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BACKGROUND: In July 2013, syndromic surveillance was conducted in 17 EDs in a nine-county region of West Virginia to supplement on-site surveillance at a 10-day outdoor high-adventure event attended by 35,000 youth and adult leaders. The system collected data before, during, and after the mass gathering, and was designed to detect preventable injuries, outbreaks of infectious disease, and estimate the anticipated increased burden on the healthcare system. Because the event included extreme sports and other physical demands on a 10,600 acre camping site, the host organization publicized body mass index (BMI) requirements: anyone with a BMI ≥ 40 was ineligible; those with BMI 32 to 39 required additional pre-screening for chronic conditions. Self-screening according to BMI reportedly occurred prior to the event; the organization excluded few individuals for medical reasons.
METHODS: Daily ED census data including disposition (admitted, transferred, expired, discharged) totals for the month of July in 2010, 2011, and 2012 were collected from hospitals. Chief complaint data were collected for ED visits made July 11-25, 2013, for anyone who answered yes to the question “Are you in West Virginia because of the [event]?” Chief complaint and diagnosis data were submitted every 24 hours with demographic (gender and age) and disposition totals. For each visit, chief complaint and diagnosis text was assigned BioSense 2.0 syndrome(s), and then categorized into sub-syndromes.
RESULTS: A total of 178 patients (mean age 28.5 years, 84% male) associated with the mass gathering were evaluated in 11 EDs; the majority (91%) were seen during the actual event. Syndrome categories included 74 (41.6%) visits for injuries (including heat-related illness), 25 (14%) gastrointestinal visits, 19 (10.7%) neurological visits, 12 (6.7%) respiratory visits, and 8 (4.5%) dehydration visits. Extreme sports including bicycle motocross (BMX) contributed to the number of injury and neurological ED visits. Visits related to exacerbation of chronic conditions including cardiovascular disease, hypertension, diabetes mellitus, and asthma accounted for 21 (11.8%) visits. An average of 15 hospitals (median 17) reported daily. Daily disposition totals during the event were at or below historic daily averages. No infectious disease outbreaks were detected via syndromic surveillance.
CONCLUSIONS: Despite intense outdoor physical activities at the mass gathering, ED volume was lower than expected, and the burden on the healthcare system in July 2013 was not increased compared to 3-year daily disposition averages. Screening based on BMI seemed effective, as minimal exacerbation of chronic conditions was noted.