Commentary: Mass gathering healthcare and safety: current knowledge and future directions

Dear Prof. Ives Hubloue, Specialty Chief Editor, Disaster Medicine,

We have read with interest the bibliometric review by Pigeon et al. (1) titled “Mass gathering healthcare and safety: current knowledge and future directions.”, recently published in Frontiers in Disaster and Emergency Medicine. This timely review examines key challenges encountered by the healthcare response during mass gathering events (MGEs), emphasizing the need for specific training and the development of formal expertise tailored to MGEs. The authors also stress the importance of required improvement in specific areas such as psychosocial aspects, quality evaluation and management, and supervision.

However, despite its comprehensive and insightful nature, the title is somewhat misleading. The safety aspects and corresponding safety tools are not addressed sufficiently, and it is not clear whether the authors were referring to public safety or occupational safety. In the results section, the largest number of articles fall under the “public health and security” category but without any mention of “safety”. In this specific context, many authors report that safety and security are being used interchangeably, and, in many dictionaries, they are defined as synonyms (2). Obviously, both concepts may have a lot in common, and the following statement reported by Line et al. (3) seems a bit excessive: “two faculties have developed with a certain degree of rivalry between them. Security people maintain that the safety people are just a gang of old men who are unwilling to learn something new, the safety people retaliate that the security people are youngsters who haven't realized that they're re-inventing the wheel!” For the emergency management and occupational safety communities, the objective is not to focus on the semantic difference between the two words but on the existing complementariness and synergies. Obviously, the fundamental challenge facing security professionals is preventing losses, and the same challenges are shared with safety professionals.

In the broad sense, security can be considered as protecting a system against intentional disruptions often caused by malicious parties, and safety can be considered as protecting that same system against unintentional disruptions. Hazards led to safety incidents in the same way that vulnerabilities lead to security incidents (4). For a comprehensive system thinking approach, a security approach—which is largely threat-based and may be tempted to conduct assessments in isolation—will have to avoid missing the larger system's perspective.

On the other hand, this review does not include several established benchmarks and updated guidelines that, in our view, are essential to the current understanding of MGEs context. This is fully understandable given their relatively recent publication dates, mainly in 2025. For instance, the World Health Organization (WHO) Mass gathering practical guide for simulation exercises and after-action reviews, published on April 11th, 2025 (5), along with several systematic reviews (6–9) represent critical references that contribute to both theoretical and practical aspects of MGEs preparedness and management.

In conclusion, the discussion related to the definition and interdisciplinarity between safety and security remains open. For the time being, we will maintain that the inability of the system to affect its environment in an undesirable way is usually called safety; the inability of the environment to affect the system in an undesirable way is usually called security.

Yours sincerely,

Dr. Georgi Popov, CSP, QEP, SMP, ARM, CMC, FASSP, FAIHA Professor, Lead Auditor ISO 45001 and ISO 14001

Occupational Risk and Safety Sciences Department

University of Central Missouri

Statements

Summary

Keywords

mass gathering, safety, security, mass gathering event, major planned event

Citation

Popov G and Eddahiri K (2025) Commentary: Mass gathering healthcare and safety: current knowledge and future directions. Front. Disaster Emerg. Med. 3:1664857. doi: 10.3389/femer.2025.1664857

Received

12 July 2025

Accepted

18 August 2025

Published

10 September 2025

Volume

3 - 2025

Edited by

Benoit Viault, Centre Hospitalier Universitaire de Toulouse, France

Reviewed by

Andrew Milsten, University of Massachusetts System, United States

Cara Taubman, Harlem Hospital Center, United States

Updates

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Copyright

© 2025 Popov and Eddahiri.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Khalid Eddahiri khalid.eddahiri@gmail.com

†ORCID: Khalid Eddahiri orcid.org/0009-0000-1477-2966

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