ORIGINAL ARTICLE
The Incidence of Sickness/trauma in Spectators of Professional
Baseball at the Meiji Jingu Baseball Stadium
Hideki Ishikawa, Shingo Hori, and Naoki Aikawa

Department of Emergency & Critical Care Medicine, School of Medicine, Keio University(Received for publication on February 19, 2007)(Revised for publication on April 28, 2007)(Accepted for publication on June 21, 2007)

Abstract. The Meiji Jingu Baseball Stadium attracts a large number of spectators in theTokyo metropolitan area. To clarify the demand for medical care at a public ballpark, we
analyzed following two types of medical records maintained at the stadium: (1) “Report ofAid”: a record of patients visiting the first-aid station in 2003 season and (2) “Report of Accidents”: a record of patients referred to clinics/hospitals between 1996 and 2003 season.
(1) In 2003, approximately 1,582,000 spectators watched 67 professional baseball games(60 night games). Of the 247 spectators received medical care at the first-aid station (3.7
persons per game, 1/6,405 spectators), 128 (51.8%) had trauma and 109 (44.1%) had illness.
The incidence of trauma was relatively higher before the start and near the end of the night
games. The risk of becoming sick/wounded per spectator or the number of the sick/wounded
per game differed depending on the participating sports teams. (2) Ninety-three spectators
referred to clinics/hospitals during the 8-year period from 1996 to 2003, of which 57 weretransferred by ambulance. Direct ball injury accounted for 65 (69.9%) cases of trauma, followed by stumbling/falls (18 cases, 19.4%). Twenty patients were diagnosed to have fractures at the clinics/hospitals. Intrinsic cardiopulmonary arrest occurred in one spectator.
Trauma due to direct ball injury accounted for the largest number of wounded patients referred to clinics/hospitals. Treatment to patients at the first-aid station in the stadium may
optimize the frequency of hospital visits. Records of medical care are effective to analyze
the demand for medical preparedness. (Keio J Med 56 (3) : 85 － 91, September 2007)
Key words: mass gathering medicine, large-scale public facility, baseball stadium, medical
facility, event planning

Introduction

this problem, we considered that it would be necessary toanalyze the demand for medical care in individual public
facilities by precisely comprehending the occurrence ofsickness and injury at the concerned facility.
Large-scale athletic games are held at many cities
around the world. Even though the players in the participating teams come in a perfect state of medical preparedness,3 adequate medical care for spectators still remains
to be established. Recently, there has been an increasingawareness of the occurrence of medical emergencies at
sports events in Japan, especially from the time that the

Various types and levels of medical aid may be provided at large-scale public facilities that are visited by large
and diverse crowds.1 Therefore, some facilities have afirst-aid station and encourage the staff to undergo training in cardiopulmonary resuscitation. However, standards for organization of the first-aid station and equipment / materials at public facilities have not yet been established to date, and are vaguely based on the subjective
experience of administrators of facilities.2 To resolve

This paper was presented in part at the free paper session of the 54th Annual Meeting of the Japanese Association for Acute Medicine, KANTO, March 6,
2005, in Tokyo, Japan (Abstract No. E-3-2).
Address for correspondence and reprint requests: Hideki Ishikawa, M.D., Ph.D. Department of Emergency & Critical Care Medicine, Keio University Schoolof Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan hideki@ishikawa.email.ne.jp85Ishikawa H, et al: Medical care in spectators at a baseball stadium

86
Table 1 Sick/wounded persons visiting a first-aid station in 2003

Disposition

Male
FemaleTotal
Discharged to home
Self-visit to clinics/hospitals
Transfer by ambulance

Number (percentage)
118 (53.4)
103 (46.6)
221 (100)
197 (89.1)
14 (6.3)
10 (4.5)

TraumaSickness
55
60
115
101
9
5

Others
56
42
98
88
5
5

7
1
8
8
0
0

Unit: Number of patients
Number of sick / wounded persons visited first-aid station was analyzed from “Report of Aid” in 2003. After receiving the first-aid, 24 (10.8%) of
the spectators visited clinics / hospitals on the day of the game, and 10 (4.5%) of them were transferred as emergency patients.

Table 2 Symptoms/diagnosis of sickness at first-aid station in 2003
Symptom, Diagnosis
Gastrointestinal symptoms (Nausea, Abdominal pain, etc.)
Hypoglycemic seizures
Headache
Discomfort
Hypotension
Dehydration/heat related illness
Common cold
Pyrexia
Dizziness
Hyperventilation
Loss of consciousness
Menstrual pain
Others
Total

Cases
29
11
11
10
9
7
6
5
5
4
3
2
8
110

Unit: Number of patients(98 patients)
Symptoms / diagnosis of sickness was analyzed from “Report of Aid”
in 2003. Diverse medical conditions were encountered.

Soccer World Cup was held in Japan in 2002.4, 5Among the many athletic facilities located in the metropolitan area of Tokyo, the Meiji Jingu Baseball Stadium attracts large crowds (at least 2,000,000 annually, including 1,582,000 who watched professional baseballgames in 2003), because a professional baseball club as afranchise often utilizes the stadium to host baseballmatches. Further, the stadium is equipped with a first-aid
station which maintains records of medical care provided
to visiting spectators with sickness/trauma. The aim of
this study was to analyze the demand for medical careduring professional baseball matches held at the stadium,based on analysis of the records.
Subjects and Methods
The Meiji Jingu Baseball Stadium built in 1926 is oneof the most famous ballparks in Japan. There is a firstaid station at the stadium and records of the recent firstaid practices at the stadium have been maintained in two

types of documents: “Report of Aid” written by nurses
and “Report of Accidents” written by clerks. The former
contains reports of information on patients visiting thefirst-aid station, including the gender, age, time of visit,
type of disease, and site of injury. The latter contains reports of patients referred to clinics/hospitals.
An investigation of the sick/wounded persons who required medical care during the professional baseballgames (March to November) was performed by examining both the records. The number and incidence of sickness and injury, the time of occurrence, the types of sickness and injury, and the sites and mechanisms of injury,
disposition after the first-aid, and diagnosis of the patients who were transferred to clinics/hospitals were noted. As for the diagnosis of the patients referred to clinics/
hospitals, it was reported to the stadium either by the patients themselves or by the clerks who visited the clinics/
hospitals with the transferred patients.
The study period spanned the professional baseballseason of 2003 (from March to November) for examination of the “Report of Aid”, and 1996 to 2003 for that of
the “Report of Accidents”.
Statistical analyses were performed by the Chi-square
test using the Mac Toukei-Kaiseki Ver. 1.5 (Esumi co.
ltd., Tokyo, Japan) program on a Macintosh computer. A
significance level of P < 0.05 was set for the comparisons.
Results
1. Number of sick/wounded persons and dispositionat the first-aid station
During the baseball season of 2003, there were 67
games (60 night games, 7 daylight games) hosted by professional baseball clubs, of which 61 were official games
and 2 were called off due to rain. A total of 1,582,000
spectators watched the 59 official games (mean: 26,813
persons per game) during this season, and 247 spectators(mean: 3.7 persons per game, including all games), accounting for 0.015% of all spectators, received aid at thefirst-aid station of the stadium. After excluding 17 staff
members of the stadium and 9 persons whose gender wasKeio J Med 2007; 56 (3): 85－ 91

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Fig. 1 Sites of trauma at a first-aid station in 2003
Sites of trauma were analyzed from “Report of Aid” in 2003. The incidence of upper and lower extremity injuries was high.

not recorded in the reports from this figure, there were
221 sick/wounded persons, consisting of 118 males(53.4%) and 103 females. In regard to the type ofsickness/trauma, 46.6%, 47.5%, and 5.9% of the males
were recorded as having suffered from trauma (including
2 cases of burns), sickness, and “others” (insect bite,
toothache, etc.), respectively. The corresponding percentages among the women were 58.3% (including 4cases of burns), 40.8%, and 0.9%, respectively. After
provision of first-aid, 24 (10.8%) of the 221 patientswere referred to clinics/hospitals, of which 10 (4.5%)
were transported by ambulance (Table 1).
2. Types of sickness and trauma encountered at thefirst-aid station
Patients with acute sickness had diverse symptoms;
e.g., gastrointestinal symptoms, abdominal pain, headache, hypoglycemia, mood disorders, hypotension,dehydration/heat stroke, and common cold (Table 2). In
127 sites of the 115 patients with trauma, trauma of theupper and lower extremities accounted for the highest
percentage of cases (Figure 1). In the referred patients toclinics/hospitals with trauma, facial and oral cavity trauma accounted for the highest percentage of cases from1996 to 2003. During this 8-year study period, direct
trauma caused by balls accounted for 118 (76.6%) of thewounded patients, followed by that due to stumbling/
falls (27 patients, 17.5%) (Figure 2).

3. Diagnoses made at the clinics/hospitals
In the patients referred during the period from 1996 to
2003, 20 patients were diagnosed to have fractures.
Among the 20, 10 who sustained the fracture by directball attack and 5 in whom it was caused by stumbling/
falls were transferred to the clinics/hospitals by ambulance, and 5 (including 4 who sustained the fracture bydirect ball attack and 1 in whom it was caused bystumbling/falls) visited the clinics/hospitals on theirown. Seven and 2 subjects among those who were injured by a direct ball attack were diagnosed to have eye
injuries and crown fractures of the teeth, respectively(Table 3).
4. Time of occurrence of the sickness/trauma in the
spectators visiting the stadium for the night games
The time of occurrence of sickness and trauma was analyzed for the 230 spectators of the 60 night games in2003 who required first-aid. The incidence of trauma
was the highest before the start of a game and near theend of the games, and the incidence of acute illness was
the highest before the start of a game and during the second half of the game (Figure 3).
5. Incidence of sickness and trauma according to theparticipating teams
In 2003, Yakult Swallows, i.e., the franchise baseballteam and a member of the Central League, played 59 official games with 5 teams. The incidence of sickness/trauma was the highest during the game played by theIshikawa H, et al: Medical care in spectators at a baseball stadium88����������
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Fig. 2 Sites and causes of trauma in patients referred to clinics/hospitals from 1996 to 2003
Sites of trauma and causes of trauma were analyzed from “Report of Accidents” during the period 1996-2003. Most of trauma is bydirect ball attacks. Trauma of the head and face are tended to be serious in many cases.

Table 3 Classification of trauma in referred patients from 1996 to
2003

Blows
FracturesOpen wounds
Eye injuries
Crown fractures
Total

Direct ball attacks
Stumbling/falls
Ambulance Self-visit Ambulance Self-visit
12
18
4
0
10
4
5
1
10
3
5
4
6
1
0
0
0
2
0
0
38
28
14
5

Unit: Number of patients
Definitive diagnosis made at clinics / hospitals and transportation to theclinics / hospitals were analyzed from “Report of Accidents” during theperiod 1996-2003.

victorious team of that season (Hanshin Tigers in 2003).
The risk (incidence of visits to first-aid station) per spectator was 2.13 times as high as compared to that for theteam with the lowest incidence of sickness/trauma in thatseason (P < 0.01), and the risk per game was 4.47 times
as high as compared to that for the team with the lowest
incidence of sickness/trauma (P < 0.01) (Table 4).
Discussion
While there have been several reports on the demand
for the medical care at mass events, the majority havedealt with only a single event.1, 6 Continuous observationof the medical demand at the same events has been reported for the national football league games in theUSA.7 Although baseball games are also popular, there
has been no study until now for medical care at any stadium hosting baseball matches. One study has reported
on the degree of sweating and water intake in baseballspectators in the summer.8 Another report reviewed
first-aid at a stadium during a US Major League Baseballseason in 1991, however, it contains no detailed data of
the patients.9
The present study revealed that 3.7 sick/wounded persons per professional baseball game utilized the first-aid
station at the stadium during the professional baseballseason in 2003. This rate is not high, and represents only
0.015 % of all the spectators, i.e., only 1 out of every
6,405 spectators, as compared with that reflected in therecords of the previously mentioned national footballleague game season in the USA (0.04%),7 2002 FIFA
World Cup soccer games in Japan (0.12 %),10 and a rockfestival in Japan (1.7 %).11
Sick/wounded persons who utilized the services of thefirst-aid station had diverse symptoms or trauma, and themost frequent cause of trauma in those who attended thefirst-aid station was direct ball attacks, followed bystumbling/falls, quarrels, and burns due to hot foods/
beverages. In particular, the incidence of trauma causedby direct hits of balls was the highest, which is considered to be characteristic of ballparks.12 The incidence of
trauma due to stumbling/falls was also high. It was speculated that the occurrence of these accidents could be in-Keio J Med 2007; 56 (3): 85－ 91

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Fig. 3 Time of occurrence of sickness / trauma in the night games
The time zone of the occurrence of sickness / trauma in the night games was analyzed from “Report of Aid” in 2003. The number ofnight games was 60, 2 of them were called-off by rain.

fluenced by the inherent stadium structure (high slope
and narrow pathways), overcrowding/stampede inside
the stadium, and alcohol consumption.
At the Meiji Jingu ballpark, the first-aid station is on
the ground floor next to the office. It is equipped with abed, refrigerator, closet for drugs, TV, stretcher, wheelchair, and crutches, however, there is no arrangement yet
for an automatic external defibrillator (AED) in 2003.13
However, rescue drills for sick/wounded persons havebeen carried out over the years about 3 - 4 times a yearwith the cooperation of the nearest fire station. During
the games hosted by professional ball teams, one physician and one or two nurses contracted by the stadium are
kept on standby at the first-aid station. Guards on duty,
recruited from a security company, who find sick/wounded patients, communicate with the station via awireless system. Depending on the situation, either thephysician or the nurse is dispatched to attend to the sick/wounded, or alternatively, the sick/wounded are transferred to the first-aid station for medical care. As a rule,the stadium takes responsibility for the care of cases oftrauma caused by inadequacy of facilities, and the franchisee ball team takes responsibility for the care of casesof trauma caused by balls.
Grange JT et al. reported that the availability of on-site
physician-level medical care at large mass gatherings
significantly reduced the number of patients requiringtransport to hospitals.14 In fact, in the 2003 season, only

24 (10.8%) patients visited clinics/hospitals on the dayof the game, and only 10 (4.5%) of these were transferred by ambulance after provision of first-aid. Thus,
the availability of a physician on-site is important to reduce the impact on the local emergency medical systemand the local medical facilities.
Analysis of the actual time of occurrence of thesickness/trauma revealed that the incidence of trauma
was the highest before the start of a game and near theend of the game, while that of sickness was highest before the start of a game and during the second half of thegame. Thus, before the start of a game, direct trauma
caused by ball attacks during warm-up practice and sickness induced by excitement before the game may becontributing factors. During the second half of the game,
alcohol consumption and excitement due to the matchcoming to an end probably induces sickness, and near
the end of the game, trauma due to overcrowding andstampede may be involved. It should be borne in mind
that sickness and trauma may be reported until all the
spectators have left the stadium.
The incidence of sickness/trauma among the spectators
may be influenced by the number of spectators, as shownby the varying incidence according to the participatingteams. During the game played by Hanshin Tigers,which emerged as the victorious team in the 2003 season, an average of 7.6 spectators (a maximum of 18
spectators per game) suffered from sickness/trauma. The

Ishikawa H, et al: Medical care in spectators at a baseball stadium

90

Table 4 Number of the sick/wounded persons classified by the participating teams in 2003

Participating teamHanshin Tigers
Chunichi Dragons
Yomiuri Giants
Hiroshima Toyo
Carp
Yokohama Bay
Stars
Exhibition game
Total

Number of
Number of
Number of
Number ofsick/wounded Relative risk
sick/wounded
spectators per sick/wounded
personslevel perpersons pergamepersons
per 10,000
game**
game
spectators
40,167
99
7.6
2.05
4.47
15,400
19
1.9
1.23
1.12
35,214
75
5.0
1.52
2.94
17,333
20
1.7
0.96
1.00

Relativerisk levelper 10,000
spectators**

Number ofgames*

Number ofspectators*

12
10
14
12

482,000
154,000
493,000
208,000

11

190,000

17,273

26

2.4

1.36

1.41

1.42

6
65

55,0001,582,000

9,167

8
247

1.3
3.7

1.45
1.56

0.76

1.51

2.13
1.28
1.58
1.00

* Excluding the called-off games** The risk level for the game relative to that for a competitor with the lowest incidence of sickness and injury is set as 1.
Number of the sick / wounded persons classified by the participating teams was analyzed from “Report of Aid” in 2003.

risk (i.e. incidence of visits to the first-aid station) per
spectator was 2.13 times as high as that for the participating team with the lowest incidence, and the risk per
game was 4.47 times as high as that for the team with thelowest incidence. These results suggest that the extent of
medical preparedness needed at the first-aid station in
the stadium varies according to the participating teams.
The survey of “Report of Accidents” revealed that intrinsic cardiopulmonary arrest (CPA) occurred in one
spectator during the 8-year study period. By-stander cardiopulmonary resuscitation (CPR) was not employed andthere was no record of the initial heart rhythm. Thus,
even ballparks should be equipped with an AED to rescue spectators who might suffer CPA.1 5 Recently, theFull Cast Stadium at Sendai (the home ground of a newball club) was equipped with 12 AEDs.
In summary, the results of the present study show that
there is a constant risk to even spectators at ballparks, although these data have been collected from only one stadium. Medical care is needed even for spectators of professional baseball games and the on-site first-aid station
at the stadium may reduce the need for clinics/hospitals
visits referral. It is considered that meticulous maintenance of records of the sick/wounded at public facilities
would allow a reasonable analysis of the demand for
medical preparedness at any particular facility, as well asplanning of reasonable medical care posts at other similar facilities.
Acknowledgement
We wish to thank Mr. Takayuki Okitsu, the former
manager of Meiji Jingu Stadium, and Mr. Kazunari
Wakatsuki, the person-in-charge of the safety of the stadium, who kindly shared with us valuable data from the

Meiji Jingu Baseball Stadium, Meiji Jingu Gaien. We
would also like to express our gratitude to the on-site
physicians and nurses at the stadium.
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