Analysis of patient load data from the 2003 Cricket World Cup in South Africa - AJOL
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SHORT COMMUNICATION
Analysis of patient load data from the 2003 Cricket World
Cup in South Africa
A Kilian1 (MB ChB)
R A Stretch2 (D Phil)
1
Medical doctor in private practice, Port Elizabeth
2
Sport Bureau, Nelson Mandela Metropolitan University, Port Elizabeth
Abstract Conclusion. The unique nature of cricket has shown a
different patient presentation rate than for other similar
Objectives. The purpose of this study was to evaluate mass gatherings, requiring additional factors be consid-
the patient presentation data for spectators attending the ered when developing a medical care plan.
opening ceremony and all the 2003 Cricket World Cup
matches played in South Africa in order to provide organ-
isers with the basis of a sound medical care plan for mass
gatherings of a similar nature. Introduction
Methods. During the 2003 Cricket World Cup, data were In addition to the medical support that is offered to an inter-
collected on the spectators presenting to the medical fa- national team, medical coverage for spectators also needs
cilities during the opening ceremony and the 42 matches to be provided at large sporting events. This has been high-
played in South Africa. Data included the total number of lighted by a number of incidents at soccer matches in par-
patient presentations and the category of illness or in- ticular. In 1992, 17 people were killed and 1 900 injured when
jury. This information was used to determine the venue a temporary stand collapsed in Corsica. In the same year 43
accommodation rate and the patient presentation rate. and 126 people were killed as a result of spectators attempt-
The illness/injury data were classified into the following ing to push their way into a soccer stadium in South Africa
1
categories: (i) heat-related illness; (ii) blisters/scrapes/ and Ghana, respectively.
bruises; (iii) headache; (iv) fractures/sprains/lacerations; Further, the terrorist attack at the 1996 Olympic Games
1
(v) eye injuries; (vi) abdominal pain; (vii) insect bite; (viii) in Atlanta where 111 people were injured and the terrorist
allergy-related illness; (ix) cardiac disorders, chest pains; attacks in the USA on 11 September 2001 and in London
(x) pulmonary disorder/shortness of breath; (xi) syncope; in 2005, have made event organisers aware of the need for
(xii) weakness/dizziness; (xiii) alcohol/drug-related con- preparedness planning for large sporting events.
ditions; (xiv) seizure; (xv) cardiac arrest; (xvi) obstetric/
Medical coverage for the needs of spectators at large
gynaecological disorder; and (xvii) other.
sporting events should cater for situations where medical
Results. The total number of patients who presented to personnel are able to deal with one case at a time, to events
the medical stations was 2 118, with a mean of 50 (range with isolated major incidents or in extreme cases such as a
14 - 91) injuries per match. The mean for the patient pres- mass casualty or disaster situation.
entation rate was 4/1 000 spectators. The most frequently In preparation for the 2002 FIFA World Cup in Japan, the
encountered illness or injury was headache (954 patients, Health Research Team (HRT-MHLW) was established by
45%), followed by fractures, sprains and lacerations (351 the Japanese government to provide an effective service for
patients, 16%). spectators attending the matches played in Japan, as well
as to analyse factors regarding patient presentations with a
3
view to develop a medical care plan for mass gatherings. A
total of 1 661 patients presented with illness or injuries to the
Correspondence: medical stations during the 32 matches played in Japan. This
patient presentation rate was 1.21/1 000 spectators, with a
R Stretch
transport-to-hospital rate of 0.05/1 000 spectators. As the
Sport Bureau
total number of spectators increased, the patient presentation
Nelson Mandela Metropolitan University
rate decreased, while the patient presentation rates increased
PO Box 77000
when spectators were not provided with shuttle-bus transport
Port Elizabeth
from the nearest railway station or had to walk for more than
6031
12 minutes to gain access to the venue.
Tel: 041-504 2584 6-12
Fax: 041-583 2605 While injuries to cricket players in South Africa,
5 4
E-mail: Richard.Stretch@nmmu.ac.za Australia and England have been well documented over
52 SAJSM vol 18 No.2 2006
pg52-56.indd 52 6/29/06 9:01:16 AMthe past number of years, there have not been any reported To ensure adequate medical cover there was at least one
studies on the illness/injury rate of spectators attending medical station at each ground, staffed by 2 doctors, 2 nurses
major cricket matches or events. The purpose of this study and on average 3 paramedics. The medical support was
was to evaluate the patient presentation data for spectators provided from 2 hours before the start of the match to 1 hour
attending the opening ceremony and all the 2003 Cricket after the end of the match. The necessary medical supplies
World Cup matches played in South Africa and to compare and equipment were available at each medical station. An
these with similar findings from the 2002 FIFA World Cup ambulance was available at each venue to transfer patients
held in Japan, in order to provide organisers with a basis for to hospital if necessary. Further, at least one hospital in each
a sound medical care plan for mass gatherings of a similar city was put on stand-by in the event of an emergency, with
nature. the normal daily staff on stand-by.
The data collected included the total number of spectators
Method at each match and the maximum spectator capacity for each
venue. The medical personnel in charge of the medical
The 2003 Cricket World Cup was organised in February and
facility documented patient information which included the
March 2003, with the opening ceremony staged in South
total number of patient presentations (PP) and the category
Africa and 54 matches staged in South Africa, Zimbabwe
of illness/injury (I). These data were used to determine
and Kenya. Only the opening ceremony and the 42 matches
the venue accommodation rate (VAR). This was defined as
played in South Africa formed part of this study. The opening
the actual number of spectators per game compared with
ceremony was held in the evening, with the one-day interna-
the maximum spectator capacity of the venue. The patient
tional matches played either as day matches (10h00 to about
presentation rate (PPR) was defined as the number of
17h30) or as day-night matches (14h30 to about 22h00).
patients per 1 000 spectators per match.
All the planning and procedures relating to the medical
To allow comparisons with similar data from the 2002
management of the spectators and players for all matches 3
FIFA World Cup the illness/injury data were classified into
were the responsibility of the medical committee. Only the
the following: (i) heat-related illness; (ii) blisters/scrapes/
spectator data are presented in this study. The medical
bruises; (iii) headache; (vi) fractures/sprains/lacerations;
committee held monthly meeting from January 2002 to May
(v) eye injuries; (vi) abdominal pain; (vii) insect bite; (viii)
2003 (16 meetings) and three seminars with the medical
allergy-related illness; (ix) cardiac disorders; chest pains; (x)
personnel prior to the start of the competition. Based on this
pulmonary disorder/shortness of breath; (xi) syncope; (xii)
a medical system was put in place for each venue that would
weakness/dizziness; (xiii) alcohol/drug-related conditions;
be able to respond to a disaster, as well as providing routine
(xiv) seizure; (xv) cardiac arrest; (xvi) obstetric/gynaecological
on-site medical emergencies.
disorder; and (xvii) other.
Table I. Spectator, venue and patient presentation data during the 2003 Cricket World Cup
Maximum Mean venue Presentations/
spectator accommodation % of Total spectator Patient 1 000
Matches capacity rate capacity attendance presentations Mean/match spectators
Venues (N) (N) (N) (%) (N) (N) (N) (N)
Paarl 3 9 030 4 207 47 12 620 57 19 4
Durban 5 19 980 16 292 82 81 459 215 43 2
Pietermaritzburg 3 7 091 3 883 55 7 765 42 21 5
Potchefstroom 2 10 169 5 902 58 17 706 44 14 2
Pretoria 4 21 160 15 427 72 61 706 366 91 5
Johannesburg 5 30 542 26 235 86 131 175 427 85 3
Kimberley 2 6 056 3 328 55 6 655 48 24 7
Port Elizabeth 5 18 109 12 206 67 61 031 241 48 3
Cape Town* 6 23 141 20 170 87 121 020 508 85 4
East London 2 13 248 5 610 42 11 220 36 18 3
Benoni 2 9 812 4 719 48 9 437 49 25 5
Bloemfontein 3 13 954 4 792 34 14 377 85 28 5
Total 42 738 508 536 171 - 536 171 2 118 - -
* The opening ceremony is included in these figures.
SAJSM vol 18 No.2 2006 53
pg52-56.indd 53 6/29/06 9:01:16 AMResults Table II. Category of medical condition and the
number (N) of patient presentations at the 2003
There were 12 venues used to stage the 42 World Cup Cricket World Cup
matches, with an average of 4 (range 2 - 6) matches per ven-
Patient Presentations
ue. The mean maximum venue capacity was 17 583 (range (N) (%)
6 056 - 30 542) spectators, with a total capacity of 738 508
Blisters, scrapes and bruises 23 1
spectators for the venues for all 42 matches. The total at-
Headache 954 45
tendance at all 42 matches was 536 171 spectators, with a
mean actual attendance of 12 765 (range 3 328 - 26 235) or Abdominal pain 120 6
73% (range 34 – 87%) of the total capacity for all the venues Heat-related illnesses 103 5
(Table I). Fracture, sprain and lacerations 351 16
The total number of patients who presented to the Weakness/dizziness 6 1
medical stations was 2 118, with a mean of 50 (range 14
Cardiovascular disorders/chest pains 16 1
- 91) injuries or illnesses per match. The mean patient
presentation rate was 4/1 000 spectators, with the matches Insect bites 25 1
played in Potchefstroom and Durban (3/1 000 spectators) Pulmonary disorders/shortness of breath 19 1
and at Kimberley (71/1 000 spectators) reporting the lowest Alergy-related 129 6
and highest rates, respectively (Table I).
Eye injury 40 2
The most frequently encountered illness or injury was
Other 322 15
headache (954 patients, 45%), followed by fractures,
Total 2 118 100
sprains and lacerations (351 patients, 16%) (Table II).
Other presentations included allergy-related illnesses (129
patients, 6%), abdominal pain (120 patients, 6%) and heat-
this may be related to other factors, some of which may be
related illnesses (103 patients, 5%). The ‘Other’ category of
beyond the control of the event organisers.
illnesses or injuries (322 patients, 15%) included 88 (4%)
patients with gastric problems and 48 (2%) and 19 (1%) with During the 2002 Soccer World Cup temperature had
urinary tract and respiratory tract infections, respectively. an effect on the number of injuries, with an increase in
temperature associated with an increased risk of illness
or injury, particularly heat-related illnesses, headaches
Discussion 3
and weakness or dizziness. One of the limitations of the
The unique nature of cricket, which is played over an ex- study was that no information was obtained on the weather
tended period of time, has shown a different patient presen- conditions. Although the effect of heat on the risk of illnesses
tation rate than that of soccer.3 Firstly, the cricket spectators or injury could not be determined, the 2003 Cricket World
showed a greater patient presentation rate per 1 000 specta- Cup was played in the hot summer months of February and
tors, although it still falls within the range of 0.14 - 90 patients March.
2
per 1 000 spectators. In conclusion, the basic epidemiological data collected at
A number of factors may influence the patient presentation the 2003 Cricket World Cup should assist organisers of future
rate, with venue capacity and the crowd size being identified Cricket World Cup competitions to predict patient presentation
13
as the more important factors. The crowd density is indicated rates. However, the unique nature of cricket requires
by the venue accommodation rate. However, neither of these additional factors that need to be considered when collecting
variables were factors in the patient presentation rate. The similar data. This should include weather conditions, time
matches played at Kimberley, the venue with the lowest of day or night when the patient presented, and information
mean venue accommodation rate, had the highest rate of on whether the patient was seated in undercover seating or
injuries per 1 000 spectators. Conversely, Johannesburg, the on the open grass banks that are common at many cricket
venue with the greatest mean venue accommodation rate, grounds. This could then assist in developing a medical care
had one of the lower rates of injuries per 1 000 spectators. plan in accordance with the capacity of the venue in order to
This may possibly be due to the fact that a number of other provide the most efficient medical care possible.
factors such as weather conditions and location of seating
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pg52-56.indd 54 6/29/06 9:01:29 AMpg52-56.indd 55 6/29/06 9:01:46 AM
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8
this sequence usually demonstrates
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