The Event Organiser should: 

Ensure appropriate medical provision is available to all those attending or involved in delivering the event 

conduct due diligence in the selection of a competent medical provider, including ensuring suitable arrangements are in place for the transfer of patients requiring hospital care 

ensure the provision of all necessary infrastructure for the delivery of the service 

minimise the effects of the event on the statutory healthcare services by providing good medical care on-site 

encourage engagement from the Safety Advisory Group (SAG) where one is convened and/or NHS Ambulance Service 

Every event is unique and the number and type of medical presentations may be influenced by a wide range of factors., which include:

• nature of the event 
• temperature and humidity
• duration of the event
• numbers of people attending
• age profile and whether there are vulnerable groups
• activities on site 
• site conditions 
• camping 

Where public camping occurs at an event, this may present specific challenges in terms of medical cover, and these should be included in the assessment. Conversely, if only a few crew members stay on site overnight, this is unlikely to have a significant impact. 

TIER 1 

Tier 1 events are the smallest and simplest events. 

The presence of some of these factors indicates that an event may be in Tier I: 

duration of a few hours or less 

no activities carrying a risk of injury 

no or minimal alcohol consumption 

no or minimal recreational drug use 

fewer than five hundred attendees 

hospital referrals very unlikely 

Cover level

Tier 1 events can often be safely covered without a healthcare professional or an ambulance in attendance. Although in some cases organisers might not need to provide a contracted resource, they should still consider: 

provision of a suitable first aid kit and someone able to use it 

location of the nearest defibrillator and how to access and use it (defibfinder.uk)

ensuring that appropriate people know how to access emergency assistance 

TIER 2 

Tier 2 events are somewhat larger events which often fall within the scope of local authority licensing. 

The presence of some of these indicates that an event may be in Tier 2:

duration more than a few hours but no longer than a day 

low risk of illness or injury from activities 

social drinking of alcohol 

no more than isolated drug use 

up to two thousand attendees 

hospital referrals unlikely 

Cover level

Tier 2 events need a dedicated first aid resource, preferably led by a healthcare professional. 

Where indicated by the medical needs assessment, provision may include: 

a nominated lead who is responsible for the delivery of the service on site 

supporting first responders or healthcare professionals 

an ambulance with suitably qualified crew if hospital transfers are expected

TIER 3 

Tier 3 are normally larger events with greater potential for illness and injury. 

The presence of some of these indicates that an event may be in Tier 3: 

duration more than one day

moderate risk of illness or injury from activities 

alcohol intoxication likely

drug intoxication likely

up to five thousand attendees 

hospital referrals foreseeable 

Cover level

Tier 3 events need a dedicated medical resource. 

Provision should normally include: 

a clinical lead, who should be a registered healthcare professional with pre-hospital experience

other healthcare professionals, such as doctors, paramedics and nurses 

first responders 

ambulance(s) with suitably qualified crew if hospital transfers are expected

TIER 4 

Tier 4 are larger and more complex events, where more medical presentations may be expected

The presence of some of these indicates that an event may be in Tier 4: 

duration one to several days 

significant risk of illness or injury from activities 

alcohol intoxication expected 

drug intoxication expected 

up to ten thousand attendees 

hospital referrals likely

Cover level

Tier 4 events need a dedicated medical resource. 

Provision should normally include: 

a clinical lead, who should be a registered healthcare professional with pre-hospital experience 

healthcare professionals, such as doctors, paramedics and nurses 

first responders 

ambulance(s) with suitably qualified crew 

TIER 5 

Tier 5 are the largest or most complex events, including all mass gatherings, as well as smaller events that have higher risks. 

The presence of some of these indicates that an event may be in Tier 5: 

duration several days

high risk of illness and injuries 

alcohol intoxication expected 

drug intoxication expected 

more than ten thousand attendees 

referrals to hospital expected 

Cover level

Tier 5 events need a comprehensive dedicated medical resource. 

Provision should normally include: 

a clinical lead, who should be a registered doctor, preferably an emergency medicine specialist 

registered healthcare professionals, including doctors, nurses and paramedics 

first responders 

ambulances with suitably qualified crew 

control staff 

Organisers should ensure that sufficient medical resources are provided to deliver the level of cover required throughout the event. If an ambulance and crew are required to undertake a hospital transfer, this should not compromise the cover left on site. No less than 2 medics must be present any any event above tier 1.

Prospective medical providers should submit a specific Medical Needs Assessment which should be used to determine the extent and level of cover required. This will then be used to create a detailed Medical Plan. 

REMEMBER: Every event should have an appropriate level of medical cover, set out in a medical plan and based on a comprehensive medical needs assessment 

First Aid At Work / CFR / Police Officer  - PHEM A, B OR C

FREC3 / Co Responder – PHEM D

FREC 4 / Ambulance ECA – PHEM E

FRECU5 / Ambulance Tech – PHEM F

Register Doctor / Nurse / HCPC Paramedic – PHEM G

In most cases, qualifications at PHEM C or below are not considered suitable at licensed events, except when working as part of a larger team under direct supervision. However, such qualifications may be acceptable at Tier 1 Events.

Cover should include both the event stage and the building/take down of the event.