Preparedness for sexual violence at mass gatherings: A scoping review of medical and operational implications for emergency and disaster response systems.

INTRODUCTION: Mass gatherings create complex operational challenges for emergency and disaster medical systems. While preparedness planning often emphasizes trauma, intoxication, and environmental illness, sexual violence represents an underrecognized but significant medical and operational concern with direct implications on emergency medical services (EMS) operations. These incidents not only threaten individual safety but also strain on-site medical and psychosocial response systems. Findings are discussed in the context of disaster preparedness and prehospital operations. OBJECTIVE: To synthesize the prevalence, risk factors, reporting patterns, and prevention/response strategies for sexual violence at mass gatherings, and to translate these findings into actionable implications for EMS systems and event medical planning. METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology, we searched nine databases (MEDLINE, Embase, Scopus, Web of Science, PsycINFO, EBSCOhost, PubMed, Science Direct, CINAHL) and gray literature for studies addressing sexual violence at events with >1,000 attendees. Two reviewers independently screened records; discrepancies were adjudicated by a third reviewer. Sixteen studies met eligibility criteria. Data were extracted on prevalence, risk factors, reporting behaviors, and prevention or response strategies. Findings were analyzed thematically to identify implications for EMS preparedness and patient care. RESULTS: Sexual violence was consistently underrecognized and underreported at mass gatherings. Six major themes emerged: (1) substance use, (2) environmental vulnerabilities, (3) risk concentration among young women, (4) bystander inaction, (5) normalization of harassment, and (6) limited effectiveness of prevention strategies. Victims often disclosed informally to friends or event staff rather than law enforcement or EMS clinicians. Across studies, opportunities emerged for EMS systems to strengthen preparedness through trauma-informed training, private treatment areas, surveillance integration, and referral pathways to sexual assault response services. CONCLUSION: EMS clinicians and event medical teams play a critical role in identifying, treating, and referring victims of sexual violence during mass gatherings. Event medical planning should explicitly anticipate sexual violence cases by incorporating trauma-informed training, private and secure treatment areas, and referral pathways to sexual assault response networks. By embedding these practices within incident command and preparedness frameworks, EMS agencies can play a proactive role in protecting vulnerable populations and enhancing survivor outcomes at high-risk events. These changes will strengthen both clinical care and overall safety at mass gatherings.