Medical personnel without adequate facilities are significantly limited in what they can do for patients at an event. A paramedic carrying a trauma bag who finds a patient in cardiac arrest in the middle of a crowd needs somewhere to bring that patient — a space where resuscitation can be performed without interference from bystanders, where equipment can be laid out, where a second provider can work without navigating around spectators. First-aid stations, medical tents, and the main medical facility are not logistics afterthoughts. They are the infrastructure that determines what level of care can actually be delivered when a patient arrives.

The design, location, equipment, and staffing of on-site medical facilities are all addressed in federal and professional guidance for special events. This article covers the requirements and best practices for establishing effective on-site medical infrastructure at live events of varying sizes.

Defining the Medical Facility Hierarchy

Event medical plans typically establish a two-tier or three-tier facility structure, depending on event size (Federal Emergency Management Agency [FEMA], 2010; Arbon, 2007):

• Primary medical facilities (first-aid posts): Forward positions distributed throughout the event site, staffed with first-aiders and at least one EMT. These handle minor injuries and initial assessment; patients requiring more advanced care are transferred to the main facility.
• Main medical facility (field hospital equivalent): The central medical treatment area staffed with the full range of medical credentials: paramedics, nurses, and physician. This facility handles complex presentations, patients requiring ongoing monitoring, and casualties awaiting ambulance transport. If a mass casualty incident occurs, a designated medical facility serves as the casualty clearing station.
• Pit area medical post: At events with a standing area in front of the stage (the pit), a dedicated medical post is established at or immediately accessible to the pit area with rapid access from the front-of-stage zone without requiring transport through the crowd. Required equipment includes a rescue board and cervical collars, oxygen therapy and resuscitation equipment, and splints.

Location Principles for the Main Medical Facility

The location of the main medical facility is one of the most consequential decisions in event site planning. A poorly positioned medical facility extends patient transport times, complicates ambulance access, and reduces the effectiveness of the entire medical operation. Guiding principles for facility placement include (FEMA, 2010; Arbon et al., 2011):

• The main medical facility should be accessible from the stage/performance area by a direct, unobstructed route, allowing rapid transfer of casualties from the pit or front-of-house area
• At least one side of the facility must be directly accessible to ambulances without requiring those vehicles to navigate through crowd areas — the ambulance access route must be unobstructed from the event perimeter to the facility door at all times during the event
• At large outdoor events, medical facilities should be positioned on the perimeter of the audience area rather than the center, enabling ambulance access and exit without crossing the audience
• The facility must be accessible for patients using wheelchairs and mobility devices — ground-level access with door widths adequate for ambulance cot or wheelchair passage
• The facility should be positioned away from the main stage and speaker stacks — while proximity to the performance area matters for response time, the facility must provide a working environment where providers can communicate with patients and each other, which is impossible in high-decibel zones

Physical Requirements for the Main Medical Facility

Whether the main medical facility is a permanent structure within the venue, a dedicated room, or a large medical tent at an outdoor event, certain minimum requirements apply to its physical configuration (FEMA, 2010):

• Adequate size for the anticipated number of simultaneous casualties plus treatment space around each. A facility that can treat only one patient at a time is insufficient for any event above minimal scale. As a minimum, space for at least two examination tables or ambulance cots with working clearance around each, plus a separate area for ambulatory patients
• Ground-level access with a doorway wide enough for an ambulance cot (a standard ambulance cot requires approximately 36 inches of clear width)
• Adequate lighting — natural light alone is insufficient for clinical assessment. Powered lighting independent of the event’s production power supply is strongly preferred
• Adequate heating and ventilation appropriate to the season and expected weather
• Running hot and cold water, or an adequate clean water supply in containers with a hand-wash basin or receptacle
• Worksurfaces for equipment and documentation — at minimum, folding tables
• Secure storage for medications and controlled substances — access must be restricted to authorized medical personnel
• A “no smoking” designation and enforcement
• Adjacent or nearby parking space for ambulances, positioned for rapid departure

Equipment Requirements

The equipment inventory for the main medical facility must be independent of the equipment carried in ambulances — they are separate resources, not shared (FEMA, 2010). The facility inventory should be determined by the appointed medical provider based on the risk assessment, but standard elements include:

• Advanced airway management equipment: bag-valve masks in adult and pediatric sizes, oropharyngeal and nasopharyngeal airways, laryngoscope and intubation supplies (if paramedic-staffed)
• Oxygen supply with appropriate delivery devices: non-rebreather masks, nasal cannulas, nebulizer equipment
• Manual defibrillator or AED (AED minimum; manual defibrillator where physicians or paramedics are on staff)
• IV/IO access supplies: catheters, IV tubing, normal saline and other crystalloid solutions
• Medication supply: specific medications authorized under medical director protocols, secured appropriately
• Patient assessment equipment: blood pressure cuffs (adult and large adult), pulse oximeters, blood glucose monitors, thermometers, ECG monitor where applicable
• Wound care supplies: sterile dressings, bandages, suture materials (if physician present), irrigation supplies
• Immobilization equipment: cervical collars (multiple sizes), backboards or vacuum mattresses, limb splints
• Patient documentation forms and the event medical log

Automated External Defibrillators (AEDs) Throughout the Site

AEDs should not be limited to the medical facility. The American Heart Association (AHA) recommends that AEDs be positioned throughout any venue or event site such that first responders can retrieve an AED and deliver the first shock within three to five minutes of cardiac arrest onset — a timeframe supported by evidence showing that survival rates decline approximately 7–10% for each minute without defibrillation (AHA, 2020).

In large outdoor events where distances between areas may exceed 300 feet (90 m), AEDs should be distributed across the site rather than centralized. All first-aiders and event security staff should know the location of the nearest AED to their assigned position, and AED locations should be included on all site maps distributed to event staff (AHA, 2020; FEMA, 2010).

Helicopter Landing Zones

At events where the distance to a major trauma center, stroke center, or cardiac intervention facility makes ground transport impractical for the most seriously ill patients, a helicopter landing zone (HLZ) should be incorporated into the site plan. An HLZ must be:

• A clear, flat area of minimum 100 by 100 feet (30 by 30 m) free of overhead obstructions (power lines, lighting rigs, tent cables, guy wires)
• Accessible to ambulances from the medical facility for patient transfer
• Marked clearly on all emergency services site maps and communicated to the local airspace management authority before the event
• Illuminated at night if nighttime helicopter operations may be required
• Free of loose material (gravel, sand, debris) that rotor wash could displace into the landing zone or surrounding crowd area

In the United States, the event organizer planning to use a helicopter landing zone should contact the local airspace manager, a qualified aviation professional, or the nearest FAA Flight Service Station (1-800-WX-BRIEF) for guidance on the specific requirements applicable to the site and airspace.

Mapping and Signage

Every medical facility must be clearly marked with international medical symbols and positioned in a way that audience members in distress can locate it, or be directed to it by event staff. Gridded maps showing all medical facility locations must be available to all event personnel before the event opens. Site maps distributed to audience members, printed on event programs, or displayed on entry information boards should include the locations of first-aid stations, using the internationally recognized first-aid cross symbol (FEMA, 2010). Where practical, medical facility locations should also be printed on event tickets.

Campsite Medical Coverage

At multi-day events with overnight camping, the medical operation must maintain coverage during campsite hours — not only during performance hours. The range of conditions requiring care at campsites differs from event-hour presentations: hypothermia, alcohol poisoning presenting overnight, carbon monoxide incidents from improper heating device use, and delayed-onset effects of heat exhaustion from the day’s event are all common overnight campsite presentations. Medical facilities must remain staffed, and additional medical patrol of campsite areas is recommended at high-capacity festivals (Arbon, 2007; FEMA, 2010).

References

American Heart Association. (2020). 2020 American Heart Association guidelines for CPR and emergency cardiovascular care. AHA.

Arbon, P. (2007). Mass-gathering medicine: A review of the evidence and future directions for research. Prehospital and Disaster Medicine, 22(2), 131–135.

Arbon, P., Bottema, M., Zeitz, K., Lund, A., Turris, S., & Anikeeva, O. (2011). Nonlinear modelling for predicting patient presentation rates for mass gatherings. Prehospital and Disaster Medicine, 26(6), 1–8.

Federal Emergency Management Agency. (2010). Special events contingency planning job aids manual. U.S. Department of Homeland Security.