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Introduction: Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate., Hypothesis: The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country., Methods: A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted., Results: The Games hosted 6000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively., Conclusion: The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.