“How much medical cover does my event actually need?”
When organisers ask how much medical cover does my event need, the answer is always driven by risk rather than attendance alone.
The honest answer is that there is no single number, ratio, or template that applies to every event. In the UK, event medical provision is not based on attendance alone. It is based on risk.
Understanding how that risk is assessed and how it translates into proportionate medical cover – is the key to planning safely, compliantly, and without unnecessary cost.
How much medical cover does my event need – and why risk matters
UK event safety guidance is clear that medical provision must be risk-led, not attendance-led. This principle sits at the heart of the Purple Guide, which is the primary reference used by Safety Advisory Groups (SAGs), local authorities and insurers when reviewing event medical arrangements.
Two events with the same audience size can require very different levels of medical cover depending on their risk profile. Equally, some relatively small events can present higher medical risk than much larger ones.
This is why a Medical Needs Assessment (MNA) is essential.
What is a Medical Needs Assessment?
A Medical Needs Assessment is a structured process used to identify:
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What medical problems are reasonably foreseeable at an event
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How likely those problems are to occur
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How severe the consequences could be if they do
The outcome of the assessment determines what level of medical resource is appropriate and proportionate for that specific event.
The Purple Guide is clear that this assessment should be carried out by a competent person who understands both the event itself and the realities of pre-hospital medical care.
The key factors that determine medical need
When assessing how much medical cover an event requires, the following factors are consistently relevant.
1. Event type and activities
Some activities carry a higher inherent risk of injury or illness. For example:
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Sporting and endurance events
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Equestrian activities
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Live music events with crowd movement
A 10k road race and a village fête may attract similar numbers, but their medical risk profiles are very different.
2. Audience profile
Who is attending matters as much as how many.
Key considerations include:
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Age profile (children, older adults, mixed audiences)
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Likelihood of alcohol or drug use
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Safeguarding considerations
Events involving alcohol, young adults, or overnight attendance consistently generate higher medical demand and a greater need for senior clinical decision-making.
3. Duration and timing
Longer events, or those running into the evening or overnight, typically see:
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Increased fatigue and intoxication
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Higher rates of mental health and safeguarding presentations
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More patients requiring observation rather than immediate discharge
Multi-day events should also consider cumulative risk and staff welfare.
4. Environment and location
Environmental factors often drive medical need more than attendance numbers.
These include:
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Weather exposure (heat, cold, wind or rain)
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Terrain and ground conditions
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Rural or remote locations
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Distance and access to the nearest emergency department
Limited access or long ambulance travel times increase the need for on-site clinical capability.
5. Impact on the NHS
UK guidance is clear that event organisers should not plan on routine reliance on 999 services.
Well-resourced events with appropriate on-site clinical staff are shown to:
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Reduce ambulance conveyance
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Reduce pressure on local emergency departments
Minimising NHS impact is a consistent expectation within event medical planning.
First aid, medical cover and ambulances are not the same thing
A common source of confusion is the assumption that “first aid cover” and “medical cover” are interchangeable. They are not.
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First aid arrangements may be appropriate for very low-risk events with minimal foreseeable medical need.
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Event medical cover involves clinically governed services, appropriate qualifications and the ability to assess, treat, observe and escalate patients safely.
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Ambulance provision is one possible component of a medical plan, not a substitute for it.
Relying solely on calling 999 does not meet an organiser’s duty of care for most public events.
Why different providers may give you very different answers
One reason organisers often feel uncertain is that different medical providers can give very different recommendations for the same event.
This does not always mean one is right and the other is wrong.
Differences commonly arise because:
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Some providers are attendance-led, using fixed ratios rather than a full risk assessment
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Some are limited by the qualifications or resources they can supply, and design plans around that
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Some build in significant contingency to protect themselves contractually
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Others take a more risk-proportionate, NHS-aligned approach
This is why two quotes can look very different on paper.
A robust medical plan should clearly explain:
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Why a certain level of cover has been recommended
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What risks it is designed to manage
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How escalation and resilience are maintained
If a recommendation cannot be clearly justified against recognised UK guidance, it is reasonable for an organiser to ask further questions.
Proportionality: what “appropriate” really means
Most events do not need excessive or gold-plated medical provision. Equally, under-resourcing medical cover is one of the most common reasons plans are challenged by SAGs or insurers.
Appropriate medical cover:
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Matches the level of risk identified
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Uses staff with suitable qualifications and supervision
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Has clear escalation and resilience arrangements
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Minimises impact on statutory services
The aim is not to eliminate risk entirely, but to reduce it so far as is reasonably practicable.
Who decides what is enough?
Ultimately, responsibility sits with the event organiser. However, decisions should be informed by:
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Recognised UK guidance (particularly the Purple Guide)
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Advice from a competent medical provider
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Any conditions set by licensing authorities or insurers
A well-documented Medical Needs Assessment demonstrates that decisions were made thoughtfully, proportionately and in line with national expectations.
A final reassurance for organisers
One of the most important points to stress is this:
Most events do not need extreme levels of medical cover – they need appropriate cover, matched to their actual risk.
Getting this right protects attendees, staff, organisers and the local NHS, while avoiding unnecessary cost and complexity.
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Further guidance for organisers
If you’re looking to sense-check what proportionate medical cover looks like for your type of event, we’ve produced a short, practical guide for organisers that brings together current UK guidance and explains how it is applied in real event settings.
The guide is free to download and is designed to help organisers understand:
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How medical risk is assessed
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What different levels of medical cover are intended to achieve
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Where first aid is sufficient – and where it is not