Prehospital and Disaster Medicine

Comprehensive Review

A Systematic Review of Noncommunicable Health Issues in Mass Gatherings

Ahmed H. Alquthamia1 c1 and Jesse M. Pinesa2

a1 Department of Health Services Administration and Leadership, George Washington University, Washington, DC USA and Civil Defense Aviation, Mekkah Province, Kingdom of Saudi Arabia

a2 Department of Emergency Medicine and Health Policy, George Washington University, Washington, DC USA


Introduction The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.

Methods A systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.

Results Across all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.

Conclusions The rate of noncommunicable health issues varies across events and very serious emergencies are rare.

AH Alquthami, JM Pines. A systematic review of noncommunicable health issues in mass gatherings. Prehosp Disaster Med. 2014;29(2):1-9 .

(Received April 19 2013)

(Revised August 28 2013)

(Accepted August 29 2013)

(Online publication February 28 2014)


  • mass-gathering medicine;
  • medical usage rate;
  • patient presentation rate;
  • transport to hospital rate


  • AHRQ:Agency for Healthcare Research and Quality;
  • CPR:cardiopulmonary resuscitationl;
  • ICU:intensive care unit;
  • MG:mass gathering;
  • MUR:medical usage rate;
  • NLM:National Library of Medicine;
  • PPR:patient presentation rate;
  • PRISMA:Preferred Reporting Items for Systematic Review and Meta-analysis;
  • TTHR:transfer to hospital rate;
  • WHO:World Health Organization


c1 Correspondence: Ahmed H. Alquthami, MD, MHSA 1301 N. Troy Street #05 Arlington, VA 22201 USA E-mail


  Conflicts of interest: The authors have no disclosures or conflicts of interest to report.