By SAM KIM, MD, CONNOR FITZPATRICK, A-EMT and MATT S. FRIEDMAN, MD
The challenges of treating the ill and injured at a 30,000 person festival.
When staffing music festivals, be prepared to treat an interesting mix of pathology. While much of the pathology is predictable based on the specific type of festival and a historical analysis of the previous medical care provided, patient presentations are quite variable between different types of music festivals featuring different music and mood.
Crowd mood, a term frequently discussed in the mass gathering medicine literature, is an important descriptor to determine crowd behavior and should be utilized as a tool to predict the patient presentation rate (PPR). Other major factors contributing to the PPR and the transport to hospital rate (TTHR) are the heat index and the amount and type of recreational drug use. For every ten-degree increase in the heat index, the medical team can anticipate three more patients per 10,000 attendees.
Some festivals have stringent security procedures utilizing canine units at venue entrances and undercover law enforcement actively looking to arrest drug sellers while other festivals have relatively lax security measures. As emergency physicians, we always prepare for the worst and we recommend multiple resuscitation areas set up for rapid sequence intubations as well as premade ice-baths and unobstructed egress off the site for critical patients.
Severely hyperthermic patients present to on-site medical teams frequently and we should be prepared to treat significant rhabdomyolysis causing acute renal failure, which in turn can cause critical hyperkalemia and acidemia. Below are some interesting cases and lessons learned from the festival which included a range of pathology such as toxicological emergencies, status epilepticus, orthopedic injuries, major trauma, crotalid envenomations, and Point Of Care Ultrasound for the win!