The Emergency Medical Services Delivery in Mass Gathering Events: A Case Study of the Hajj

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Saudi Digital Library
The increasing ease of travel has meant that mass gatherings occur more frequently in today's world; they have also increased in size and magnitude. Mass gatherings can be organized/regular events or non-organized/irregular events, local or international, and peaceful or conflict oriented. One of the best well-known of these international mass-gathering events is the Hajj (or pilgrimage to Mecca), which occurs annually and involves more than three million people who come to a defined area within a very well-known schedule to perform a set of specific Islamic rituals. Over its long history, the Hajj has been prone to many documented risks ─ ¬either security-related risks, health-related, or others ─ attributed to factors such as transportation, human mistakes, interstate tensions, and misunderstandings due to its diverse international attendance. Several instances happened in the past when those risks materialized, as attested by various historical accounts. It is in this context that studying the response of public health and emergency organizations in these mass-gathering events can generate knowledge for improving the safety of those attending these types of events. The current study focuses on investigating the emergency medical services delivery system in the Hajj sites to reveal the factors associated with the EMS systems’ successes and failures during both regular times and emergencies. The study includes 5 aims: 1) revealing factors affecting the EMS providers’ response within the Hajj mass gathering context, 2) understanding the mechanism by which those factors interplay with EMS, 3) describing the demands for the emergency medical services, 4) analyzing the EMS systems’ performance indicators and examining the relationship between the EMS response time (RT: the primary indicator for the performance) and covariates germane to EMS cases, and 5) developing a theoretical framework for explaining EMS in mass gatherings. A mixed-method research design is developed with multiple data collection approaches: mainly the EMS providers’ interviews and records of reported patients. An extensive set of analyses toolkits was utilized, including two qualitative analyses, geographical information analysis, and multilevel modeling (MLM). The multi-methods here are complementary approaches that yield a fuller picture of the phenomenon under this research and serve different study aims. The qualitative analysis narrative, serving aims 1 and 2, highlights several factors affecting the EMS in the Hajj mass gathering. The most important of them are traffic control points, the language barriers, the lack of medical history, and the high demand of non-emergency cases. The MLM shows EMS call processing and ambulance traffic time are significantly associated with an increase in the RT averages in the Hajj, while being a walk-in case is significantly associated with a decrease in the RT averages (all have p < 0.001). The study’s inductive theoretical framework explains the medical services at mass gatherings and how milieus of demands, participating organizations and institutions, and activities and decision-making shape the EMS. The study concludes with suggestions to improve the EMS practice in mass gathering events. Calibrating the planned operations to the event contexts and the attendees’ health profile and collective behavior; and discussing the detailed plans with other participating organizations to develop mutual agreements and conflict resolution protocols are pivotal strategies for well-planned and coordinated EMS operations and responses. Researchers examining EMS and patients' demands in the mass gatherings should consider conducting empirical studies with an interdisciplinary research orientation.