Our findings show that the workloads of both the EMS and the rescue services increased during MG events, peaking especially in the evening and at night. The results showed a statistically significant increase in violence-related missions and the traffic accident and other accident/injury categories during the MG events. According to the urgency categories, urgent C-level missions increased the RR and non-urgent category D missions decreased the RR during the events. This affects the initial response efficiency, as urgent missions have shorter response time windows than non-urgent missions. The geospatial analysis revealed hotspots of EMS missions in the vicinity of the event area, as well as an increase in missions between the venue and the city centre. This study revealed information about EMS and rescue services’ workloads during MGs in a completely new level of detail.
Our results confirm previous findings that showed that most missions during MG events are allocated to EMS, whereas the increase in the rescue service workload is minor [1, 6]. Furthermore, previous studies support the finding that MG events impact local healthcare resources [2, 3, 31, 38]. According to our findings, the increase in missions is higher in rural areas than in big cities. This is another aspect that requires attention when considering the need for preparedness, as local resources are typically scaled for their usual population. In this study, the highest increase in workload occurred in the location in which the population was the smallest. As resources in smaller settlements may be more easily overwhelmed than in bigger cities, event organizers’ own levels of preparedness need special focus and attention. This conclusion is supported by previous studies indicating that austere environments also create a need for stronger preparedness for event organizers [6, 30].
A closer investigation of mission causes showed that the RR was highest for violence-related missions. Traffic accidents and other accidents and injuries, including intoxications, also increased. Previous studies have shown that the presence of alcohol and drugs increases the need for medical care [3, 13, 15, 20, 21, 24, 32, 33], whereas on-site medical care [9,10,11,12,13, 31] and alcohol sobering-up facilities [18] decrease the need for outside medical care. A recent study suggested, with an 86% consensus, that in the largest and highest-risk events, event organizers should be required to arrange on-site professional medical services and limit volunteer-based care. However, the expert board did not reach consensus about the event’s professional healthcare operator also participating in the treatment of emergency patients. In other words, treatment of major/life-threatening injuries should be performed by the EMS despite the level of on-site medical care [39]. An increased workload for police is deducible from the high increase in violence-related missions; this has also been recognized in previous studies [1, 4].
The geospatial analysis revealed dense concentrations of EMS missions in the outskirts of the event areas. These hotspots were more visible in the venues outside city centres, as there was also a concentration of missions in the reference data. In addition, in some cases, there was an increase in missions in the geographical area between the event area and the city centre hotspots. Our findings also showed that the workloads peaked at certain times of day, especially at night-time in the vicinity of the event area. According to previous studies, authorities need to pre-allocate additional resources for MG events, but this preparedness should concentrate on the outskirts of the event area [6, 39].
Strengths and limitations
Using the mission data, we were able to obtain comprehensive information on the EMS and rescue service workloads during MG events. The mission volume, profiles and timestamps were accurate numeric information, which gave more precise results than prior qualitative studies.
Our study included only two of the three major emergency services authorities because police mission data with no EMS participation was not included in the study due to data availability and confidentiality. Despite this limitation, our results indicated an increase in violence-related missions. Investigation of police forces’ workloads could thus give additional valuable information for better overall emergency services preparedness. Unit-specific information was unavailable in our data; therefore, the selection of the responsible authority between the EMS and rescue services was done based on the mission code. In Finland, both EMS and rescue services occasionally respond to each other’s missions. Such mission types are for different types of accidents. In some mission types, such as house fires with no casualties, EMS are dispatched in a work safety role. Rescue services may be used in medical emergencies in the first responder role. Many EMS and rescue service mission types involve both authorities. Therefore, in the general analysis, all missions including both authorities were included in the five-category classification.
The results of this study provide detailed information on the EMS and rescue service workload during MG events. This information can be utilized in the preparedness and resource planning stages of MG events. The use of statistical and geospatial methods enabled the analysis of accurate and adequate resource deployment in the correct geographical locations in the right time window. This effective and sufficient resource deployment enforces the level of service during MG events and may improve opportunities to respond to emergencies.
Outcome measures, such as delay in routine missions and mortality and morbidity during the event, were not included in this study, which may be considered a limitation for the importance of this study. In addition, X-percentage (no transportation to hospital with ambulance) would give valuable and more detailed information on the mission profiles. However, the dataset used in this study contained only city, dispatch time, mission code and GIS information.