Use of Treat-and-Release Medical Directives for Paramedics at a Mass Gathering

Abstract

Introduction. Paramedics provide a substantial proportion of care at mass gatherings but do not typically release patients without physician assessment. Objective. To evaluate treat-and-release medical directives implemented at a large single-day summer rock concert. Methods. Medical directives allowed paramedics to administer acetaminophen, dimenhydrinate, diphenhydramine, or polymyxin B ointment for common complaints without evidence of serious illness on history or examination. After treatment, patients were released or transferred to a medical facility according to predefined criteria. Patient demographics, chief complaint, treatment, anddisposition were obtained from paramedic records. To determine whether any patients released by paramedic subsequently required ambulance transport, all ambulance records were searched for a period of eight hours before to 24 hours after the event. Results. More than 450,000 people attended the concert, with 1,870 presenting for medical attention. Four hundred seven patients received medications under the directives. No disposition was recorded in 13 cases. Two hundred ninety-nine patients were treated with acetaminophen, of whom 269 (90.0%) were released and23 (7.7%) required additional care. Sixty-two patients received dimenhydrinate, 44 (71%) were released, and14 (23%) required transport. Thirty-six patients received diphenhydramine, and34 (94%) were released. Ten patients received polymyxin B andwere released. No patient released by paramedics was found to have later required ambulance transport. Conclusions. Treat-and-release medical directives for paramedics at mass gatherings may help divert patients from requiring care at a medical facility. Future research is needed to determine the safety (morbidity andmortality) of these directives. Key words: emergency medical services; paramedic; treat andrelease; mass gathering; medical directives.