The ‘ins and outs’ of the sports physician’s role in pre-hospital medical care for mass gatherings

Sport and Exercise Medicine: The UK trainee perspective, a monthly blog series

By Dr Amir Pakravan

sports medicine and pre-hospital medical care

As the number of sports physicians providing medical care in the pre-hospital environment for mass gatherings is increasing, it is  important to share both resources and experiential information about this type of work.

‘A mass gathering’ is a public event attended by large number of people, often in excess of 20,000. There are, however, significant differences between different types of mass gathering. This depends on a variety of factors such as: size and duration of the event, demographics, venue, weather, crowd intentions and presence of alcohol.

Sports physicians likely provide crowd assistance in certain sporting events, either as a designated crowd doctor or occasionally doubled up as the event or team doctor.

In this role, a sport physician is expected to be able to work efficiently alongside a much bigger team of care providers. This includes: paramedics, nurses, and first aiders with varying levels of experience and expertise from different organisations such as local ambulance services, St John’s Ambulance and the Red Cross.

A crowd or event physician is further expected to understand responsibilities and scope of services provided by different members of the larger emergency response team such as Police and Fire services.  Familiarity with the venue and local hospitals and emergency services is always a bonus but regardless, one should enquire and learn about specific information such as access routes, and importantly, the venue major incident plan.

In case of a major incident, the crowd or event physician will often act as the initial Medical Incident Commander and as such must be familiar with relevant responsibilities in relation to Ambulance Incident Commander, Police and Fire services.

Many of these responsibilities require skills and knowledge beyond those used on a daily basis by a sport and exercise medicine physician.

A sound knowledge and experience of pre-hospital practice is essential. In the majority of cases you may be dealing with minor injuries and ailments, but nonetheless, accepting the role of a crowd or event doctor is not to be taken lightly. Emergency preparedness is of the utmost importance.

Many retrospective and stratification methods predict the potential medical workload for different types of mass gatherings. Still, there is an apparent lack of sufficient analytical data and mass gathering research is still developing.

As “event doctor” is touched on in the specialty-training curriculum, colleagues may expect a familiarity with this role. However, before deeply venturing into this area, I recommend talking to your peers in the field, and tapping into a variety of available resources gain a more comprehensive perspective.

Further reading:

  1. The Green Guide: Guide to Safety at Sports Grounds.
  2. Arbon P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131-135.
  3. Milsten AM, Maguire BJ, Bissell RA, et al. Mass-gathering medical care: a review of the literature. Prehosp Disaster Med. 2002;17(3):151-162.
  4. Bhangu A, Agar C, Pickard L, Leary A. The Villa Park experience: crowd consultations at an English Premiership football stadium, season 2007-8. Emerg Med J. 2010 Jun;27(6):424-9.
  5. Roberts DM, Blackwell TH, Marx JA. Emergency medical care for spectators attending National Football League games. Prehosp Emerg Care. 1997 Jul-Sep;1(3):149-55.
  6. 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.
  7. Faculty of Pre-Hospital Care.



Dr Amir Pakravan is a Sport & Exercise Medicine Registrar.  He works in elite sport and has experience working both as a crowd and event doctor.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

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