Acute Medicine & Surgery 2021;8:e626

doi: 10.1002/ams2.626

Review Article

Medicine at mass gatherings: current progress of
preparedness of emergency medical services and disastermedical response during 2020 Tokyo Olympic andParalympic Games from the perspective of the Academic
Consortium (AC2020)
Naoto Morimura,1,2 Yasumitsu Mizobata,3 Manabu Sugita,1 Satoshi Takeda,4,5
Tetsuro Kiyozumi,4 Tomohisa Shoko,4 Yoshiaki Inoue,4 Yasuhiro Otomo,2,6 Atsushi
Sakurai,7 Yuichi Koido,8 Seizan Tanabe,8 Tetsu Okumura,9 Fumihiro Yamasawa,10 Hideharu
Tanaka,5 Tomoya Kinoshi,11 Koki Kaku,12 Kiyoshi Matsuda,13 Nobuya Kitamura,14 Tatsuya
Hayakawa,14 Yasuhiro Kuroda,7,15 Yumiko Kuroki,9 Junichi Sasaki,16,17 Jun Oda,16Masataka Inokuchi,18 Toru Kakuta,18 Satoru Arai,18 Noriaki Sato,19 Hiroyuki Matsuura,20
Masahiro Nozawa,20 Toshio Osamura,20 Kazunori Yamashita,15 Hiroshi Okudera,11
Akihiko Kawana,17 Tsugumichi Koshinaga,21 Satoshi Hirano,21 Erisa Sugawara,12 Michihiro
Kamata,22 Yasuhito Tajiri,22 Mototsugu Kohno,23 Michiyasu Suzuki,24 Hiroyuki Nakase,24
Eiichi Suehiro,24 Hiroaki Yamase,25 Hiroshi Otake,26 Hiroshi Morisaki,26 Akiko Ozawa,26 Sho
Takahashi,27 Kotaro Otsuka,28 Kiyokazu Harikae,13 Kazuo Kishi,28 Hiroshi Mizuno,28 Hideaki
Nakajima,29 Hiroki Ueta,29 Masao Nagayama,30 Migaku Kikuchi,30 Hiroyuki Yokota,2Takeshi Shimazu,1 Tetsuo Yukioka,1 and The Joint Committee of the Academic Consortiumon Emergency Medical Services, Disaster Medical Response Plan during the Tokyo
Olympic and Paralympic Games in 2020 (AC2020)
1
Japanese Association for Acute Medicine, Tokyo, Japan, 2The Scientific Research Group of Ministry of Health,
Labor and Welfare of Japan, Tokyo, Japan, 3Japanese Society for Emergency Medicine, Tokyo, Japan, 4The
Education and Training Working Group of AC2020, Tokyo, Japan, 5AED Foundation of Japan, Tokyo, Japan,
6Japanese Association for the Surgery of Trauma, Tokyo, Japan, 7Japanese Society of Intensive Care Medicine,Tokyo, Japan, 8Japanese Association for Disaster Medicine, Tokyo, Japan, 9Japanese Society for Clinical
Toxicology, Tokyo, Japan, 10Japanese Society of Clinical Sports Medicine, Tokyo, Japan, 11Japanese Associationof First Aid and Emergency Medicine, Kyoto, Japan, 12Japanese Society for Infection Prevention and Control,
Tokyo, Japan, 13Japan Prehospital Trauma Evaluation and Care Council, Tokyo, Japan, 14Japanese Society for
Aeromedical Services, Tokyo, Japan, 15Japanese Society of Reanimatology, Ube, Japan, 16Japanese Society for
Burn Injuries, Tokyo, Japan, 17Japanese Association for Infectious Diseases, Tokyo, Japan, 18Tokyo Medical
Association, Tokyo, Japan, 19Japanese Association for Emergency Nursing, Tokyo, Japan, 20Japan PediatricSociety, Tokyo, Japan, 21Japan Surgical Society, Tokyo, Japan, 22Japanese Orthopaedic Association, Tokyo,
Japan, 23Japanese Society for Prehospital Medicine, Tokyo, Japan, 24Japan Society of Neurotraumatology, Tokyo,
Japan, 25Japan Academy of Critical Care Nursing, Tokyo, Japan, 26Japanese Society of Anesthesiologists, Kobe,
Japan, 27Japanese Society of Psychiatry and Neurology, Tokyo, Japan, 28Japan Society of Plastic and*See Appendix S1S1 for complete details of The Joint Committee of the Academic Consortium on Emergency Medical Services andDisaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020).
The institutions at which the work was carried out together with: Secretariat of Japanese Association for Acute Medicine, Ks Building
3F, 3-3-12 Hongo, Bunkyo-kuu, Tokyo 113-8033 Japan.
Corresponding: Naoto Morimura, MD, PhD, The Joint Committee of AC2020, Department for Acute Medicine, Graduate School of
Medicine, University of Tokyo, Tokyo, Japan. E-mail: morimuran-eme@h.u-tokyo.ac.jp; molimula@r6.dion.ne.jp.
Received 18 Dec, 2020; accepted 23 Dec, 2020
Funding information
Grants from the Japan Ministry of Health, Labor and Welfare Scientific Research Fund.

© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of
1 of 12
Japanese Association for Acute Medicine
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License,
which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial andno modiﬁcations or adaptations are made.

2 of 12 N. Morimura et al.

Acute Medicine & Surgery 2021;8:e626

Reconstructive Surgery, Tokyo, Japan, 29Japan EMT School Association, Kyoto, Japan, and 30Japan Resuscitation
Council, Tokyo, Japan
Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports
showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The
response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and tomaintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care andimprovement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held inTokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The
Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic
Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on
assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.
Key words: COVID-19, emergency medical service, mass gathering, Olympics, public health-care

INTRODUCTIONM

ASS GATHERINGS ARE events characterized by“the concentration of people at a speciﬁc location
for a speciﬁc purpose over a set period of time thathave the potential to strain the planning and response
resources of the host country or community” by theWorld Health Organization (WHO).1 These include
large-scale sports competitions, city marathons, concerts,
and ﬁreworks. Traditional deﬁnitions according to thenumber of people range from “25,000 or more”2 to“1,000 or more”.3 One of the largest mass gatherings in
the world is a pilgrimage of millions to Mecca (Saudi
Arabia). Another deﬁnition is "a situation in which has
potential for a delayed response to emergencies becauseof limited access or other features of the environment or
location” such as transportation in large cities (subway/train), large shopping malls, airport, cruise ships,
public demonstrations.4 Needless to say, the Olympics
and Paralympics are two of the largest mass gathering
events in the world.
On 24 March, 2020, the Olympic and Paralympic Games(the 2020 Tokyo Olympics) were postponed to the summerof 2021 in consideration of the new coronavirus infection(COVID-19) epidemic.5 The 2020 Tokyo Olympics will beheld in Tokyo and will involve mass gatherings on a daily
basis. This paper outlines the issues and countermeasuresfor emergency and disaster medical care related to the running of this big event, focusing on the activities of the Academic Consortium.

RISKS AND BENEFITS OF MASS GATHERINGEVENTS FOR THE LOCAL HEALTH-CARE
SYSTEMM

ASS GATHERING CAUSES an increase in theemergency medical demand due to a temporary concentration of people in the area, and imposes a burden on
the operation of daily emergency medical service systems.
Previous reports showed that injuries and illnesses occurred
as a result of the concentration of people in a limited area. It
is necessary to build a comprehensive emergency medical
services system that includes local residents not related tothe events. Severity of the injuries and illnesses are not often
serious, but occasionally serious cases were reported. Crowd
size and density, venue air conditioning, or weather conditions such as high or low temperature and high humidity,
event type and period,2 access to the venue,6 public healthfacilities, enthusiasm,7 alcohol, legal drugs, and the adequacy of the medical services system in the venue are therisk factors of the increase of patient presentation. The limitation of access to the local emergency medical services system is also regarded as a risk factor.8
In these situations involving high concentrations of people, mass casualty incidents (MCI) can occur due to crowd
avalanches, terrorism, and the spread of infectious diseases.
A previous report described a crowd avalanche at the Akashi
Fireworks Festival in 2001 that caused MCI of 11 dead and
247 injured.9,10 An unusual congestion at the pedestrian
bridge on the access route to the venue was the cause of this
MCI. The concentration of 13 to 15 people per square meter© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

Acute Medicine & Surgery 2021;8:e626

Medical preparedness of the 2020 Tokyo Olympics 3 of 12

occurred at the end of the bridge where spectators from thetrain station and spectators from the venue met.
High level of international interest of a mass gathering
event such as the Olympic Games is also associated with
causing MCI. During the 1996 Atlanta Olympics, a bomb
explosion occurred at an outdoor concert space at the Centennial Olympic Park in the city. The casualties were morethan 100 injured and two dead.11 Another report of MCI
was the terrorism that occurred during the 1972 Munich
Olympics.12 Eleven athletes were killed.
More recently, a terrorist bombing occurred at the citizen
marathon held in Boston, USA in 2014, resulting in threedeaths and 264 injuries.13 In the 2015 Paris terrorist attacks,

356 injured people were transported to 18 hospitals and 129
people died at the scene.14,15
Infectious diseases represent another signiﬁcant problem. Mass gatherings also have the potential to escalate
the transmission of widespread infectious diseases, suchas COVID-19. In 2000 and 2001, an outbreak ofmeningococcal infection was reported during a pilgrimage to Mecca. Since then, vaccination of participants has
been carried out.16,17 At the 23rd World Scout Jamboree(WSJ2015) held in Japan in 2015, it was reported thatthree Scouts from the North Scotland Corps and one
Scout from the Swedish Corps developed meningococcal
infection.18,19 In addition, epidemics of infectious

Fig. 1. Organization chart of the Academic Consortium on Emergency Medical Services, Disaster Medical Response Plan during theTokyo Olympic and Paralympic Games in 2020 (AC2020).

© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

4 of 12 N. Morimura et al.

Acute Medicine & Surgery 2021;8:e626

Fig. 2. Website of the Academic Consortium on Emergency Medical Services, Disaster Medical Response Plan during the Tokyo
Olympic and Paralympic Games in 2020 (AC2020).

diseases such as inﬂuenza, measles, and norovirus20 havebeen reported at mass gathering events.
In recent years, it has been reported that the mortality rateof out-of-hospital cardiac arrest and acute myocardial infarction during a large-scale citizen marathon event in the United States was signiﬁcantly higher than when it was notheld. The delay of deﬁnitive treatment by restricting accessto emergency medical institutions is considered to be one of
the causes.8 The WHO Collaborating Centres on Mass
Gatherings refers to local residents who are not involved in
the event as "penumbra"; these residents may be adversely
affected by the mass gathering in terms of provision oftimely medical care.21,22 Thus, maintaining the activities
and quality of a daily emergency medical services system
for local residents is essentially very important.
In view of the above context, mass gathering events witha predetermined date can be prepared as a “scheduled disaster or MCI”. In other words, it is easy to make a preliminaryplan "because the time of the disaster or MCI, if any, hasbeen determined". A mass gathering event places a signiﬁcant burden on the local health-care system, including the
preparation of an aggressive response plan, but provides theopportunity for long-term beneﬁts after the end of the event.
It can provide a stronger public health-care system andopportunities to determine how to protect against certain illness and injury for residents and visitors.

HISTORY OF MEDICINE AT MASSGATHERINGS IN JAPANT

HE SOPHISTICATED PRACTICE of medical support at mass gatherings and the formation of consensus among medical professionals and stakeholders have
gradually increased through the lessons learned from previous experiences of events such as the 1985 International Science and Technology Expo (Science Expo,
Tsukuba 1985),23 the 1998 Nagano Winter Olympics,24
the 2000 Okinawa Summit,25 the 2001 Akashi Fireworks
Festival accident,9,10 and the 2002 FIFA World Cup
Games in Japan and Korea.6
At the 2002 FIFA World Cup Games, an emergency medical information sharing system based on a mailing list at 10
venues was established, which was old-fashioned but novelat that time.26 At the symposium of the 12th Annual Meeting of the Japanese Association for Disaster Medicine(JADM) at Nagoya in 2007, a statement was made on thedeﬁnition of mass gathering and the need for medical assistance. Since then, municipal department and health-care professionals, also with the event organizer, have tended to plan
an on-site emergency medical services system in order torealize the early initial care and to reduce the burden on
health-care providers in the surrounding hospitals and clinics. At the same time, JADM has been working on© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

Acute Medicine & Surgery 2021;8:e626

Medical preparedness of the 2020 Tokyo Olympics 5 of 12

Table 1. Medical problems and their causes related to2020 Tokyo Olympics

LAUNCH OF THE ACADEMIC CONSORTIUM
TOWARDS THE 2020 TOKYO OLYMPICS

Concentration of people in venue and surrounding area
on daily emergency medical system• Impact• Increase of number of medical telephone
consultations and ambulance callsof ambulance usage• Increase• Hospital burden resulting from increase of referral
to ED• Impact on disaster medical system

a MCI due to increased population density in limited areasb Earthquake directly under the capital city as an
assumed natural disaster
Weather condition-related• Heatstroke• Lightning strike

Nationwide increase in tourists including visiting foreigners• Epidemic of infectious diseasea COVID-19• Impact on daily emergency medical systema Language, religion, insurance, repatriation
High international interest-related

MCI caused by terrorism• Multisite• Explosion, gunshot wound, special disaster
Health-care worker-related• Training of large number of medical staff and volunteers
ED, emergency department; MCI, mass casualty incident.

establishing a clear standard for how much valuable medical
personnel and equipment should be put into the ﬁeld for“preparation”. The committee of the JADM has tried todevelop of formula by using an algorithm based on the daily
emergency patient presentation rate (PPR) in Japan and thetransport to hospital rate at past similar events. However, as
the same kind of event data in the past is indispensable,
more useful methods are still being studied.
At a series of international conferences, such as the 2000
Okinawa Summit, the 2008 Toyako Summit, the 2010
Yokohama APEC, the 2016 Ise-Shima Summit, and the2019 Osaka G20, as well as Rugby World Cup 2019 and theEnthronement Ceremony in 2019, a nationwide support system has come to be assembled according to the predictedrisks. Of particular note is the 2019 Osaka G20, the ﬁrst system with a clear awareness of maintaining the activities andquality of emergency medical care for local residents. The"local residents unrelated to the event (penumbra)" mentioned above were clearly considered.

I

N APRIL 2016, the Academic Consortium on Emergency
Medical Services and Disaster Medical Response Plan
during the Tokyo Olympic and Paralympic Games in 2020
(AC2020) was launched to provide academic support for theestablishment of an emergency and disaster medical system
during the Games. As of October 2020, 28 various medical
associations have participated.27 The joint committee, consisting of members from each organization, has been set up
as a department in charge of gathering knowledge from eachspecialty ﬁeld (Fig. 1), undertaking academic studies, issuing statements, and disseminating manuals, seminar information, lecture content, and simulation training through its
website (Fig. 2). AC2020 aims to be a "platform" for thetransmission of information by experts, and a "portal" of
information sources for citizens and those involved in planning.

EXTRACTING ISSUES RELATED TO
EMERGENCY MEDICAL CARE DURING THE
2020 TOKYO OLYMPICS BY THE AC2020IN TOKYO IN 2021, enormous mass gatherings will be
added to the daily mass gathering. Not only the venue but
also the area with the concentration of people on the roadfrom the nearest public transport station to the venue (lastmile), outdoor events (live sites or public viewing), and“penumbra” should be covered in the planning. Again, theresponse plan should provide timely medical care to thepatients and reduce the burden on emergency hospitals, andmaintain a daily emergency medical system for residents inand around the area.
First, the joint committee of the AC2020 discussed
extracting the medical issues to formulate a plan for thisevent (Table 1). The ﬁrst issue is caused by a concentrationof people in the venue and surrounding areas. The emergency medical services system, which is tight on a daily
basis, faces an additional burden. Emergency telephone consultation center calls (dial number: #7119 and #8000) and anincrease in the number of operations for ambulance dispatch(dial number: 119) are considered inevitable. It is feared that
not only the number of emergency outpatients will increase,
but also congestion in the trafﬁc network could cause delayin the arrival of ambulances and treatment within a therapeutic time. The second issue is weather-related. In the extremely hot and humid environment, there is a concern that theincidence of heatstroke will increase.
The third issue is associated with the increase in the number of foreign visitors, which is considered nationwide. The© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

6 of 12 N. Morimura et al.

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Table 2. Risk assessment: staff, stuff (equipment, drug, ambulance), patient presentation rate (PPR), severity, load of hospitals
Problem

Predicted decline in the quality of emergency medical care accompanying addition of emergency
demandTask
Topic-related cause

Reduce the load on EMS demand and lighten the impact on daily EMS flow
Impact of temporary influx and concentration of people
Impact of opening
Impact of risk included in the event
time
Heatstroke Lightning Mass casualty
Daily emergency
strikeincident(CVD, ACS, trauma)

Topic

Theme oftopic

Command/control
SafetyCommunication
Assessment
TriageTreatment
Transport

MCI due tonaturaldisaster

Explosive/
Chemical Infection
burn/(COVID-19)
penetrating
injuryEstablishment of unified coordination center during the exhibition
Prevention
Reduction of access
restriction to EMS
Communication flow path, monitoring of illness/injury
Risk assessment: staff, stuff (equipment, drug, ambulance), PPR, severity, load of hospitals
Standard manual of on-site medical station/first aid station
Standard manual of on-site medical station/first aid station, treatment for foreigners
Interhospital transport system, repatriation

ACS, acute coronary syndrome; CVD, cerebrovascular disease; EMS, emergency medical service; MCI, mass casualty incident.

work burden associated with language, religion, insurance,and repatriation has a major impact on the daily emergency
medical services system. Infectious diseases, including
COVID-19, will spread as a result of the temporary increaseof inbound and movement of domestic visitors. Finally, therisk of simultaneous or multisite MCI caused by terrorism inlight of the recent international situation should be regarded
as an important issue. It is necessary to keep in mind thepossibility of vehicle ramming, mass shooting, and chemical, biological, radiological, nuclear, and explosive disasters,
which are rarely experienced.
The participating organizations of AC2020 were thendivided into groups according to related specialized areas,
and after extracting the problems in each area, they wereorganized into command and control, safety, communication, assessment, triage, treatment, and transport categories(Table 2). Based on these problems, statements, guidelines,
and manuals have been created as follows.

AC2020’S APPROACH TO PROBLEMSTHE JOINT COMMITTEE of AC2020 released statements in September 2016 and November 2017 throughits website, and in April 2018 that was directly sent to theTokyo Metropolitan Government Administration Ofﬁce.
These three statements included the proposal to establish amulti-institutional coordination center being held during theholding period that functions as a joint command and coordination headquarters in case of an MCI. The statement also
described a necessity of planning for the “last mile”,
strengthening of communication and information systems
based on the existing ones, code names and operations when
MCI occurs (we do not yet have an emergency code, such as“Code Brown,” used in the UK, USA, and other countries),
medical risk assessment based on daily emergency medical
supply and demand balance, and veriﬁcation at test event.
As a result, a medical advisory board was established in theTokyo Metropolitan Government in January 2019. Thisboard has the function of giving advice from a medical pointof view with the policies of AC2020 to the response plan for
the entire host area, while keeping an eye on the medical
response plan in the venue that the Tokyo Organising Committee of the Olympic and Paralympic Games (TOC) has
been in charge of.
In addition, AC2020 has distributed approximately 40
items of information, including guidelines and manuals on© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

Acute Medicine & Surgery 2021;8:e626

Medical preparedness of the 2020 Tokyo Olympics 7 of 12

Table 3. Proposal on necessity for multiagency coordination center for medical and first response system at mass gathering
eventsNo.

Organization in charge of document
preparation

Document type

Title of document

Uploaded date1
2

AC2020 Joint Committee
AC2020 Joint CommitteeStatement
Statement

20 May, 2016
30 Sep, 20163
4
5

ReportStatement
Report6

AC2020 Joint Committee
AC2020 Joint Committee
Japanese Society of Intensive Care
Medicine
Japanese Society for Burn Injuries

7

AC2020 Joint CommitteeStatement

8

AC2020 Joint CommitteeStatement

9
10
11

The AED Foundation of JapanThe Japanese MHLW research teamAC2020 Joint CommitteeStatement
ReportStatement

12

AC2020 Joint Committee

Recommendation

13

Tokyo Medical Association

Event news

14

Japanese Association for Surgery ofTraumaJapanese Society for Aeromedical
Services

Guideline

16

AC2020 Joint Committee

Recommendation

17

The Japanese Society of Intensive Care
Medicine
Japanese Society for Emergency
Medicine
Japanese Society for Emergency
Medicine
National Center for Global Health andMedicine

ReportFormation of AC2020 joint committee
Basic policy of emergency medical service
and disaster medical response plan during
Tokyo Olympics 2020
Report from participating organizations
The kick-off symposium of AC2020
Survey of ICU capacity of each hospitalaround each venue
Survey on severe burns and guidebook of first
response on burns
Proposal on necessity for multiagency
coordination center for medical and first
response system at mass gathering events
Proposal from the consortium regarding
preparation for mass gathering event basedon a plan by Tokyo Metropolitan
Government
Preventing sudden death during exercise
Report of the Japanese MHLW research teamProposal for constructing medical and first
responding system in event-site during
Tokyo Olympics 2020
Consortium proposal of requirements for
medical and EMS staff, version 1
Workshop program on disaster responses forTokyo Olympic and Paralympic Games by
Tokyo Medical Association
Guideline of treatment for trauma by gunshot
and explosion
Prehospital emergency medical care at the2020 Tokyo Olympics – based on theexperience of London helicopter EMS
response at the 2012 London Olympics
Consortium proposal of requirements for
medical and EMS staff, version 2
Guidance for disaster responses andpreparedness in ICU
Guideline of medical care for heatstroke

12 Dec, 2018

The Japanese Association for
Emergency Nursing, The Japan
Academy of Critical Care Nursing, The
Japanese Society for Emergency

Guideline

Guideline of medical care points for visiting
foreigners
Report of symposium on medical
preparedness for Tokyo Olympic andParalympic Games 2020
Guideline for nurses on Tokyo Olympic andParalympic Games 2020

15

18
19
20

21

Guideline

Overseas
invited lecture

Guideline
Guideline
Report7 Nov, 2017
7 Nov, 201720 Apr, 201820 Apr, 201820 Apr, 201820 Apr, 201818 May, 201819 June, 201824 July, 2018

5 Sep, 2018
19 Sep, 2018

20 Sep, 201812 Oct, 201818 Oct, 2018
5 Nov, 201812 Dec, 201821 Dec, 201819 Feb, 2019

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8 of 12 N. Morimura et al.

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Table 3. (Continued)
No.

Organization in charge of document
preparation

Document type

Title of document

Uploaded date

Recommendation

The curriculum and program for theknowledge and skills training necessary for
medical staff during the event have been
startedQuestionnaire results about correspondence
at the time of genital injury
Response to inbound infectious diseases, forTokyo 2020 Games: infectious diseases
quick reference
Survey on the current state of medical carefor severe burns, Heisei 30th, supported by
Administrative Promotion for Survey of the
Ministry of Health, Labor, and Welfare.
Committee visit report on heat stroke andhypothermia
Symposium session “Emergency and disastermedical system for international mass
gathering events”
Panel discussion in “Activities and issues for
the Academic Consortium on Emergency
Medical Service and Disaster Medical
Response Plan during the Tokyo Olympic
and Paralympic Games in 2020”
Medical staff training for the athletes in thevenue has been started by the program
created by the consortium
Fourth generation agents: medical
management guidelines (updated 18 Jan,2019) (in Japanese translation)
Guideline of in-hospital response for masscasualty incident: the final version
Instructional video in countermeasure forimported infectious disease “To prevent an
outbreak: infection control measures we all
can start and deal with”
Activities of response to COVID-19 by AC2020
Online QQ: Guide for pediatric medical
emergency
Guideline for holding training course of
emergency/disaster medicine during theepidemic of COVID-19

19 June, 201922

Medicine, The Japanese Society of
Intensive Care Medicine, The Japan
Society for Infection Prevention andControl, The Japanese Association ofFirst Aid and Emergency Medicine
AC2020 Joint Committee

23

Japanese Orthopaedic Association

24

Japanese Association for Infectious
DiseasesManual25

Japanese Society for Burn Injuries

Report updated

26

Japanese Association for Acute
Medicine
Japanese Association for Acute
Medicine

Report28

Japanese Association for Acute
Medicine

Report29

AC2020 Joint Committee

Recommendation

30

Special Research in Health and Labor
Sciences

Guideline

31

Japanese Society of Anesthesiologists

Guideline

32

Japanese Society for Infection
Prevention and Control

Guideline

33
34

AC2020 Joint Committee
Japan Pediatric Society

Statement
Manual35

AC2020 Joint Committee

Guideline

27

Statement

29 July, 201929 July, 201923 Aug, 201912 Sep, 20197 Oct, 20197 Oct, 201924 Nov, 201916 Jan, 2020

3 Feb, 2020
3 Feb, 2020

17 Mar, 2020
5 June, 2020
27 July, 2020

AC2020, Academic Consortium on Emergency Medical Services, Disaster Medical Response Plan during the Tokyo Olympic and Paralympic
Games 2020; EMS, emergency medical service; ICU, intensive care unit; MHLW, Ministry of Health and Welfare; QQ, emergency.

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Medical preparedness of the 2020 Tokyo Olympics 9 of 12

medical care and nursing on themes of heatstroke, foreign
visitors to Japan, burns, gunshot wounds and bomb injuries,
intensive care unit operation, and infectious diseases(Table 3). AC2020 formulated recommendations for medical
staff requirements, and also drafted a curriculum and program for the knowledge and skills training necessary for thestaff (Table 4). At the request of TOC, related academic
societies and organizations have led the development of a
training program with 30 videos for medical staff at thevenue (Figs. 3 and 4). Currently, the Education and Training
Working Group of AC2020 is exploring remote training
methods using this educational content especially for skills
training. The training courses are progressing in sequence
using this content. Over the last 20 years, we have a wealthof experience in the development and implementation of
off-the-job training courses for citizens and medical staff,
with the aim of improving quality through standardization of
medical care. A number of organizations worked together toformulate teaching materials and programs in a short periodof time based on their achievements. Recommendations
regarding these staff requirements and guidelines and teaching materials are widely taken up, and reﬂected and utilized
in the training plan not only by TOC, but also by local governments, medical associations, and other related organizations at each venue.

The effects of the ﬂamework of the AC2020 are the great
impact of the information transmitted from many organizations, the spread of information from each academic societysite, and the rapid transmission of information based on theease of building a collaborative system in related ﬁelds. A
brief summary of activities of each member society of theAC2020 is shown in Appendix S1.

CORRESPONDENCE TO INFECTIOUS DISEASEM

EASURES AGAINST INFECTIOUS diseases havebeen initially taken from the viewpoint of responding
to bioterrorism. For example, the government is importingﬁve highly deadly viruses, such as Ebola and Lassa fever, toverify the accuracy of diagnostic tests under development.28
The Tokyo Metropolitan Government has built an infectious
disease emergency transport monitoring system based on an
analysis of ambulance transport cases.29 The WHO has published guidance on risk assessment of mass gathering eventsin the COVID-19 epidemic, emphasizing the importance ofcontinuous risk assessment.30,31 In order to hold the 2020
Tokyo Olympics in the international epidemic of COVID19, continuous status and trend monitoring and an accurate
assessment of the current situation based on it are indispensable. At the same time, the preparation of surge capacity andTable 4. Control of infectious diseases during mass gathering events
Title

Health-care
workers

General issues
Medical control and regional EMS system
Medicine at mass gathering
Medical care points for visiting foreigners
Control of infectious disease
Common issues
Resuscitation: BLS/AED
Resuscitation: ALS
Initial approach for trauma
First aid including tourniquet use
Triage for MCI, radio communication
Special issues
Heatstroke medical treatment including ice pool
Gun wound/blast injury
Toxidrome
Lightning strikeE-learning

Modular skills training

Total training time 4 h

Dr

Ns

Other

Total training time 2.5–3 h

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◎, required; 〇, optional; AED, automated external defibrillation; ALS, advanced life support; BLS, basic life support; Dr, doctor; EMS, emergency medical service; MCI, mass casualty incident; Ns, nurse.

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10 of 12 N. Morimura et al.

Acute Medicine & Surgery 2021;8:e626

Fig. 3. Training program of medical staff for the spectators of the Tokyo Olympic and Paralympic Games in 2020 (E-learning lectureand skills training for 4 h). ADLS, advanced disaster life support; ALS, advanced life support; BLS, basic life support; DMAT, disastermedical assistant team; EMS, emergency medical services; JATEC, japan advanced trauma evaluation and care; JPTEC, japan prehospital trauma evaluation and care; MCI, mass casualty incident; MIMMS, major incident medical management and support.

Practical training in each venue
The Academic Consortium on Emergency Medical Service
and Disaster Medical Response Plan during the Tokyo
Olympic and Paralympic Games in 2020

Training for medical staff
e-learning

Training for medical staff
remote skill training

Lecture course: shared issues andinformation about the Games
Knowledge and skills based on roles
and qualifications of staff
Fig. 4. Flamework of training of venue staff.

© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine

Acute Medicine & Surgery 2021;8:e626

Medical preparedness of the 2020 Tokyo Olympics 11 of 12

the system for systematically and efﬁciently implementing
these must be promoted by gathering the power of all relatedorganizations.
In the future, we would like to use the abbreviation“MASS Gathering” to capture the salient features of thesemanagement tactics: Monitoring, Assessment, Surge capacity, and Systems. MASS Gathering could be used as a keyword for dealing with the double risks of this mass gathering
event and COVID-19.

spillover as the cause of the 2019 novel Coronavirus Epidemic. Infez. Med 2020; 28: 3–5.
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care and mortality during major U.S. marathons. N. Engl. J.
Med. 2017; 376: 1441–50.
9 Akashi Citizens Summer Festival Accident Investigation
Committee. Accident investigation report at the 32nd Akashi
Citizens Summer Festival. 2002; 12–27.(in Japanese).
10 Ishii N, Nakayama S, Nakamura M et al. Akashi citizens
summer festival ﬁreworks festival crowd accident. Tiryogaku.
2002; 36: 993–8.(in Japanese).
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12 Boyle P, Haggerty KD. Planning for the worst: risk, uncertainty and the Olympic Games. Br. J. Sociol. 2012; 63: 241–59.
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for the next disaster. Ann. Surg. 2014; 260: 960–6.
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2589–93.
16 Borrow R. Meningococcal disease and prevention at the Hajj.
Travel Med. Infect. Dis. 2009; 7: 219–25.
17 Tezer H, G€ulhan B, Simge Gisßi A et al. The impact ofmeningococcal conjugate vaccine (MenACWY-TT) on
meningococcal carriage in Hajj Pilgrims returning to Turkey.
Hum. Vaccin. Immunother. 2020; 16: 1268–71.
18 European Centre for Disease Prevention and Control, Rapid
Risk Assessment. Outbreak of invasive meningococcal disease in the EU associated with a mass gathering event, the23rd World Scout Jamboree in Japan. 21 August 2015 http://
ecdc.europa.eu/en/publications/Publications/Meningococcaldisease-scouts-EU-August-2015.pdf (accessed Aug 17,2020).
19 Meningococcal disease in Scouts returning from international
Jamboree HPS Weekly Report, 18 August 2015, Volume 49
No 2015/33. http://www.hps.scot.nhs.uk/documents/ewr/pdf
2015/1533.pdf (accessed Aug 17, 2020).
20 Kim K, Jang JY, Moon G et al. Experiences of the emergency
department at the pyeongchang polyclinic during the 2018
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21 Lund A, Turris SA, Bowles R et al. Mass-gathering healthresearch foundational theory: part 1 - population models for

ACKNOWLEDGEMENTSTHE AUTHORS WOULD like to acknowledge Dr.
Takashi Tagami, Dr. Yoshihiro Hagiwara, Dr. Mariko
Omura, Dr. Kyota Nakamura, Dr. Takeshi Abe, and Mr.
Keisuke Fukushima from the JAAM Task Force for facilitating activities on the webpage. We appreciate Mr. Toshimitsu
Morizumi and Mr. Toru Okamoto of the Tokyo Fire Department for their activities as members of the Joint Committeeof AC2020 from the Japanese Society for Emergency Medicine. We also would like to thank Ms. Mizuki Takeuchi,
Ms.Yumiko Ogawa, Ms. Natsuko Kabuta, and Dr. Chiaki
Toida for the support in the interpretation of English documents. Finally, we would like to acknowledge Ms. Narumi
Funayama of the AC2020 secretariat for continued administrative support.

DISCLOSURE
Approval of the research protocol: N/A.
Informed consent: N/A.
Registry and the registration no. of the study/trial: N/A.
Animal studies: N/A.
Conﬂict of interest: None declared.

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SUPPORTING INFORMATION
Additional Supporting Information may be found in the
online version of this article at the publisher’s web-site:
Appendix S1. Brief summary of the activities of each academic society.

© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf ofJapanese Association for Acute Medicine