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

The field hospital was staffed by physicians, nurses, paramedics, respiratory therapists, administrative staff, and pharmacists, and was divided into three separate color-coded sections based on patient acuity—a “green” section with 16 beds for low-acuity patients; a “yellow” section with 10 beds for medium-acuity patients; and a “red” section with four beds for critical care patients. The critical care area, which was set up as a free-standing ED, had ventilators, ultrasound equipment, an ice bath, and advanced life support equipment. Board-certified emergency physicians were present in each area at all times throughout the event, in addition to several emergency medicine residents and medical students. The field hospital also housed a fully stocked pharmacy.

To direct and manage patients, a registration section was set up in front of the field hospital; intake/triage took place in a separate 15-chair, low-acuity area located beyond the front door. Charting was performed on CFDC charts and maintained for records; however, no patients were billed for care.

Separate command vehicles were set up for operations, radio communication, and storage of the staff’s personal belongings. The festival organizers provided meals to all medical personnel.

Access, Communications, and Transportation

A designated road was closed off to all nonemergency traffic leading from the field hospital to an open access point. Our closed communication system meant that 911 calls inside the event would be dispatched to our personnel stationed on-site.

The field hospital served as a single casualty collection point for the entire event, so any patient transported out would first go to the field hospital for evaluation, then move to a waiting transport vehicle, if necessary. This arrangement not only allowed the on-scene staff to evaluate and, when necessary, stabilize patients before transport, but also permitted us to identify and care for those who could be treated on-scene instead of sending them to the hospital. Routing all patients through one location also allowed the EMS staff to appropriately monitor the exact number of patients being treated. The first aid stations were staffed by paramedics and emergency medical technicians, and stocked with advanced life support and first aid equipment.

Motorized golf carts, “gators,” and hand-held carts were used to convey patients from first aid stations and other parts of the festival grounds to the field hospital. On several occasions, physicians accompanied paramedics responding to calls on the festival grounds.

The 2016 Festival: First-Person Report

An hour before the event began, we arrived at the scene, familiarized ourselves with the layout, and met with incident command, EMS, medical directors, and festival staff to discuss plans and divide the teams up. Prior to the event, a medical toxicologist reviewed with participating medical staff several priority resuscitation measures for patients presenting with drug intoxication. These priorities included control of hyperthermia, management of drug-related arrhythmias, seizures, and agitation, all of which permitted smooth transition of care and mutual understanding about which patients ultimately required transfer to the hospital.

Unexpected Needs

The medical needs were not great during the daytime hours. However, by sunset, a constant stream of attendees visited our field hospital, bringing their own prescription medications, including some requiring refrigeration, and requested that we store these on their behalf. We quickly created a process for safe storage and accountability of these medications.

In addition to requesting an unanticipated storage facility, attendees presented with more expected and typical “urgent care needs,” including headaches, rashes, and blisters. By the late afternoon, we began seeing patients who had been vomiting after riding fair attractions and those with heat-related syncope.

As evening descended, our triage area became busy with a wave of agitated, intoxicated patients presenting via EMS, friends, and GCs. When indicated, benzodiazepines (lorazepam and midazolam) were administered to mild-to-moderately agitated patients after verbal de-escalation attempts were unsuccessful. Severely agitated patients required sedative treatment with an antipsychotic (haloperidol or ziprasidone).

In the low-acuity (green) section, arousable patients whose vital signs were stable rested on cots, as did those requiring oral ondansetron for vomiting and who were able to tolerate oral hydration. The moderate-­acuity (yellow) section housed a large number of dehydrated and/or intoxicated patients who required IV fluid therapy. Patients in the critical care (red) area suffered primarily from behavioral issues and altered mental status requiring chemical or physical restraint; many of these patients were transported to the hospital once they could be safely moved. Other critical care patients with medical emergencies were also housed in this area, including an overdose victim for whom endotracheal intubation was needed for airway protection.

As the evening progressed, we saw more severe overdoses and intoxications, including several cases of alcohol- and drug-induced seizures. Any seizure that occurred on the festival grounds was considered a potential cardiac arrest, requiring physician response. Some of our most difficult patient encounters included seizing or postictal patients presenting in an agitated fashion among crowds of intoxicated people who were attempting to help. We also treated a middle-aged festival employee with cardiac disease who presented with chest pain and acute electrocardiogram changes.

One festival attendee with a history of shoulder dislocation presented with a recurrent dislocation. Without needing to sedate the patient, we successfully reduced the dislocated shoulder at the field hospital. Afterward, the patient refused transport to the hospital and insisted on returning to the festival in a sling. Several patients were seen for complaints of eye pain or irritation attributed to vigorous wind and pyrotechnic displays around the large stages—two underwent ophthalmologic evaluation with a small eye kit (topical anesthetic, fluorescein stain, and a Woods lamp) and were diagnosed with corneal abrasions.

Multiple patients with histories of asthma presented with respiratory complaints ranging from mild to severe. Most of these patients were successfully treated with albuterol, though some required supplemental oxygen and corticosteroid therapy. One patient required transport to ORMC for additional care and treatment.