regional, and federal authorities come together to support the unique security, public health, and logistical issues characterized by special events is crucial. During these large-scale events, local health departments (LHDs) play a major role in public health and disease surveillance, including monitoring multiple potential risk factors, such as the time of year (weather and seasonal infectious diseases), type of event, duration of the event, and the age and nature of the crowd.

One recent example of effective preparation and response for a special event is the work of the Philadelphia Department of Public Health (PHDP) during the 2016 Democratic National Convention (DNC).  The 2016 DNC, from July 25 – July 28 in Philadelphia, PA, attracted high-profile guests, including the Democratic Party nominee, the President and Vice President of the United States, the First Lady, delegates of the Democratic Party, members of Congress, leaders of national organizations, and celebrity supporters. Also attending were thousands of supporters, protesters, reporters, and many others. PDPH was tasked with understanding and planning for the environmental and psycho-social factors that influenced the health and safety of all conference attendees and the general public.

The PDPH staff worked with local, regional, and federal partners to ensure a coordinated response throughout the DNC, mitigating any potential threat or risk. Disease surveillance, a core function of PDPH, was enhanced and implemented in partnership with surrounding states and cities to produce two daily regional disease surveillance reports. These reports were analyzed and interpreted to understand if diseases being reported were seasonal, or caused by the inflow of convention attendees. Health advisories were also issued to surrounding hotels that described what illnesses and symptoms to monitor and instructions on how to report cases to the local health department. Due to the potential security threats brought on by such a high profile event, PDPH also planned for emergency mass prophylaxis or prevention of widespread disease. An effort made possible through a collaborative relationship with a local pharmacy chain included ordering 10,000 doses of doxycycline, an antibiotic commonly used to treat severe infections, to have on standby should anything happen. Restaurant and kitchen inspections were also conducted by PDPH to ensure food safety for many of the convention attendees.

Most notably, PDPH worked closely with its well-trained Medical Reserve Corps (MRC). Fifty Philadelphia-based MRC volunteers were deployed to support PDPH staff at medical stations covering the convention venue and surrounding areas throughout five days. Given that July is one of the hottest months in Philadelphia, and the heightened risk of violence from protest activities, PDPH preparedness staff worked closely with the Philadelphia Fire Department and Police Department to improve security and accountability for deployed staff and volunteers. Throughout the five-day convention, over 200 patients were assisted at the medical stations, with the most commonly reported symptoms including dehydration and dizziness.

The examples above illustrate only a few ways PDPH prevented and addressed various health risks during the DNC. Like PDPH, many LHDs are tasked with effectively preparing for and ensuring public health and safety at special events and mass gatherings. A factor that underscores the importance of ensuring LHD staff understand the scope of largescale events, by receiving appropriate training and simulation practice, expanding existing preparedness plans, and strategizing for possible security threats and disease outbreaks.

One particularly useful resource for LHDs related to special event preparedness is the Technical Resources, Assistance Center, and Information Exchange (TRACIE). This healthcare emergency preparedness information gateway, sponsored by the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR), provides guidance and tools to help improve preparedness, response and recovery, and mitigation efforts. TRACIE’s Topic Collection: Mass Gatherings/Special Events features an abundance of resources supporting special events preparedness efforts.

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