The Tier System Explained

The tier system within the Purple Guide categorises events based on factors such as size, complexity, and risk, helping organisers decide the appropriate medical cover required. Rather than just focusing on attendance numbers, it looks at multiple elements that influence medical needs.

The tiers range from Tier 1 to Tier 5:

Tier 1: Small and Simple Events

Tier 1 events are the smallest and least complex gatherings, typically lasting only a few hours or less and involving fewer than 500 attendees. These events are generally low risk, with no high-risk activities taking place, minimal or no alcohol consumption, and a very low likelihood of hospital referrals. Examples might include local community fairs, small markets, or low-key cultural events.

Medical cover at Tier 1 is often minimal. Organisers might not need to contract a professional medical provider but should ensure that basic first aid provision is in place. This can include having a first aid kit readily available, someone trained in basic first aid present, and clear access to emergency services if needed. It is also advised to know the location of the nearest defibrillator and ensure staff understand how to use it. The aim is to provide a safe environment without the need for dedicated healthcare professionals onsite.

Tier 2: Medium-Sized, Low-Risk Events

Tier 2 events tend to be larger, with up to around 2,000 attendees, and may last several hours up to a full day. These events often fall within the scope of local authority licensing and typically involve low-risk activities. Social alcohol consumption is common, and isolated instances of recreational drug use might occur, though overall risk remains low.

Medical provision for Tier 2 requires a dedicated first aid resource, ideally led or supported by a healthcare professional. The medical team might include trained first aiders and possibly paramedics or nurses depending on the risk assessment. Ambulance cover may be arranged if hospital transfers are anticipated, though this is less common. There should be a nominated medical lead responsible for the delivery and coordination of medical services on site. The medical facilities may be simple but need to be well-organised to respond promptly to incidents.

Tier 3: Larger Events with Moderate Risk

Tier 3 events are typically multi-day or long-duration events with up to 5,000 attendees. These are more complex due to a higher likelihood of alcohol and drug intoxication, along with an increased risk of illness or injury from the event’s activities. Examples could include music festivals, sporting events, or large public gatherings.

At this tier, medical provision becomes more comprehensive and structured. A clinical lead, usually a registered healthcare professional with pre-hospital experience such as a paramedic or nurse, is essential. The medical team will often include doctors, paramedics, nurses, and first responders to cover a wide range of medical needs. Ambulance availability is important to facilitate timely hospital transfers if required. Medical facilities should be suitably equipped and staffed to manage trauma, medical emergencies, and intoxication cases. Communication systems and coordination with emergency services must be robust.

Tier 4: Large, Complex Events

Tier 4 events are larger still, ranging up to 10,000 attendees, often lasting several days and featuring significant risks due to activities, environmental conditions, and expected substance use. These events might include major festivals, large-scale sporting tournaments, or multi-day cultural events.

The medical provision at this level requires a fully integrated team led by experienced clinical professionals, including doctors, paramedics, and nurses with advanced skills. Multiple ambulances are necessary to ensure continuous cover on site and the ability to transfer patients to hospital without reducing medical presence at the event. Medical facilities should be substantial, well-equipped, and strategically located. The team must be prepared to deal with a wide range of medical and trauma presentations, substance misuse, and vulnerable individuals. Effective command and control systems, alongside dedicated communication channels, are critical for coordinating care and responding to incidents efficiently.

Tier 5: The Largest and Most Complex Events

Tier 5 represents the highest level of medical complexity, encompassing mass gatherings with over 10,000 attendees or smaller events with particularly high risks. These events can span several days and include large music festivals, international sporting events, or occasions with heightened security concerns.

Medical provision at Tier 5 is extensive and comprehensive. A clinical lead, often a registered doctor with emergency medicine or pre-hospital expertise, oversees the entire medical operation. The team consists of doctors, nurses, paramedics, first responders, and specialist support staff, all working together with a clear command hierarchy. Multiple ambulances with suitably qualified crews ensure patient transfer capability without compromising onsite coverage. Dedicated control staff manage resources and communications, ensuring smooth coordination. The medical plan must include contingency arrangements for major incidents or surges in demand, and safeguarding vulnerable adults and children is a key focus. Collaboration with NHS Ambulance Services and other emergency responders is essential.