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On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years

Published online by Cambridge University Press:  27 December 2018

Sheila A. Turris ,
Christopher W. Callaghan Open the ORCID record for Christopher W. Callaghan [Opens in a new window] ,
Haddon Rabb ,
Matthew Brendan Munn  and
Adam Lund
Sheila A. Turris
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Christopher W. Callaghan*
Affiliation:
Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada University of Guelph, Guelph, Ontario, Canada
Haddon Rabb
Affiliation:
Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada University of British Columbia, Vancouver, British Columbia, Canada
Matthew Brendan Munn
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Adam Lund
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada Mass Gathering Medicine Interest Group, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
*
Correspondence: Christopher W. Callaghan Mass Gathering Medicine Interest Group University of British Columbia E-mail: [email protected]
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Abstract

Introduction

Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have on-site medical care to help reduce the impact on local health care systems. Historically, the literature suggests that patient transfers off-site are frequently related to complications of substance use. However, there is a gap in understanding why patients are transferred to hospital when an on-site medical team, capable of providing first aid services blended with a higher level of care (HLC) team, is present.

Objective

The purpose of this study is to better understand patterns of injuries and illnesses that necessitate transfer when physician-led HLC teams are accessible on-site.

Methods

This is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.

Results/Discussion

On-site medical teams that included HLC team members were present for the duration of each festival, so every team was able to “treat and release” when clinically appropriate. Over the course of the combined 34 event days, there were 10,406 patient encounters resulting in 156 individuals being transferred off-site for assessment, diagnostic testing, and/or treatment. A minority of patients seen were transferred off-site (1.5%). The patient presentation rate (PPR) was 16.5/1,000. The ambulance transfer rate (ATR) was 0.12/1,000 attendees, whereas the total transfer-to-hospital rate (TTHR), when factoring in non-ambulance transport, was 0.25/1,000. In contrast to existing literature on transfers from music festivals, the most common reason for transfer off-site was for musculo-skeletal (MSK) injuries (53.8%) that required imaging.

Conclusion

The presence of on-site HLC teams impacted the case mix of patients transferred to hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required specialized imaging and testing that could not be performed in an out-of-hospital setting. These results suggest that a better understanding of the specific effects on-site HLC teams have on avoiding off-site transfers will aid in improving planning for music festivals. The findings also identify areas for further improvement in on-site care, such as integrated on-site radiology, which could potentially further reduce the impact of music festivals on local health services. The role of non-emergency transport vehicles (NETVs) deserves further attention.

TurrisSA, CallaghanCW, RabbH, MunnMB, LundA. On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two YearsPrehosp Disaster Med. 2019;34(1):72–81.

Keywords

health services impacthospital transfermajor planned eventsmass gatheringsmusic festivalspatient acuity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 1 , February 2019 , pp. 72 - 81
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: Turris takes on both paid and volunteer roles at special events. She provided medical direction at two of the four music festivals described in this study. She is a shareholder with the medical services company that provided health care services for three of the music festivals. Callaghan was contracted by the medical services company that provided health care services for three of the festivals. He worked at two of the four music festivals in this study. Rabb provided medical coverage for two of the four festivals in 2017. He was contracted by the medical services company that provided service. Munn was the medical director for one of the music festivals described. He has provided paid and volunteer services working as a director and clinician at other events. Lund provided medical direction and clinical care for three of the music festivals described. He is the medical director and a shareholder of the medical services company that provided health care services for three of the festivals in the present study. None of the authors received income for this study.

References

1. FitzGibbon, KM, Nable, JV, Ayd, B, et al. Mass-gathering medical care in electronic dance music festivals. Prehosp Disaster Med. 2017;32(5):563-567.Google Scholar
2. Hutton, A, Savage, C, Ranse, J, Finnell, D, Kub, J The use of Haddon’s Matrix to plan for injury and illness prevention at outdoor music festivals. Prehosp Disaster Med. 2015;30(2):175-183.Google Scholar
3. Hutton, A, Ranse, J, Verdonk, N, Ullah, S, Arbon, P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehosp Disaster Med. 2014;29(2):160-166.Google Scholar
4. Jenkinson, R, Bowring, A, Dietze, P, Hellard, M, Lim, MSC. Young risk takers: alcohol, illicit drugs, and sexual practices among a sample of music festival attendees. J Sex Transm Dis. 2014;2014:1-6.Google Scholar
5. Turris, SA, Lund, A. Mortality at music festivals: academic and grey literature for case finding. Prehosp Disaster Med. 2017;32(1):58-63.Google Scholar
6. Munn, MB, Lund, A, Golby, R, Turris, SA. Observed benefits to on-site medical services during an annual 5-day electronic dance music event with harm reduction services. Prehosp Disaster Med. 2016;31(2):228-234.Google Scholar
7. Milsten, AM, Tennyson, J, Weisberg, S Retrospective analysis of mosh-pit-related injuries. Prehosp Disaster Med. 2017;32(6):636-641.Google Scholar
8. Nadesan, K, Kumari, C, Afiq, M Dancing to death: a case of heat stroke. J Forensic Leg Med. 2017;50:1-5.Google Scholar
9. Lund, A, Turris, SA Mass-gathering medicine: risks and patient presentations at a 2-day electronic dance music event. Prehosp Disaster Med. 2015;30(3):271-278.Google Scholar
10. Friedman, MS, Plocki, A, Likourezos, A, et al. A prospective analysis of patients presenting for medical attention at a large electronic dance music festival. Prehosp Disaster Med. 2017;32(1):78-82.Google Scholar
11. Chan, C. Penticton’s Boonstock festival ends with one dead, 80 sent to hospital. The Province. http://www.theprovince.com/Penticton+Boonstock+Festival+ends+with+dead+sent+hospital/10089307/story.html#__federated=1. Accessed May 2018.Google Scholar
12. Reilly J. Teenage, 19, dies and two of his friends are hospitalized after taking ‘legal high’ Benzo Fury at music festival. DailyMail Online. http://www.dailymail.co.uk/news/article2157524/RockNess02012-Alex-Heriot-dies-festival-taking-10-legal-high-Benzo-Fury.html. Accessed May 2018.Google Scholar
13. Zattell, J. Final day of New York electronic dance festival cancelled due to drug overdoses. CTV News. http://www.ctvnews.ca/entertainment/final-day-of-n-y-electronic-music-festival-cancelled-due-to-drug-overdoses-1.1435885. Accessed May 2018.Google Scholar
14. Lund, A, Turris, S. The event chain of survival in the context of music festivals: a framework for improving outcomes at major planned events. Prehosp Disaster Med. 2017;32(4):437-443.Google Scholar
15. Botelho-Nevers, E, Gautret, P. Outbreaks associated to large open-air festivals, including music festivals, 1980 to 2012. Eurosurveillance. 2013;18(11).Google Scholar
16. Lund, A, Turris, SA, Bowles, R. Conceptualizing the impact of special events on community health service levels: an operational analysis. Prehosp Disaster Med. 2014;29(5):525-531.Google Scholar
17. Ridpath, A, Driver, CR, Nolan, ML, et al. Illnesses and deaths among persons attending an electronic dance-music festival - New York City, 2013. MMWR. 2014;63(50):1195-1198.Google Scholar
18. Lund, A, Turris, SA, Amiri, N, Lewis, K, Carson, M Mass-gathering medicine: creation of an online event and patient registry. Prehosp Disaster Med. 2012;27(6):601–611.Google Scholar
19. Nix, CM, Khan, IJ, Hoban, M, Little, G, Keye, G, O’Connor, HJ Oxegen 2004: the impact of a major music festival on the workload of a local hospital. Ir Med J. 2006;99(6):167-169.Google Scholar
20. Chapman, KR, Carmichael, FJ, Goode, JE Medical services for outdoor rock music festivals. Can Med Assoc J. 1982;126(8):935-938.Google Scholar
21. Mascola, L Ecstasy overdoses at a New Year’s Eve Rave. CDC Reports. MMWR Rep. 2010;59(22):677-681.Google Scholar
22. Archer, JRH, Beaumont, PO, May, D, Dargan, PI, Wood, DM Clinical survey assessing the appropriate management of individuals with acute recreational drug toxicity at a large outdoor festival event. J Subst Use. 2012;17(4):356-362.Google Scholar
23. Armenian, P, Mamantov, TM, Tsutaoka, BT, et al. Multiple MDMA (ecstasy) overdoses at a rave event. J Intensive Care Med. 2013;28(4):252-258.Google Scholar
24. Bledsoe, B, Songer, P, Buchanan, K, Westin, J, Hodnick, R, Gorosh, L Burning Man 2011: mass gathering medical care in an austere environment. Prehospital Emerg Care. 2012;16(4):469-476.Google Scholar
25. Dutch, MJ, Austin, KB Hospital in the field: prehospital management of GHB intoxication by medical assistance teams. Prehosp Disaster Med. 2012;27(5):463-467.Google Scholar
26. Gutman, SJ, Lund, A, Turris, SA Medical support for the 2009 World Police and Fire Games: a descriptive analysis of a large-scale participation event and its impact. Prehosp Disaster Med. 2011;26(1):33-39.Google Scholar
27. McAndrew, SE, Smith, TL, Groothuis, E, et al. Epidemic adolescent binge drinking at Lollapalooza, a music festival in Chicago. Pediatr Emerg Care. 2017.Google Scholar
28. Chhabra, N, Gimbar, RP, Walla, LM, Thompson, TM Emergency department patient burden from an electronic dance music festival. J Emerg Med. 2018;54(4):435–439.Google Scholar
29. Stagelund, S, Jans, Ø, Nielsen, K, Jans, H, Wildgaard, K Medical care and organization at the 2012 Roskilde Music Festival: a prospective observational study. Acta Anaesthesiol Scand. 2014;58(9):1086-1092.Google Scholar
30. Westrol, MS, Koneru, S, Mcintyre, N, Caruso, AT, Arshad, FH, Merlin, MA Music genre as a predictor of resource utilization at outdoor music concerts. Prehosp Disaster Med. 2017;32(3):289-296.Google Scholar
31. Wood, DM, Beaumont, PO, May, D, Dargan, PI Recreational drug use presentations during a large outdoor festival event: reduction in hospital emergency department transfer where medical physicians are present. J Subst Use. 2010;15(6):434-441.Google Scholar
32. Luther, M, Gardiner, F, Lenson, S, et al. An effective risk minimization strategy applied to an outdoor music festival: a multi-agency approach. Prehosp Disaster Med. 2018;33(2):220-224.Google Scholar
33. Grange, JT, Baumann, GW, Vaezazizi, R. On-Site physicians reduce ambulance transports at mass gatherings. Prehospital Emerg Care. 2003;7(3):322-326.Google Scholar
34. Kamour, A, Yardley, R, Longshaw, M, Stuart, J. The experience of a district general hospital with a large outdoor music festival in England. Acute Med. 2017;16(2):65-68.Google Scholar
35. Calle, P, Sundahl, N, Maudens, K, et al. Medical emergencies related to ethanol and illicit drugs at an annual, nocturnal, indoor, electronic dance music event. Prehosp Disaster Med. 2017;33(1):71-76.Google Scholar
36. Ruest, SM, Stephan, AM, Masiakos, PT, Biddinger, PD, Camargo, CA, Kharasch, S Substance use patterns and in-hospital care of adolescents and young adults attending music concerts. Addict Sci Clin Pract. 2018;13(1):1.Google Scholar
37. Major planned events: harm reduction fact sheet. 2015. http://www2.gov.bc.ca/assets/gov/health/keeping-bc-healthy-safe/major-planned-events/factsheet5-harm-reduction.pdf. Accessed May 2018.Google Scholar
38. Proudfoot, J, Whitton, A, Parker, G, Doran, J, Manicavasagar, V, Delmas, K. Triggers of mania and depression in young adults with bipolar disorder. J Affect Disord. 2012;143(1-3):196-202.Google Scholar
39. Munn, MB, Laraya, JF, Lund, A, Turris, S Altered mental status at music festivals: a case study examining clinical concepts and controversies. Prehosp Disaster Med. 2017;32(S1):S131-132.Google Scholar
40. Memish, ZA, Zumla, A, McCloskey, B, et al. Mass gatherings medicine: international cooperation and progress. The Lancet. 2014;383:2030-2032.Google Scholar
41. Lund, A, Turris, SA, Bowles, R, et al. Mass-gathering health research foundational theory: part 1 - population models for mass gatherings. Prehosp Disaster Med. 2014;29(6):648-654.Google Scholar
42. Turris, SA, Lund, A, Hutton, A, et al. Mass-gathering health research foundational theory: part 2-event modeling for mass gatherings. Prehosp Disaster Med. 2014;29(6):655-663.Google Scholar
43. Gogaert, S, Vande Veegaete, A, Scholliers, A, Vandekerckhove, P. MedTRIS (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.Google Scholar
44. Perioperative Interactive Education. Point of Care Ultrasound. Toronto General Hospital Department of Anesthesia. 2015. http://pie.med.utoronto.ca/POCUS/index.htm. Accessed May 2018.Google Scholar
45. Carestream. CARESTREAM DRX-Revolution Nano Mobile X-ray System. Carestream. 2017. https://www.carestream.com/en/us/medical/products/radiography/dr-systems/carestream-drx-revolution-nano-mobile-x-ray-system. Accessed May 2018.Google Scholar
46. General Electric. Vscan with Dual Probe. General Electric Healthcare. 2017. https://www.gehealthcare.com/en/products/ultrasound/vscan-family/vscan-with-dual-probe. Accessed May 2018.Google Scholar
47. Prager, R, Sedgwick, C, Lund, A, et al. Point of care ultrasound at a remote multi-day mass gathering: a prospective case series. Prehosp Disaster Med. 2017;32(S1):S137-138.Google Scholar