Emergency Care at a Music Festival: A First-Person Report

Nonmedical Presentations

The location of the field hospital beyond the perimeter fence of the event created a slight “disconnect” from the crowds and lights—but not from the sound. Several attendees presented to the field hospital, asking for a place to “chill out.” To accommodate these presentations, several chairs were set up under the cover of a pop-up tent for a place to rest and drink a bottle of water. Some individuals remained in this tent for nearly the entire event—refusing care, but feeling more comfortable being in proximity of the field hospital. Although many of these individuals appeared to be intoxicated, the area remained calm throughout the event. This makeshift rest area also served as cover during a brief rain storm in the late afternoon on day 1, as well as for those seeking shelter from the hot afternoon.

Emergency Medical Services

The OFD contributed substantial resources to the 2016 festival, and their support continued throughout the event. Operations were based on the National Incident Management System’s framework, which was developed in coordination with the OMD, OFD, and other stakeholders within ORMC. Logistics and medical groups were created, and the event was divided geographically into “northern,” “southern,” and “eastern” divisions. The unified command structure included a fire department deputy chief and a liaison officer (the OFD off-duty coordinator) who maintained face-to-face communications with festival operators throughout the event. The medical group was coordinated by the OFD EMS chief in collaboration with the OMD. A communications plan was created and used effectively throughout the event to coordinate patient movement, transfers, and transports to the field hospital and ORMC. Briefings were conducted for each operational period and included all personnel involved in the event.

At least one EMS medical director was on-site at all times, in constant communication with the EMS chief on scene, who functioned primarily at the field hospital to guide throughput of patients. The OFD staffed three first aid stations with advanced and basic life support providers, and had personnel roving the festival grounds. In addition to having advanced life support capabilities, the first aid stations dispensed acetaminophen, adhesive bandages, ear plugs, and bottled water, and responded to nearby calls for help and transported patients to the field hospital as needed.

The OFD was also the primary transport agency. Ambulances were dedicated to the event and stationed at the field hospital to transport patients to ORMC. In total, 32 EMS personnel were on scene, including ambulance personnel, staffing at first aid stations, and personnel circulating among the crowd.

The Orlando Police Department (OPD) was also a constant presence at the event, providing security for both festivalgoers and staff at the field hospital. We did not have our own security personnel at the field hospital, and OPD provided a comfort level for the medical staff as the number of agitated, intoxicated patients increased.

Orlando Regional Medical Center

During the 2015 EDM festival, ORMC had been inundated with festivalgoers. Many required only minor care, but some were in need of critical care, including two cardiac arrest patients. Based on this festival experience, hospital administration at ORMC ensured adequate staffing for the 2016 festival, including nursing, medical technicians, radiology technicians, and respiratory therapists. Communication between familiar colleagues, operating under mutually understood protocols, and the ability to communicate with the field hospital, allowed for very smooth transitions of care throughout the 2016 event.

There was a direct correlation between the time of day and number and severity of patients transported to the hospital. Early in the day, patients presented with heat illness and altered mental status, syncope, and confusion; all were easily managed. By late evening, patients with possible arrhythmias, seizures, hyperthermia, chest pain, and altered mental status began to arrive. While the number of patients with the clinical presentation of intoxication and agitation was not surprising, the outcomes were occasionally unexpected—including several elevated troponin levels and occasional arrhythmias.

The hospital received 68 patients directly from the field hospital at the festival. More than 100 presented to the field hospital with altered mental status, of which dozens resolved with observation and close monitoring. Thirty patients had transient arrhythmias ranging from tachycardia and a slightly widened QRS complex. Six had seizures which responded to benzodiazepine treatment. One patient suffered respiratory failure; he was managed by mechanical ventilation, which was performed at the field hospital, and afterward transported to ORMC with a resident physician. Five patients had hyponatremia, which may have been dilutional from excess free-water intake or mediated by syndrome of inappropriate antidiuretic hormone secretion secondary to MDMA use. Hyperthermic patients were managed with active cooling.

Laboratory evaluation revealed elevated troponin levels in six patients, though none of the patients required emergent cardiac intervention. The elevated troponin levels were possibly secondary to demand ischemia from sympathomimetic toxidromes.

Although many patients admitted to using recreational drugs, few specified the type or amount of drug taken, either because they were too altered to communicate, were unfamiliar with what they ingested, or feared legal repercussions. Ethanol, marijuana, and MDMA were the most commonly reported drugs.