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

Abstract

IntroductionMusic 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.ObjectiveThe 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.MethodsThis is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.Results/DiscussionOn-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.ConclusionThe 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.

Preparedness for Mass Gatherings: Factors to Consider According to the Rescue Authorities

“…The aim of the interviews was to identify all the factors that the rescue authorities need to consider when they are preparing for mass gatherings. The interview structure was based on previous studies on mass gatherings [8,11,[13][14][15]23,25,37]. The original interview structure included background information and eight topics.…”

“…According to our results, multi-authority collaboration in the pre-event planning phase manifests, for example, as consultation of an EMS specialist regarding the planned attendee numbers, and the competence of the on-site medical care provided in the emergency plan. Previous studies showed that having medical professionals available among the first-aid providers and the use of treat-and-release directives have an impact on the need for transport to hospital, and in turn affect the workload for the EMS system and healthcare facilities [15,16,18,21,23]. According to an Australian study by Zeitz et al [8], the increase in workload for the rescue service in mass gatherings with a total of 5.7 million attendees in a two-year period, was only minor.…”

“…Sufficient first-aid capability and the quality of security emerged from the results along with other needed services, such as taking care of water supply. Previous studies indicated that on-site medical staff should include health professionals along with first-aid providers [15,18,19,23,40]. According to Locoh-Donou et al [26], absence of free drinking water is strongly associated with patient presentations.…”

“…Different factors were shown to have an impact on the need of transport to hospital, the number of patients, and the injury patterns. These include weather [13,14], the level of the on-site medical care [15][16][17][18][19][20][21][22][23], audience profile [24], event type [25][26][27], duration [28], and geographical location [29]. Alcohol and drug use, attendance, and the age and mood of the crowd can also have an effect on the level and the need of medical response [28].…”

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

“…This was evident with the 420 cases seen within the facility over the 7‐day period with only a small proportion (0.03%, 0.3/1000) requiring transfer by ambulance to the ED. As noted in other out‐of‐hospital ED avoidance strategies the multi‐disciplinary and inter‐agency staffing configuration likely contributed to this success; however, accompanying comprehensive structure and process evaluations of this and other EHS located at MGEs is required to understand this further. Additional public messaging to young adults attending Schoolies may be considered by event planners to create awareness of the EHS which may further minimise the impact on the ED …”