Munn MB§, Lund A¶, Golby Rł, Turris S

On-site medical response during an annual 5-day electronic
dance music event with harm reduction services
Munn
Background
§  Large scale electronic dance music events (EDME) are increasingly common.1
The lay media has been reporting frequently on EDME-associated deaths, which
has generated a growing interest in both preventative and medical response
services to improve health outcomes while minimizing the impacts on host
community health services.2-4
§  Several reviews have examined the utilization of harm reduction strategies at
music festivals, inferring their relationship with medical services; however, no
comments on their efficacy in minimizing negative health outcomes has been
explicitly described.5
§  Shambhala Music Festival (SMF) represents a remotely set EDME in the West
Kootenays of British Columbia (BC) with a cumulative daily attendance of more
than 67,000 visits. SMF has been recognized publicly in the media for its
approach to festival safety.6
Objective
§  Describe the medical response at a multi-day electronic music festival where onsite harm reduction interventions and dedicated medical care are delivered as
parallel public health measures.
Methods
§  This study is a descriptive case report.
§  Event-related data regarding attendee numbers and event site hazards and
conditions were provided by event organizers and on-site medical team leaders.
In addition, meteorological data were gathered from Environment Canada.
§  Patient-related data was collected via the Mass Gathering Medicine (MGM)
Online Registry Project. Harm reduction encounter data was obtained via reports
generated by harm reduction service providers.
§
MB ,
Lund
¶
A,
Golby
ł
R,
Turris
¶
S
Services Provided At Shambhala
Discussion
Medical Services (MS)
Defined: Clinical treatment given to an attendee for illness or injury, including both first aid and higher level of care
§  Each shift was composed at minimum of: one physician, three experienced (emergency medicine or critical care)
registered nurses, three paramedics, three occupational first aiders, and one medical office assistant.
Harm Reduction (HR) Services
Defined: Any policy or program designed to reduce behaviour-related harm without requiring the cessation of the
behaviour itself.7
Service Offered
Description
§  The efficacy of HR services on medical acuity and patient volume remains
unproven at SMF; however, observed benefits of HR services included:
Contacts
A safe, comfortable space with access to peer support, food, and
Sanctuary
volunteers of other HR disciplines. This was a resource for individuals
feeling overwhelmed or over stimulated.
Roaming teams throughout festival grounds engaging with attendees and
Outreach
promoting HR strategies
Peer initiated interactions with volunteers involving non-judgmental
ANKORS
dialogue regarding plans drug use, minimizing adverse mixing events and
overdoses, and point of care reagent drug testing kits.
Fixed and roaming teams engaging attendees to educate on sexual and
Options for Sexual reproductive health information, available counseling, the importance of
Health
consent with sexual encounters, in addition to distribution of safer sex
supplies.
A safe space for women to come for support, including resources
Women’s Safe
regarding the counseling, response, and off site follow up of any
Space
disclosure of sexual assault.
A drug and alcohol free campsite with appropriate support grouping
Camp Clean Beats meetings (NA and AA) for those with addictions and other specific
abstinence needs.
~ 1,000
2,987
5,099 with
2,786 drug tests, 7%
discard rate
~ 1,200
& 10,000 Condoms
Distributed
117
§  When preparing on-site medical protocols at EDMEs, the inclusion of HR
services and approaches can inform patient care, reduce presentation rates and
acuity, and decrease impact on the host community’s local health services.
16
§  The specific extent to which HR strategies reduce the medical care needs is not
well understood and further collaborative research is needed in order to
characterize and quantify the impact.
§  Limitations of this study include a potential lack of generalizability of HR
interventions to other events due to heterogeneity in event characteristics
Patient Encounters, Transfers, Analytics & Acuity by Day
Triage Acuity Scaled
Event Day
Attendance
#(%)a
Patients
#(%)
PPR
(/1000)
Ambulance
Transfers
PPTA
(%)
ATR
(/1000)
Unknownb
Whitec
Greenc
Yellowc
Redc
Pre-show
7,907(51.4)
92(6.6)
11.635
0
0.00
0.000
13(14.1)
46(58.2)
28(35.4)
5(6.3)
0(0)
Day 1
12,181(79.2)
150(10.8)
12.314
5
3.33
0.410
10(6.7)
46(32.9)
79(56.4)
14(10.0)
1(0.7)
Day 2
14,540(94.5)
214(15.4)
14.718
2
0.93
0.138
53(24.8)
60(37.3)
78(48.4)
18(11.2)
5(3.1)
Day 3
15,380(100)
375(26.9)
24.382
2
0.53
0.130
92(24.5)
50(17.7)
213(75.3)
18(6.4)
2(0.7)
Day 4
13,905(90.4)
403(28.9)
28.982
0
0.00
0.000
72(17.9)
95(28.7)
210(63.4)
22(6.6)
4(1.2)
Day 5
2,859(18.6)
149(10.7)
52.116
4
2.68
1.399
26(17.4)
46(37.4)
65(52.8)
9(7.3)
3(2.4)
Post-show
348 (2.3)
10(0.7)
28.736
0
0.00
0.000
2(20)
4(50)
3(37.5)
1(12.5)
0(0)
Cumulative
67,120
1393(100)
20.754
13
0.93
0.194
268(19.2)
347(30.8)
676(60.1)
87(7.7)
15(1.3)
a. 
b. 
c. 
d. 
Percentages reported as percentages of peak attendance (Day 3)
Only 1125 (80.8%) of encounters had TAS completed
Percentages expressed using encounters where TAS was recorded as denominator
There were no deaths; no “black” TAS category patients
o  Redistribution of care and decongestion of medical services
o  Assistance for attendees once medically cleared
o  Spaces with peer support away from the dance setting to rest, cool down,
and rehydrate
o  Drug testing allowing for discarding of potentially dangerous drugs
o  Dissemination of drug testing results to attendees and medical services
regarding high-risk substances on-site
o  Non-judgmental interactions and educational materials promoting more
informed and safer drug use
o  Close communication with medical services and security, allowing for a more
dynamic and adaptable response to on-site incidents
Conclusions
Results
Attendance, Patient Encounters and Transfers
§  Medical encounter volume, acuity, and transfer rates were consistent with
previously published results for dance music festivals. Metrics of PPR and ATR
are of common interest to Mass Gatherings and the PPTA has been proposed as
a measure of the ability of MS to care for patients on-site. The high PPR (20.8
per thousand cumulative attendee days), low ATR (0.194 per thousand
cumulative attendee days) and low PPTA (0.93%) suggest that dedicated, on-site
HR and higher level of care (HLC) MS help to minimize the effects of a more
than 13-fold increase in population on local health services.
Triage Acuity Scale for Mass Gatherings is a 5-colour, categorical
system for triage and acuity assessment based on the widely used
START triage system with the addition of a white ‘dispensary’
acuity category and modifiers, as in the CTAS system.8
References
1)  Lund A, Turris SA. Mass gathering medicine: risks and patient presentations at a 2-Day electronic dance music event. (In Review).
2)  MacPherson, D. (2014). Preventing music festival drug deaths must go beyond ‘just say no’. National Post [online]. Available at: http://
fullcomment.nationalpost.com/2014/08/20/donald-macpherson-preventing-music-festival-drug-deaths-must-go-beyond-saying-just-sayno/ Accessed October 19, 2014.
3)  Memish Z, Zumla A, McCloskey B, Heymann D, Al Rabeeah A, Barbeschi M, Horton R. Mass gatherings medicine: international
cooperation and progress. Lancet. 2014;383(9934):2030-2032
4)  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
5)  Akbar T, Baldacchino A, Cecil J, Riglietta M, Sommer B, Humphris G. Poly-substance use and related harms: a systematic review of
harm reduction strategies implemented in recreational settings. Neurosci Biobehav Rev. 2011;35(5):1186-1202
6)  Shambhala music festival. (2014). Available at: http://www.shambhalamusicfestival.com/about/ Accessed December 15, 2014.
7)  Camh.ca,. 'CAMH: CAMH And Harm Reduction: A Background Paper On Its Meaning And Application For Substance Use Issues'. N.p.,
2015. Web. 18 Feb. 2015.
8)  Turris SA, Lund A. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):531-535
Acknowledgements
Many thanks to Kerrie Lewis, Michael Camporese, Hadi Rezaei, Pedram Laghaei, Alain Dennis, Ivan Hoffman, and Erik Spence who helped
with data entry, to Chloe Sage and Stacey Lock who shared harm reduction data. Thank you Michael Carson for your work on the Registry
and all the timely reports. Photo credit to Mark Galloway.
§UBC
Faculty of Medicine, Kelowna General Hospital Emergency Department, Kelowna, BC
¶UBC Department of Emergency Medicine, Vancouver, BC
łUBC Faculty of Medicine, Vancouver, BC