During the day, Dr. Paul E. Pepe focuses on directing EMS medical response for Dallas County, Texas, and several special operations/tactical agencies. But at night, Dr. Pepe’s medical expertise extends to a new arena—literally. He is a trailblazer and expert in the field of mass-gathering medicine, including serving as the lead physician for global tours with rock bands such as U2. 

There’s no typical day when responsible for hundreds of touring personnel traveling from one country to the next. Sometimes he’s supporting efforts at local hospitals to treat ill or injured crew members. Other times, he’s creating advance plans to optimize preparedness and response for any number of incidents that could happen during a show, whether that’s stroke or heart attack, trauma, burn, crowd crush, lightning strike, mass casualty incident, or countless other scenarios. 

Early in his career, he became the first full-time EMS medical director in Houston and published a significant portion of the research that informed EMS best practices as it evolved into the largest recognized sub-specialty of emergency medicine.  

He also held roles in disaster and tactical response for Hurricane Katrina, the Parkland, Florida school shootings, and other activities that led to the opportunities to be part of the concert tours and career-spanning alliances with the U.S. Secret Service and White House medical unit. 

“EMS and tactical backgrounds make crowd management and mass casualty incident preparedness second nature,” Dr. Pepe said. His work with the concert tours is unpredictable, and he said it’s important to remain nimble. “I could be navigating air quality concerns, altitude challenges, and even emerging infectious disease threats.” 

This aspect of event medicine can be challenging. There’s little, if any, ready-made guidance for mass gathering events that travel around the globe, and it’s hard work that involves a major time commitment away from family and friends. Would-be touring physicians should consider extended apprenticeships and be sensitive to the unique cultural and philosophical differences that can impact medical response in different countries, Dr. Pepe advises. 

On tour, he can face health risks of his own—many sleepless nights, regular contact with hundreds of people and traveling in close quarters. The rewards outweigh those risks, he said. Being part of the team that facilitates iconic musical performances is the thrill of a lifetime. As he walks the barricade separating thousands of jubilant fans from their musical heroes, he gets to witness sheer elation.