Table 1.

Health-related risks in mass gatherings based on the articles included in the study

Authors and references	Publication date	Methodology	Mass gathering type	Health risks	Study conclusion
Hutton et al.[15]	2012	Pilot study to assess the tool (cross-sectional)	Music festival	Crowd behavior (“jumping up and down”). Crowd mood (energetic). Crowd type (participatory and cohesive). Presence of alcohol and drugs. Crowd density. Temperature and humidity	We need to explore the interaction of MG domains by further research
Perron et al.[16]	2005	Retrospective study	Games	Heat index (high)	Cold-related correlation will be researched
Alqahtani et al.[17]	2017	Cross-sectional surveys	Hajj, religious	Lack of some pilgrims’ awareness about the risk of accidents such as stampedes	In the pretravel briefing, injuries and personal safety must be mentioned
Bledsoe et al.[18]	2012	Retrospective, observational	Art festival	Lack of paramedic or physician. Attendance size. Significant distance. Austere environment	Our experience is useful for similar event
Sokhna et al.[19]	2017	Cross-sectional	Socio-religious	Road traffic accidents, heatstroke, terrorist attacks, cholera outbreak, infectious diseases	In the context that available medical resource is limited, international collaboration is needed
Selig et al.[12]	2013	Observational, retrospective	Race weekend	Weather factors such as temperature, precipitation, and humidity	Weather data influence the use of medical services
Dong et al.[20]	2017	Cross-sectional report	New year	Density of crowd, lack of flow direction, lack of self-protection awareness, environmental factors, lack of risk assessment, and lack of surveillance system and communications	Government must improve the fast emergency reaction in MG events
Feldman et al.[21]	2016	Retrospective, cross-sectional	Games	High temperatures	Individual education has an important role in prevention and improvement behaviors
Ma et al.[22]	2002	Cross-sectional	Games	Alcohol consumption	Alcohol drinking was responsible for most events
Alqahtani et al.[23]	2016	Cross-sectional	Hajj, religious	Lack of pre-event advice	We have to progress the participants’ awareness and have better communication with them
Gocotano et al.[24]	2015	Lessons from the field	Religious visit	Cold weather	Information accumulation from the venue is important to event assessment
Blumberg et al.[25]	2016	Cross-sectional	Sport event	Lack of pretravel vaccination. Lack of surveillance system	To encounter communicable disease, enhanced surveillance system is needed
Joseph et al.[26]	2016	Cross-sectional	Religious	Human stampedes, person-to-person communicable disease, lack of coordination, shortage of paramedical staff, difficulty in access to medical facilities	The findings are useful for any health sector for risk factor assessment in MGs
Cariappa et al.[27]	2015	Lessons from the field. Cross-sectional	Religious	Quality assurance of food and water, disease monitoring and surveillance, water sanitation, disposal of solid and liquid waste, allocation of medical resources	MG management requires modern medical services, sufficient funding, planning, and preparation
Hutton et al.[28]	2010	Cross-sectional	Mobile MG	Access to food and water, overcrowding	Health is an important issue in young minds who participate in MGs
Memish et al.[29]	2015	Cross-sectional	Religious (Hajj)	Crowded conditions	International MGs can provide a ground for globalization of a pathogen
Shirah et al.[30]	2016	Retrospective cohort analysis	Religious (Hajj)	Participants aged >50 years and participants with chronic diseases	Health workers’ and participants’ adherence to preventive measures is very effective in preventing the spread of diseases
Arbon et al.[31]	2001	Cross-sectional. Model creation	All types	Crowd size, weather, mobility of the crowd, availability of alcohol, number of patient care personnel on duty	For better health-care planning in MGs and predicting the rate of patients, we need to model making research
Locoh-Donou et al.[32]	2016	Retrospective	Mix (outdoor and indoor)	Outside and unbounded venues, absence of free water, no climate control, percentage of (occupied) seating, increase in heat index	The findings are useful for EMS resource providing before MGs
Kemp[33]	2016	Prospective, observational	Not mentioned	Lack of trained and experienced advanced nurse practitioners	Presence of professional nurses to reduce patient referral rates is very helpful
Grant et al.[34]	2010	Case study	Multi-day	Gender (female), age (increase)	Must notice at-risk participants
Khan et al.[35]	2017	Cross-sectional	Hajj, religious	Old age	Health-care system must improve the knowledge of participants about their health status and preventive measures
Grange et al.[36]	2016	Prospective, observational	Motor sports	Lack of on-site physicians	Presence of physician on the venue reduces the patient transportation and EMS workload
Hutton et al.[37]	2010	Framework evaluation	Scholes event	Alcohol consumption	Further evaluation is needed to judge this model
Polkinghorne et al.[38]	2013	Cross-sectional. Mix method	Music festival	Duration of MG, heat-related ailments	MGs in rural areas are facing more challenges due to limited resource and infrastructure and hence require more comprehensive planning
Balsari et al.[39]	2016	Cross-sectional, case study	Religious festival	Density of people, waterborne infection, and disease	To better communicate between the organizations in disasters, we need a incidence command system
Eberhardt et al.[40]	2016	Case-control	Sport	Insect bites, sunburns	The risks of participants in sport MGs are different from those of other travelers
Vortmann et al.[41]	2015	Mix method	Religious festival	Waterborne disease	As the number of people will increase in the coming years, the likelihood of disaster will increase
Zeitz et al.[42]	2003	Retrospective analysis	All types	Crowd size, daily temperature, humidity, day of the week	Historical experiences analysis is very useful to design a management framework

MGs=Mass gatherings, EMS=Emergency medical service