Introduction
Since 1969, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual+ (LGBTQIA+) rights movements around the world have been organizing annual pride events to advocate for civil rights, promote inclusion, and combat discrimination against people based on their sexual orientation and gender identity.Reference Markwell and Waitt1 Since then, participation has expanded dramatically, and the Milan Pride has become a symbol of LGBTQIA+ and civil rights in Italy.
The final day in Milan includes a parade through the city’s streets and a final event featuring testimonies, institutional speeches, and a large free concert.
The Milano Pride consists of both a “unbounded” and “bounded” features: combining a mobile route (parade) with a high-density static aggregation (concert) requires a hybrid model of in-event health services, with careful integration including dual-scenario risk assessment, planning of mobile units along the parade, flexible medical resources in the final area, integration between health resources, and a field hospital.Reference Chang, Wang, Anandjiwala and Hsu2, Reference Liu, Wu and Liu3
The purpose of this article is to present the health care plan developed for the final day of Milan Pride and to describe the medical assistance provided to individuals with health care needs throughout the celebration.
Methods
Study Design
Retrospective observational study of the medical plans and electronic patient records during the final day of Milano Pride across 3 consecutive editions (2022–2024, inclusive).
Setting
Event Characteristics
The final day of Milano Pride is usually held on the last Saturday of June and includes a 3 km parade through the city streets, followed by institutional speeches and a free concert. The parade begins in the early afternoon (2:00–3:00 p.m.), and the final event starts around 6:30 p.m.
Approximately 300,000 people take part in the parade, while around 20,000 attend the final concert, held in a square adjacent to Parco Sempione.
Health Care Resources
Throughout the study period, the in-event health services supporting Milano Pride maintained a consistent configuration consisting of Basic Life Support (BLS) ambulances, Advanced Life Support (ALS) car, bicycle teams, field hospital, and coordination center. An overview of staffing is displayed in Table 1.
Medical facility and human resources
a Basic life support.
b Two ambulances are intermediate-level units with a nurse on board.
c Advanced life support.
d A foot rescue team is provided with an emergency off-road vehicle for rescue operations within the park.
e One nurse from the Regional Emergency-Urgency Agency (AREU).
f One emergency medical technician from the Regional Emergency-Urgency Agency (AREU).
The coordination center kept a stable core of nurses with at least one from the local Emergency Medical Service authority, Agenzia Regionale Emergenza Urgenza (AREU).
Nurse-staffed ambulances carried equipment for peripheral venous access, infusion, and supraglottic airway management. Foot teams comprised ≥3 EMTs with a tactical stretcher/trolley, BLS backpack, automated external defibrillator (AED), and oxygen. Bicycle teams consisted of 2 EMTs with bicycles, emergency backpacks, AEDs, and oxygen. One foot patrol team was supported by a 4 × 4 off-road vehicle equipped as a BLS ambulance.
The number of vehicles and personnel is summarized in Table 1.
Mass Event Coordination Unit
The event employed a Mass Event Coordination Unit (MECU) housed in a purpose-equipped truck, featuring 10 computer workstations and independent phone and internet lines to maintain continuous communications and data handling. The architecture facilitated rapid integration with the field hospital, law enforcement, and local hospitals. Specialized software enabled real-time oversight and control of rescue operations. Full technical details are reported elsewhere.Reference Mercalli, Ghio and Bonizzato4 Assistance requests were received either from organizer spotters positioned along the route or via the national emergency number, which routed calls to the MECU. The presence of the local EMS agency, AREU, personnel allowed on-scene determination of hospital destinations, improving patient throughput and resource use.
Field Hospital
The field hospital comprised a central tent with up to 10 beds, expandable to 15 using auxiliary tensile structures outside the main unit. It maintained continuous voice and data links with the coordination center, and a large screen provided real-time tracking of patients awaiting admission and those under care. The structure housed 2 ICU-capable beds, each outfitted with a multiparameter monitor, ventilator, syringe and volumetric pumps, and suction. Oxygen cylinders were used to provide high-flow therapy to up to 5 patients simultaneously for 1 hour. Three further multiparameter monitors were available for the other beds. Medications and supplies supported full emergency management, including central venous cannulation, chest tube placement, and simple/complex suturing. Diagnostic tools comprised a blood gas analyzer and an ultrasound. Patient triage was conducted by a nurse and an EMT. Given the absence of waiting times for admission, a 3-color triage system (green, yellow, red) was used solely for classification purposes and to allocate patients to beds equipped with the most appropriate technology and resources according to the severity of presentation.
The field hospital was configured to stabilize time-critical conditions and major trauma pending transfer to a definitive care facility. Limb injuries requiring radiologic evaluation were assessed onsite, with analgesia initiated before transport.
Data Collection
Data were collected prospectively during the event by health care teams and subsequently consolidated by the coordination center using mission logs, field hospital records, and coordination documentation.
For each intervention, the mission type, main clinical characteristics, and outcome were recorded. For field hospital patients, additional data included mode of access, diagnostic category, treatments provided, and length of stay.
All data were anonymized prior to analysis to ensure confidentiality.
Statistical Analysis
Data were analyzed using descriptive statistics. Continuous variables were reported as mean and standard deviation, and categorical variables as frequencies and percentages. Interventions were stratified by year, mission type, and outcome (including patient presentation rate [PPR] and transfer to hospital rate [TTHR]). Analyses were performed using SPSS version 29.0.
Ethics
Ethical approval for this study was granted by the Comitato Etico Territoriale Lombardia 5 (Milano, Italy; protocol 02–25) and all study procedures were performed in accordance with the principles of the Declaration of Helsinki.
Results
Across the 3 editions of the event (2022-2024), participation increased progressively, accompanied by a steady rise in the number of rescue missions coordinated by the Mass Event Coordination Unit (Table 2). Basic Life Support (BLS) ambulances consistently accounted for more than half of all interventions, representing the main operational resource each year. Foot rescue teams provided an important complementary response, particularly during crowded phases of the parade, while Advanced Life Support (ALS) missions and bicycle rescue interventions remained limited but showed a gradual increase over time.
Rescue missions and patient destination (Mass Emergency Coordination Center) and field hospital activity and patient outcomes
a Patients assessed by the foot rescue units are all transported to the field hospital.
b Patients assessed by the bicycle rescue unit access the field hospital alongside the foot units.
The PPR ranged from 0.2 to 0.47 per 10,000 participants during the parades and from 15 to 17 per 10,000 during the concerts and the TTHR increased across the 3 years, from 2/10,000 in 2022 to 6.5/10,000 in 2024.
The majority of BLS missions were conducted for patients with non-traumatic conditions.
Trauma-related cases within BLS activity decreased over time, while ALS teams predominantly managed non-traumatic conditions throughout all editions. Direct hospitalizations from the scene remained infrequent, while transfers to the field hospital accounted for approximately one-third of all cases. Refusals of treatment or transport continued to represent a significant proportion of total responses.
At the field hospital, patient inflow originated primarily from self-presentations and BLS transfers, while a smaller yet stable proportion was referred by the foot rescue teams. Clinical presentations were heterogeneous, encompassing neurological or consciousness alterations, respiratory and cardiovascular disorders, wounds, trauma, and reported or suspected use of psychoactive substances and/or alcohol. The latter categories, together with trauma and cardiovascular conditions, were the most frequently recorded across the 3 years. Most patients were triaged with green or yellow codes, while red codes were rare.
Patient outcomes are detailed in Table 2.
Most individuals were discharged after short observation periods, with mean lengths of stay ranging between approximately half an hour and just over half an hour across the three editions. Transfers from the field hospital to external emergency departments increased gradually, while refusals of further treatment or hospitalization declined. Mean patient age remained stable, averaging around 32 years throughout all 3 events.
The pattern of activity followed the progression of the event: the number of missions increased during the afternoon hours of the parade, peaking in the evening during the concert phase. The highest operational demand occurred between 21:00 and 23:00, when both rescue missions and field hospital admissions peaked.
Discussion
To the best of our knowledge and based on the available literature, this is the first study to describe emergency preparedness and medical response at an LGBTQIA+ event. Previous studies estimate that mass gathering events (MGEs) report between 0.5 and 2 patients per 1,000 attendees; both the robust organization and the inherently celebratory and nonviolent nature of the event likely contributed to this outcome. As observed in other large-scale MGEs, the majority of cases involved minor conditions.Reference De Lorenzo5, Reference Van Remoortel, Scheers and Lauwers6
Another relevant aspect was pharmacological management: although the field hospital was equipped with a wide range of emergency drugs, only a limited number—mainly antiemetics, analgesics, and gastroprotective agents—were used. This indicates that most cases were manageable with basic therapeutic interventions, consistent with findings from other MGEs.Reference Ranse, Spaepen and Arbon7
Events such as rock concerts are often associated with a high number of presentations related to alcohol consumption and illicit drug use.Reference De Lorenzo5 In our series, reported or suspected use of psychoactive substances and/or alcohol accounted for 20.0%, 28.3%, and 25.6% of on-site presentations—about a quarter of the caseload each year. This share is higher than that reported at some large European music festivals, where intoxication-related presentations account for around 5%, but it is consistent with evidence that outdoor celebratory events with alcohol availability carry a substantial burden of substance-related cases. Surveys and observational studies in festival settings consistently show high planned/actual consumption and frequent involvement of alcohol in adverse events, supporting the plausibility of our proportions.Reference Bennett and Cottrell8
The PPRs and TTHRs observed across the 3 editions of the event show values consistent with those reported in the literature for low-risk mass gatherings. The recorded PPR, ranging from 0.2 to 0.47 per 10,000 participants during the parades and from 15 to 17 per 10,000 during the concerts, is substantially lower than figures reported for high-attendance or higher-risk events, where values may vary from 1 to over 100 presentations per 10,000 participants. The TTHR also demonstrates a progressive increase, from 2 to 6.5 per 10,000, yet it remains within the lower spectrum of rates described internationally (0.05-15 per 10,000), suggesting effective on-site patient management and a limited burden on external hospital services.Reference Ranse, Hutton, Turris and Lund9
Clinical outcomes further highlight the predominance of patient discharge following short observation periods and a gradual reduction in refusals of treatment. Most individuals were assessed and discharged directly from the temporary medical facility, while only a minority required hospital transfer. These findings indicate an appropriate triage process and an efficient medical response capacity throughout the event.
A relevant proportion of field hospital presentations were associated with alcohol and psychoactive substance use, particularly during evening hours corresponding to concert activities. These cases represented one of the main reasons for medical evaluation and, although generally of mild to moderate severity, contributed significantly to the overall clinical workload.
Limitations
This study has several limitations. Its retrospective design and reliance on operational records may introduce information bias and misclassification. Attendance estimates were aggregated rather than phase-specific, and some cases (e.g., self-managed or direct ED presentations) were likely not captured. Follow-up data and hospital linkage were unavailable. Year-to-year variability in contextual factors may have introduced confounding. The removal of sensitive identifiers limited subgroup analyses, and the low number of critical events reduced statistical power. Finally, findings from a single urban setting may limit generalizability to other mass gatherings.
Conclusion
Health care operations at Milano Pride over 3 years were associated with a low rate of interventions versus international mass-gathering benchmarks; the majority of patient presentations were minor in nature and were managed at the MGE. Availability of ALS units, a comprehensive field hospital, and a dedicated coordination center supported safe care for severe cases. Notable strengths were inter-agency integration, structured preparedness, and ethical safeguards (minors, confidentiality). The approach is a useful template for other large public events.
Acknowledgments
The authors thank all the emergency medical technicians, as well as all physicians and nurses, who contributed to the organization and implementation of the event.
Author contribution
Conceptualization: SM, IZ, FG; Data curation: DT, LS, DB, LB, FG; Formal analysis: SM, MI, FS; Methodology: SM, CB; Project administration: SM, FS; Resources: SM; Software: SM; Supervision: FEG, CC, PM, AI; Validation: AI, LC; Visualization: LC, AI, SM; Writing—original draft: SM, LC, JR; Writing—review and editing: SM, LC, JR.
Funding statement
No funding
Competing interests
The authors have no conflicts of interest to disclose.
Ethics approval
Study protocol approved by Comitato Etico Territoriale Lombardia 5 (Milano, Italy; protocol 02-25) and all study procedures were performed in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Retrospective observational research performed by IRCCS is waived from the requirement of obtaining informed consent for publication, as specified under the Italian Data Protection Code (Legislative Decree No. 196/2003) and the General Data Protection Regulation (GDPR), when the research involves data that is anonymized and does not involve any intervention with the participants. As this study adheres to these legal and ethical standards, informed consent for publication of results is not required.
Use of AI technology
The authors confirm that no generative artificial intelligence tools were used in the preparation, writing, or revision of this manuscript.
