Preparing EMS Agencies for Large-Scale International Events: Lessons from the FIFA World Cup, Qatar 2022

By Dr. Andre Jones, Assistant Executive Director and Head of Profession for the Hamad Medical Corporation, State of Qatar

Large-scale international events, such as the FIFA World Cup, represent some of the most complex operational challenges emergency medical services (EMS) agencies will ever face. These events compress millions of people, dozens of venues, and high-profile stakeholders into a limited geographic area over a short time. The World Cup held in Qatar in 2022, for example, welcomed approximately 1.9 million visitors, with peak daily attendance exceeding 560,000 people. 

Unlike routine EMS operations, mega-events like the World Cup require systems that can scale rapidly, adapt to changing conditions, and coordinate across multiple agencies and jurisdictions. EMS agencies must be prepared to provide routine care, manage high-risk incidents, and ensure patient safety across stadiums, fan zones, transportation hubs, and hotels—all simultaneously.

In this article we’ll take the practical, field-tested framework for EMS preparedness provided and show you how to apply similar practices to prepare your city to host your own mega-event. This model focuses on four critical pillars: command and coordination, workforce planning, preparedness and training, and operational deployment.

The Four C’s: Command, Control, Coordination, and Communication

At the center of any successful large-event EMS operation is a strong command and coordination structure. Qatar implemented a multi-layered system based on the 4 C’s: Command, Control, Coordination, and Communication. The system was organized into four levels, Political (Platinum), Strategic (Gold), Tactical (Silver), and Operational (Bronze). This hierarchy ensured that high-level policy decisions, strategic planning, real-time incident management, and frontline care were clearly delineated, yet connected. EMS operations were integrated with national health authorities, FIFA leadership, and security agencies, allowing unified decision-making across all stakeholders. 
 

Another big part of this structure came from having centralized command centers that operated simultaneously. The National Command Center (NCC) oversaw emergency communications and dispatch, while the Medical Command Center (MCC) coordinated healthcare operations across venues, and the Tournament Command Center (TCC) managed overall event activities. This centralized model ensured consistent situational awareness and allowed rapid coordination between EMS, hospitals, and event organizers.
 

Within the NCC, Qatar’s EMS agencies utilize the Medical Priority Dispatch System™ (MPDS®) to process incoming emergency calls using standardized, protocol-driven questioning. Qatar has been an MPDS user since 2012 and holds Accredited Center of Excellence (ACE) status, reflecting a sustained commitment to quality assurance and dispatch best practices.

When it comes to communication between command centers, technology plays a critical role in enabling coordination. In Qatar, they deployed their Computer-aided dispatch (CAD) systems, mobile data terminals (MDT), and electronic patient care reporting (ePCR) to ensure that EMS personnel across different agencies and locations could communicate in real time and share patient information seamlessly.

When it came to integrating the four C’s at each World Cup venue, clearly defined leadership roles ensured operational efficiency. Each venue had an Ambulance Venue Manager (AVM), Venue Medical Manager (VMM), and Mobile Medical Teams (MMT) that allowed them to enable coordination between EMS, fire services, law enforcement, and event staff, ensuring an all-important unified response at the operational level.

Manpower Planning and Recruitment

A major determinant of success for Qatar during their World Cup EMS operations was the ability to recruit, train, and manage a sufficient workforce. To do this, they began planning years in advance, carefully forecasting staffing needs and allocating resources between key operational centers such as the Healthcare Coordination Center (HCC) and National Command Center (NCC). This proactive approach ensured adequate staffing levels even during peak demand. 

To meet their staffing requirements, Qatar conducted international recruitment missions in countries such as Jordan and India with a multi-phased hiring process to ensure all standards and requirements were met. Depending on where your center is located, these recruitment missions may not take you out of the country, or even out of the state, but the important thing to remember is to make sure you plan ahead for adequate staff to handle the influx of calls during a mega-event like the World Cup. 

 
In Qatar, the onboarding process included integrating staff from different countries and backgrounds. In total, dozens of new personnel were deployed to key roles across command centers but, because of this, several challenges, like staffing shortages, travel restrictions, and increased workload demands emerged. To address these issues, they redeployed nonessential healthcare staff, adjusted shift schedules, and divided teams to maintain operational continuity. No matter how well staffed and prepared you are for a world event, it’s important to maintain flexibility and make contingency plans in all areas, but especially workforce management.

Preparedness and Training

Preparation for a mega-event extends far beyond staffing—it requires comprehensive, scenario-based training and system-wide readiness. The World Cup in Qatar included 32 teams and 64 matches, over 168 official event sites, and multiple fan zones, hotels, and transportation hubs. This large scale required detailed modeling of crowd movement, peak usage times, and risk scenarios to guide planning decisions and a comprehensive training plan. 

To ensure all on-the-ground personnel were prepared for both routine and high-risk situations, training covered a wide range of topics, including major incident response, venue operations and coordination, player and VIP medical care, and an electronic medical record system. Training also emphasized real-world scenarios like mass casualty incidents, high-density crowd management, and VIP emergencies. By simulating these scenarios, EMS teams were better prepared to respond effectively under pressure.

Along with training, a key objective was to minimize unnecessary hospital transports. To achieve this, Qatar established on-site clinics and treatment centers, created sobering stations, and developed dedicated hospital pathways for event-related patients. This approach preserved hospital capacity while maintaining high-quality patient care.
 

Planners also had to address non-clinical factors like extreme weather conditions, traffic congestion, alcohol-related incidents, and cultural sensitivities involving international visitors. These considerations were essential for ensuring culturally competent and context-aware care.

Operational Deployment and Resource Management
The success of EMS operations during a major event ultimately depends on effective deployment of personnel and resources. Qatar maintained both routine emergency operations and event-specific coverage simultaneously. This required careful coordination to avoid compromising everyday EMS services while meeting event demands. To do this, each stadium was equipped with extensive medical resources, including multiple ambulances, mobile medical teams, and dedicated clinics for spectators, players, and VIPs. Additional resources included bike teams, foot patrols, and mobile command units to ensure rapid response within these large venues. They then expanded coverage far beyond just the stadiums to include fan festivals and entertainment zones, hotels and team base camps, transportation hubs (airports and ports), and other public gathering areas. This comprehensive approach ensured continuous EMS presence across all high-risk locations.

Because daily operations included significant assets, key resources like ambulances, critical care units, and air medical services were dynamically allocated based on real-time demand and event schedules. At the same time, patients were categorized based on their role to help prioritize care and streamline transport decisions. And the only way this all worked seamlessly was real-time monitoring and adaptation. Operational leaders continuously monitored call volumes, patient outcomes, and resource utilization for a data-driven approach that allowed rapid adjustments to staffing and deployment as conditions evolved in real-time.

Key Lessons Learned and Best Practices
Qatar’s experience running EMS services during the World Cup highlights several best practices for EMS agencies in the throws of, or preparing to host, a similar world event. First, start early and plan thoroughly. Mega-event planning must begin years in advance, with clear alignment between all stakeholders. Second, build flexible systems. Staffing models, deployment strategies, and operational plans should be adaptable to changing conditions. Third, invest in communication infrastructure. Modern, interoperable technology is essential for real-time coordination. Fourth, prioritize workforce resilience. Cross-training, backup staffing plans, and workforce support systems are critical. And finally, optimize patient flow. Keeping patients out of hospitals when appropriate helps maintain system capacity during peak demand.

The World Cup in Qatar demonstrated that successful EMS coverage of a global event requires more than additional resources—it requires a fully integrated system built on coordination, preparation, and adaptability. While not every EMS agency will manage an event of this scale, the principles outlined in this framework are broadly applicable to large gatherings, including the Olympics, concerts, and national events. By focusing on strong command structures, strategic workforce planning, comprehensive training, and dynamic deployment, EMS agencies can ensure they are ready to meet the demands of any large-scale event. Ultimately, preparedness is not just about responding to emergencies—it is about building systems capable of managing complexity, protecting communities, and delivering care when it matters most.