From Crowd to Care: Telemedical Delegation in Mass Gathering Medicine and Its Projected Impact on Hospital Transport-A Modified Delphi Study with Retrospective Modelling.

Background/Objectives: Physician shortages increasingly challenge the provision of medical care at mass gathering events. Telemedicine may expand the treatment capabilities of Emergency medical technician intermediates (EMT-I), but the extent to which medical procedures are suitable for telemedical delegation and how such a care model might affect hospital transport rates remain unclear. Methods: In this retrospective modelling study, patient records from the 2022 Summerjam Festival were reviewed, and all documented diagnostic and therapeutic measures were extracted for assessment in a modified Delphi process. We then applied the resulting expert consensus on telemedical delegability to the original patient cohort to classify cases by theoretical suitability for telemedical management and to project hospital transport rates under a predefined telemedicine-only scenario. Results: Based on the retrospective application of the final modified Delphi consensus, 385 of 403 cases (95.5%; 95% CI 93.0-97.3%) were classified as theoretically eligible for telemedicine-only management. Overall, 144 of 200 interventions were classified as fully delegable, 48 as suitable for bridging delegation, and 8 as requiring an on-site physician. Under the predefined telemedicine-only scenario, the projected hospital transport rate increased from 6.2% to 9.2%, corresponding to an absolute increase of 3.0 percentage points (95% CI 1.3-5.0%). Conclusions: These findings suggest that telemedicine may substantially expand the theoretical scope of care provided by EMT-Is in mass gathering medicine. The projected increase in hospital transports under the predefined telemedicine-only scenario was partly determined by the assumption that patients requiring bridging or physician-only measures would require hospital transport in the absence of an on-site physician. Hybrid care models combining telemedical physician support with targeted on-site physician availability may therefore warrant prospective evaluation in future mass gathering settings.