Planning and Execution of an EMS-Based Field Hospital: A Case Report

Mass gathering events can produce large volumes of patients and burden local emergency medical services (EMS) systems. This is particularly true of rural communities where local EMS resources may be scarce. Field-based hospitals are one strategy that has been shown to alleviate transport-to-hospital rates. This case report describes planning and execution of an EMS-based field hospital for a rural mass gathering event. In September 2023, an outdoor country music concert was hosted on a working farm in south central Wisconsin. Approximately 20,600 patrons and staff attended this event. To help preserve local EMS resources, a field-based hospital was developed using a hybrid staffing model of EMS clinicians (e.g., emergency medical technicians, paramedics) and EMS physicians. During the 11 h of operation, 51 patients were treated by EMS personnel. Thirty-six patients were treated at the field hospital, with 30 of these patients arriving during a 90-minute surge. The median age of patients presenting to the field hospital was 29.5 years (IQR: 20.0-49.3). Seven of the patients (19.4%) were pediatric. 52.7% of patients presenting to the field hospital had abnormal vital signs at triage, most commonly tachycardia. The most common presenting problems were alcohol intoxication (41.6%), cardiac problems (16.6%), and traumatic injuries (13.9%). The median length of stay at the field hospital was 26 min (IQR: 19-55), ranging from 4 min to 115 min. Six patients were transported, and five of the six patients were transported by units that were staged at the event. It is estimated that at least 15 patients would have been transported without the field hospital due to cognitive incapacity or medical necessity. The overall patient presentation rate of the event was 2.55 per 1,000 and the transport-to-hospital rate was 0.3 per 1,000. After action evaluation noted areas for improvement related to communications and security. We concluded that the use of a field hospital staffed by physicians and EMS clinicians helped preserve local EMS resources during a rural mass gathering event. Several opportunities for improvement related to critical infrastructure and staffing were identified.