Integrating emergency medical services and hospital surge capacity for mass-gathering preparedness: a structured narrative review

Integrating emergency medical services and hospital surge capacity for mass-gathering preparedness: a structured narrative review. BACKGROUND: Mass gatherings can generate concentrated, time-dependent demand across in-event health services, municipal emergency medical services (EMS), emergency departments, and inpatient services. Evidence relevant to preparedness is heterogeneous and is often reported with inconsistent denominators, limiting direct comparison. METHODS: This structured narrative review synthesizes published evidence on EMS and hospital surge-capacity integration across the four surge domains of staff, stuff/supplies, space, and systems. The review retained the original structured search of MEDLINE/PubMed, Embase, Scopus, Web of Science, and the Cochrane Library for 2010-February 2026 and incorporated a focused PubMed and citation update through September 2026. Because the purpose is interpretive synthesis rather than exhaustive effect estimation, no de novo meta-analysis or pooled estimates were produced; quantitative findings are reported with the denominators and analytic context used by the source publications. RESULTS: A 2025 scoping review of 41 papers reported medical-doctor presence in 34/41 papers (82.9%), medication interventions in 23/41 (56.1%), procedural interventions in 23/41 (56.1%), health-support systems in 18/41 (43.9%), mobile treatment spaces in 23/41 (56.1%), and temporary structures in 21/41 (51.2%). That review reported median calculated patient-presentation and transport-to-hospital rates of 6.2 and 0.35 per 1,000 attendees, respectively, whereas a separate 22-article stadium review reported much lower medians when standardized per 10,000 spectators. Hospital effects were directionally heterogeneous: a 14-study systematic review found event-associated emergency-department changes ranging from 7.5%-37% decreases to increases as high as 83% in specific settings. Digital integration has shown promising simulated gains, but clinic…