Mass gatherings create challenges for timely and efficient medical response. Compounded by exceptional noise from cheering crowds and ambient entertainment, compacted audiences form predictable barriers to patient sightings and access. Timely access also may be complicated by steep arena stairwells or poorly-defined locations along a longitudinal raceway, parade, or beachside festival. On-scene responders often encounter fixed barricades, inebriated crowds, obtrusive noise, and relative distances from on-site medical aid centers. Very often, potentially ill or injured persons are adamantly set against leaving their coveted position in the audience having purchased expensive tickets, traveled far and awaited many months, or even years, to be there. Once retrieved, patients need to be conveyed with protective measures and evaluated appropriately despite resource-limited settings and often pervasive heat, humidity and intoxication. Accordingly, patient identification, intra-site retrieval, evacuation, tracking, and communications need to be optimally planned and well-coordinated to mitigate these challenges. Recent experiences have provided evolving insights into best practices for mass gathering medical professionals. Many are addressed within this discussion including definitions for reportable patients, use of spotters and geospatial applications, coordinated tandem response with security personnel, dedicated record-keepers at medical care sites and electronic tracking devices for vulnerable populations and even entire audiences.