Design and practice of medical service for the main venue of the 19th Hangzhou Asian Games / 中华急诊医学杂志

Objective:To clarify the medical security plan and its practical effects at the main venue of the 19th Hangzhou Asian Games.Methods:The plan described the medical security implementation plan of the main venue of the 19th Asian Games in Hangzhou (organizational management and operation mechanism, medical security operation system, standardized training and support processes, application of Asian Games intelligent first aid security system, and so on). And through high-facticity simulation verify the operation effect of the main venue's medical support (team mode and response time). Finally, the feasibility and effectiveness of the medical security program verified through the effect of medical services (quantity, disease types, transfers, etc.) during the Asian Games and Asian Paralympic Games.Results:The medical security team of the main venue of the 19th Hangzhou Asian Games included the management team and the operation team, of which consisted of 44 medical staffs (22 doctors and 22 nurses); and were deployed to 16 different security positions. It was also accompanied with 16 volunteers to assist medical staff to transport patients. In addition, a total of 300 medical observers were enrolled in audience area to assist rapid identification, intervention, and collaborative diagnosis and treatment with the medical team. Medical security teams were arranged to cover all the audience areas who can arrive at the patient's area within 2 minutes after receiving orders, transfer the patient to the ambulance’s site in 8 minutes, and transport the patient to a designated hospital within 10-20 minutes. During the Asian Games and Asian Paralympic Games, the medical-care team treated a total of 3 742 patients, including 9 patients transported from medical service sites of the audience area to the stadium infirmary, as well as 83 patients referred to the designated hospital.Conclusions:The medical security implementation plan for the main venues of the Asian Games provides good medical security for the Asian Games and Asian Paralympic Games. It also provides theoretical and practical experience for the development of the medical security system for international events in future.

Multi-source surveillance conducted by the Tokyo Metropolitan Government during the Tokyo 2020 Olympic and Paralympic Games

@#The Tokyo 2020 Olympic and Paralympic Games (the Games) were held from 23 July to 5 September 2021 in Tokyo, Japan, after a 1-year delay due to the coronavirus disease (COVID-19) pandemic. The Tokyo Metropolitan Government was responsible for monitoring and responding to infectious disease outbreaks other than COVID-19 during the Games. A multi-source surveillance system was used from 1 July to 12 September 2021 for the early detection and rapid response to infectious diseases. This included routine notifiable disease surveillance, sentinel surveillance, syndromic surveillance, cluster surveillance, ambulance transfer surveillance and the Tokyo Infectious Alert system. Daily reports were disseminated summarizing the data collected from the multi-source surveillance system. No case of infectious disease under the Tokyo Metropolitan Government system required a response during the Games. The multi-source surveillance was useful for providing intelligence during the Games and, if required, could contribute to the early detection and rapid response to outbreaks during other mass gatherings. The system could be improved to overcome the challenges implied by the findings of this multi-source surveillance.

Medical planning for mass gathering sports events in brazil / Planificación médica para eventos deportivos masivos en brasil / Planejamento médico para eventos esportivos de massa no brasil

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

RESUMEN Introducción: La planificación médica de eventos masivos tiene como pilares la estructuración de la atención a la población involucrada y la preservación de las capacidades de respuesta del sistema local de salud. Los grandes eventos deportivos a los que asisten multitudes son cada vez más comunes en la sociedad. Estos eventos han demostrado ser peligrosos, generando una mayor incidencia de lesiones y enfermedades de lo habitual. Por lo tanto, es necesaria la planificación y la interacción de diversos sectores, públicos y privados, para la prevención y respuesta a emergencias o incidentes con múltiples víctimas. Métodos: Se seleccionaron estudios recientes publicados sobre la planificación médica de grandes eventos deportivos y la legislación vigente en organismos federales con el objetivo de realizar una revisión actualizada sobre el tema. Resultados: Después de leer los títulos y resúmenes, se eligieron 159 artículos para lectura completa y 50 cumplieron los criterios de elegibilidad y se utilizaron como base para esta revisión. El tamaño del público, las condiciones climáticas y el comportamiento de la multitud parecen contribuir significativamente a la estimación de los requisitos de recursos en los eventos deportivos. Conclusión: Los eventos masivos requieren una planificación para la prevención y el fortalecimiento de la resiliencia de las comunidades anfitrionas. Todavía no hay pruebas de que estos eventos aumenten el riesgo de propagación masiva de enfermedades. Nivel de Evidencia: V; Opinión experta .

RESUMO Introdução: O planejamento médico para eventos de massa tem como pilares a estruturação dos atendimentos à população envolvida e a preservação da capacidade de resposta do sistema de saúde local. Grandes eventos esportivos frequentados por multidões são cada vez mais comuns na sociedade. Esses eventos têm se mostrado perigosos, gerando maiores incidências de lesões e doenças do que o habitual. Dessa forma, é necessário planejamento e interação de diversos setores, públicos e privados, para prevenção e resposta à ocorrência de emergências ou incidentes com múltiplas vítimas. Métodos: Foram selecionados trabalhos recentes publicados sobre o planejamento médico para grandes eventos esportivos e a legislação vigente em órgãos federais com o objetivo de realizar uma revisão atualizada sobre o assunto. Resultados: Após a leitura de títulos e resumos, 159 trabalhos foram escolhidos para leitura integral e 50 preencheram os critérios de elegibilidade e foram usados como base para esta revisão. O tamanho do público, as condições climáticas e o comportamento da multidão parecem contribuir significativamente para a estimativa da necessidade de recursos em eventos esportivos. Conclusão: Eventos de massa exigem planejamento para prevenção e fortalecimento da resiliência das comunidades anfitriãs. Ainda faltam evidências de que esses eventos aumentem o risco de propagação maciça de doenças. Nível de evidência: V; Opinião do especialista .

Global warming and the Summer Olympic and Paralympic games: a perspective from the Tokyo 2020 Games

The Tokyo 2020 Olympic and Paralympic Games provided a significant opportunity to consider global warming as an issue to be seriously addressed to run the safe and fair games in the era of climate change. As the global temperature continuously rises and extreme hot-weather events increase in frequency and intensity, the future summer Olympic and Paralympic games will need to deal with the heat by applying thorough and appropriate countermeasures. In the recent decades, many mitigation measures to protect athletes from heat have been rapidly discussed by the sports community, including countermeasures to hold games at times and places with moderate temperature and climatic risk assessments with Wet Bulb Globe Temperature (WBGT) during the games. However, the excessive heat conditions in the Tokyo 2020 Games affected not only athletes, but also all people concerned the events. While deliberate considerations by organizers had been given to mitigate extraordinary heat, the evaluations of these measures and epidemiological analyses of risk factors of patients must be further enhanced to develop efficient measures for the future. Therefore, we discussed the underlying climate-related problems of the summer Olympic and Paralympic Games in view of what we had experienced in the Tokyo 2020 Games. Facing with emerging global warming, future intervention against heat in the summer Olympic and Paralympic games will need to integrate systematic disease surveillance and evaluation of intervention with an effective combination with the approaches previously conducted. The Tokyo 2020 Games is a wake-up call to accelerate the public health measures towards the creeping global warming.

Use of Epidemic Intelligence from Open Sources for global event-based surveillance of infectious diseases for the Tokyo 2020 Olympic and Paralympic Games

@#The establishment of enhanced surveillance systems for mass gatherings to detect infectious diseases that may be imported during an event is recommended. The World Health Organization Regional Office for the Western Pacific contributed to enhanced event-based surveillance for the Tokyo 2020 Olympic and Paralympic Games (the Games) by using Epidemic Intelligence from Open Sources (EIOS) to detect potential imported diseases and report them to the National Institute of Infectious Diseases (NIID), Japan. Daily screening of media articles on global infectious diseases was conducted using EIOS, which were systematically assessed to determine the likelihood of disease importation, spread and significant impact to Japan during the Games. Over 81 days of surveillance, 103 830 articles were screened by EIOS, of which 5441 (5.2%) met the selection criteria for initial assessment, with 587 (0.6%) assessed as signals and reported to NIID. None of the signals were considered to pose a significant risk to the Games based on three risk assessment criteria. While EIOS successfully captured media articles on infectious diseases with a likelihood of importation to and spread in Japan, a significant manual effort was required to assess the articles for duplicates and against the risk assessment criteria. Continued improvement of artificial intelligence is recommended to reduce this effort.

Health risks of selected mass gatherings in the Philippines in 2015 and implications for public health preparedness

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Mass gatherings (MG) are events that draw together a large number of people in one or several occasions happening in single or multiple places for a definite period of time. These can lead to different public health risks through exposure to infectious diseases, trauma, and environmental factors. The Philippine Department of Health (DOH) in 2015 participated in special planned events that constituted mass gatherings namely the Asia- Pacific Economic Cooperation (APEC) meetings, the Black Nazarene procession, and the Papal Visit.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to describe the different health risks arising from the three (3) identified mass gathering events in the Philippines in 2015 and relate them to public health preparedness.</p><p style="text-align: justify;"><strong>METHODS:</strong> This was a descriptive study of the health risks arising from the MG events. Sources of data were reports submitted by deployed medical teams to the Operations Center (Opcen) that closely monitored the MG.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The study found infectious causes, trauma, temperature-related conditions, and noncommunicable diseases to be the important categories of health risks in the specified mass gatherings. These validated the common health risk categories observed in previously well-studied mass gatherings.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The study highlighted important health risks and factors for consideration in public health preparedness for mass gatherings in terms of appropriate and effective public health strategies that should be established to minimize health risks and reduce health system impacts of mass gatherings.</p>

Epidemiology of vaccine-preventable diseases in Japan: considerations for pre-travel advice for the 2019 Rugby World Cup and 2020 Summer Olympic and Paralympic Games

Introduction@#In 2019 and 2020, Japan will host two international sporting events estimated to draw a combined 22 million visitors. Mass gatherings like these ones increase the risk of spread of infectious disease outbreaks and international transmission. Pre-travel advice reduces that risk. @*Methods@#To assist ministries of health and related organizations in developing pre-travel advice, we summarized national surveillance data in Japan (2000–2016, to the extent available) for rubella, invasive pneumococcal disease, measles, non-A and non-E viral hepatitis, hepatitis A, invasive Haemophilus influenzae disease, tetanus, typhoid fever, invasive meningococcal disease, Japanese encephalitis, influenza, varicella, mumps and pertussis by calculating descriptive statistics of reported cases and reviewing trends. (See Annex A for details of reviewed diseases.)@*Results@#Our findings showed notable incidences of rubella (1.78 per 100 000 person-years), influenza (243.5 cases per sentinel site), and mumps (40.1 per sentinel site); seasonal increases for influenza (November–May) and Japanese encephalitis (August–November); and a geographical concentration of Japanese encephalitis in western Japan. Measles cases decreased from 11 013 in 2008 to 35 in 2015, but outbreaks (n = 165 cases) associated with importation occurred in 2016. Though invasive meningococcal disease incidence was only 0.03 per 100 000, international transmission occurred at a mass gathering in Japan in 2015.@*Discussion@#Ministries of health and related organizations should use these findings to develop targeted pre-travel advice for travellers to the 2019 Rugby World Cup and the 2020 Summer Olympic and Paralympic Games, especially for mumps, measles, rubella, influenza, and meningitis. Travellers with increased exposure risk should also be advised about hepatitis A and Japanese encephalitis.

Cricket worldcup: a stress test for the surveillance system in the Caribbean / La copa mundial de críquet: un test de estrés para el sistema de vigilancia en el Caribe

OBJECTIVE: To describe the development and implementation of, and major findings and recommendations from, a regional mass gathering surveillance system (MGSS) in support of the International Cricket Council Cricket World C up West Indies 2007. METHODS: The regional MGSS was developed by the Caribbean Epidemiology Centre (CAREC) and its member countries as an adaptation of the routine communicable disease surveillance system in order to rapidly detect unusual disease events during the tournament. The implementation of the MGSS required the identification of additional human and financial resources, capacity building activities, laboratory strengthening, and improved global epidemic surveillance and communication mechanisms. RESULTS: Timeliness and completeness of data reporting in the MGSS were both > 85%. No unusual pathogens were identified in the region during the tournament. Only dengue and influenza, both endemic to the region, were identified. The early alert detection software used identified a total of 24 aberrations from seven countries, the largest proportions being gastroenteritis, fever and respiratory symptoms and injuries. All aberrations were promptly investigated and most were found to be false alerts. Three unusual disease events were detected, all from one country. They were responded to in a timely manner and did not adversely affect the tournament. CONCLUSIONS: The surveillance capacities gained in preparing for, and supporting, the tournament assisted in strengthening and testing the already existing national and regional communicable disease surveillance systems. Events such as these should be utilized to strengthen already existing surveillance systems, which should be flexible enough to respond to changing events.

OBJETIVO: Describir el desarrollo e implementación, así como los hallazgos principales y las recomendaciones de un sistema de vigilancia regional de eventos masivos (MGSS), en apoyo al Consejo Internacional de Críquet en la Copa Mundial de Críquet de West Indies 2007. MÉTODOS: El sistema de vigilancia regional de eventos masivos, conocido por sus siglas en inglés MGSS, fue desarrollado por el Centro de Epidemiología del Caribe (CAREC) y sus países miembros, como una adaptación del sistema de vigilancia rutinaria de enfermedades comunicables a fin de detectar rápidamente manifestaciones inusuales de enfermedades durante el torneo. La implementación del MSGS requirió la identificación de recursos humanos y financieros adicionales, actividades de construcción de capacidades, fortalecimiento de los laboratorios, así como el mejoramiento de la vigilancia epidemiológica y los mecanismos de comunicación globales. RESULTADOS: La calidad del reporte de los datos en cuanto a su integridad y disponibilidad en tiempo y forma fue en ambos casos > 85%. No se identificaron patógenos raros en la región durante el torneo. Sólo el dengue y la influenza, ambos endémicos de la región, fueron identificados. El software de detección y alerta tempranosutilizado, identificó un total de 24 anomalías de 7 países, entre las cuales la gastroenteritis, los síntomas febriles y respiratorios, y las lesiones, alcanzaron las mayores proporciones. Todas las anomalías fueron investigadas rápidamente y en la mayor parte de los casos se encontró que se trataba de falsas alarmas. Se detectaron tres manifestaciones patológicas inusuales, todas de un mismo país. A todas se les dio respuesta oportuna, y no afectaron adversamente el curso del torneo. CONCLUSIONES: Las capacidades de vigilancia desarrolladas en la preparación y apoyo al torneo, contribuyeron a fortalecer y a poner a prueba los sistemas nacionales y regionales ya existentes para la vigilancia de enfermedades comunicables. Debe utilizarse eventos como éstos, a fin de fortalecer los sistemas de vigilancia ya existentes, y hacerlos suficientemente flexibles para responder a las condiciones cambiantes en eventos futuros.

Medical services during the 24th summer universiade.

Background: International sports competitions are one of the mass gathering events which require a well-planned medical care system for large numbers of participants. The Universiade, the World University Games, is organized for university athletes every two years. Methods: The medical service organization was presented and the medical care for injuries and illnesses provided during the 24th Summer Universiade were described. Results: During 1 to 23 August 2007, a total of 5,641 patients aged 12-89 years (including 1,700 athletes) received medical care. There were 2,535 cases (44.9%) using the Athletes’ Village Polyclinic, 2,755 cases (48.8%) using the on-site medical units, and 351 cases (6.2%) using Thammasat Hospital. For the patients presented at the Athletes’ Village Polyclinic, muscle strain was the most common injury (n=287, 34.1%), and musculoskeletal system problems were the most common illnesses (n= 484, 27.33%). Nineteen patients required hospital admission at Thammasat Hospital. Conclusion: This information might be useful for planning medical services in international multi-sport competitions in the future.

Medical care delivery at the Beijing 2008 Olympic Games / 世界急诊医学杂志（英文）

BACKGROUND: Beijing successfully hosted the 2008 Olympic Games, and the services including medical services were widely appreciated by both participants and visitors. We retrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs, and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would be useful for planning strategies for managing mass gatherings. METHODS: Medical encounter forms filled during the Beijing 2008 Olympic Games were retrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation and diagnostic categories. RESULTS: A total of 22892 medical encounters were documented during the Beijing 2008 Olympic Games. Among them, 10549 (46.08％) involved the workforce, 3365 (14.70％) athletes, 3019 (13.19％) spectators, 585 (2.56％) members of the media, 1065 (4.65％) VIPs, and 4309 (18.82％) others. Of the 22892 cases, physical injury accounted for 27.90％ (6386), respiratory disease 18.21％ (4169), and heat-related illnesses 2.68％ (615). CONCLUSIONS: Preparations of the medical service for the Beijing 2008 Olympic Games were made for 7 years, and the service provided has been praised worldwide. This study provides valuable information that may be useful for planning medical services for upcoming Olympic Games, including the London 2012 Olympic Games and other mass gatherings.