Gone Phishin

Gone Phishin'

EMS organization & responsibilities at Phish’s final 2004 summer concert

Story by David M. Tauber, NREMT-P, CCEMTP, I/C

Photos by Jeffrey Mayes

Used with kind permission of Elsevier Public Safety

The phone rings and on the other end is a friend who invites you to attend a party they’re throwing for 100,000 friends—and, oh yes, they want you to organize the EMS. The party turned out to be the seventh city-size concert of the jam band Phish. The friend was a concert promoter we had worked with before. In this case, we are a not-for-profit EMS educational organization called the Advanced Life Support Institute (ALSI).

Based in Conway, N.H., ALSI has used mass-gathering events as one of our educational methods since the institute’s inception in 1995. For the past seven years, Phish has ended its summer tour with a four-day music, camping and arts festival. Our friend, the promoter Great Northeast Productions, told us the party this year (in August 2004) would be on a rural group of farm fields and a small airport with no infrastructure and in a county with no paramedic-level EMS. When we looked up the location on a map, we found it was the last highway exit in Vermont before you reach the Canadian border.

We contacted Newport EMS, the local ambulance service, and North Country Hospital, the local hospital. Both were helpful and gracious. The nearest Level 1 trauma centers are both about 1.5 hours away by ground. We found a competent, rural, not-for-profit service that responds to about a thousand calls for service a year at the basic level with some EMT-intermediates. At night, members often cover oncall from their homes. The local hospital has a new seven-bed emergency department (ED) and 49 beds total in the hospital. Both were also supportive of bringing in paramedics and setting up an ALS system for the week of the concert.

To help local providers prepare for the anticipated need for increased EMS, the ED medical director, the director of nursing and ALSI collaborated to present several education programs. The first was a four-hour session on concert medicine and the medical plan for the event. Half of this session was spent on the signs, symptoms and treatment of patients intoxicated with various recreational substances potentially found at concerts and raves.

The second educational offering was a tabletop drill with patient and operational scenarios presented by the medical director to explore which hospital patients should be transferred to from the concert medical station. The medical director wrote algorithms based on potential patient needs and the capability of the various hospitals.

The third educational session was a teleconference presented by the medical director of the Northern New England Poison Control Center, Anthony Tomassoni, MD. Tomassoni is also both an ED attending physician and the medical director for ALSI. Because there was great local concern about the issue, the third session again dealt with the drugs of abuse not normally seen in this rural community.

Also, the week of the event, a session was held at the on-site medical facility to familiarize all the physicians with the facilities and equipment available. The final pre-event educational session was held at the concert site for all the medical staff. In addition to communications and operational policies and procedures, this meeting reviewed customer service, recreational toxicology, crowd control and security, and patient restraint procedures. Presentations were also made by the state public health department on communicable disease surveillance, such as food-borne illnesses, and by the Office of the Medical Examiner on procedures in the event a death occurred.

The Vermont Department of Safety mass gatherings permit required an EMS operational plan approved by the state’s Department of Health before final approval of the event. When it was completed, the plan ran in excess of 50 pages.

We were setting up what amounted to be the largest city in the state with the largest EMS system in the state for five days. We needed to bring together EMS personnel and paramedics from outside the area with local resources. The outside EMS providers were brought in to avoid adversely affecting the local services by reducing their staffing and also to bring in staff who had experience with mass gatherings of this magnitude.

The word was already out, and the phone started to ring with EMS folks and nurses interested in being part of this large undertaking. Our administrative director, Todd Robinson, was already contacting our core group of graduates, affiliate faculty, friends and others who had worked similar events with us in the past. We had to provide medical service not only to ticket holders but also to event staff numbering several thousand. With a total on-site head count projected to be around 100,000, we needed 100 EMS providers minimum, working 12- to 18-hour shifts. Our efforts culminated with more than 120 EMS providers, including EMTs, paramedics, nurses, physicians, logisticians, system status controllers, command staff and other support personnel.

As previously mentioned, Newport Ambulance Service doesn’t usually have paramedics in this county, but for the event the service imported several from another station to staff the transport ambulances. Therefore, we wouldn’t have to send site medics to the hospitals with transports.

We needed a main medical facility with a command compound and seven peripheral tents. The compound had a command and dispatch trailer, a logistics office trailer and a logistics storage trailer. We also had an equipment-washing station and sleeping and gathering areas for staff. We decided to keep the EMS staff nearby for sleeping rather than have EMS personnel go to the general staff sleeping areas more than a mile away. This made transport back and forth easier at shift changes and allowed for a ready reserve to call back to work if necessary.

Two of the peripheral tents would be in the area of the concert itself, called the venue. One venue medical tent was at the side of the entrance, near the main flow of fans as they entered. This way all the ticket holders could see it and later find the tent if they needed assistance. This resulted in a busy tent between sets and directly after concerts. The other venue medical tent was stage right, accessible to the area directly in front of the stage and the backstage areas. In the camping area, we put five outpost tents. All medical tents were conspicuously marked.

Each of the tents would have at least one paramedic at all times and a crew of EMTs and/or nurses. They were co-located in what were known as super pods. These were areas of guest services consisting of a line of portable toilets, hand-washing stations, food venders and a security/fire-watch lookout tower. Each tent had all the equipment normally found in an ALS-level ambulance, as well as a supply of over-the-counter medications, such as aspirin, acetaminophen and aloe.

At previous events, we used an airport crash rescue station or an open-floor tent for the main medical station. This time we were contacted by a group from St. Johnsbury, Vt., called Mobile Medical International. They asked us to field test a prototype portable field hospital system. This tent was deployed from an intermodal shipping container and was completely selfcontained. It was airtight for use in hazardous materials situations and had its own generator with air-conditioning and heat.

The tent has a capacity for 40 beds in two wings. One side we used for acute care, and the other side we used as a quiet holding and detox area. On one end we added another tent that held three resuscitation tables. This area was used for triage and stabilization of any patient transferred from an outpost tent or directly from the field.

In front of the main medical tent we had a third tent for walk-in triage and minor care, similar to the outpost tents. This gave us a separate walk-in entrance. The main medical facility was staffed by a physician throughout the event and managed by a paramedic/RN on each shift.

For patient transportation we arranged to have four John Deer Gators fitted with Med-Beds. These 4 x 6 wheel drive units with off-road, knobby tires earned their keep when the rain started. They carry a crew of three with a patient and equipment. They’re small and maneuverable in tight quarters and open to the crowd, allowing great visibility. We also deployed two four-wheel drive ATVs with power winches. After the first two days of a 70-year-record rain, there were muddy places where even the Gators needed to be accompanied by an ATV.

In addition to the ATVs, we used three teams of two mountain bikes for first response. The bikes were maneuverable in normal conditions, but in mud and deep grass they were not as effective. During the concerts themselves and when the venues were open to the public, we also used walking patrols with portable equipment.

We used a golf cart equipped to carry a backboard for logistics transport and for on-pavement transport. For transport to the hospitals and on roadways closed to patrons, we had four ambulances at the event and back-up ambulances on stand-by.

An incident command system with several management layers was used throughout the event. The Vermont State Police had a unified command with the county regional dispatch and an EMS control officer to handle all incidents off the actual site. On site, we had an overall EMS commander and two shift commanders. Each shift had a logistician, a systems status controller, a data entry person, main medical facility manager and a transport officer. One of the shift commanders acted as the overall narcotics control officer and the other was the overall personnel manager.

Shift commanders and the IC met one hour before shift change. Fifteen minutes before each shift change, they conducted a briefing for each oncoming shift. Topics included operational issues, assignments for the shift, environmental concerns, public health issues, safety alerts and the activity of the previous 12 hours.

Communications are always a major part of a large operation. We used UHF trunked portables and a portable repeater set up for the event. There was a “9-1-1” emergency dispatch channel for any other department, such as security, to call in on. We used one channel for EMS command, one for logistics, one for tactical operations, such as within the venue during concerts, and one dedicated for medical control communications to the on-site physician. In addition, we could directly access any of the 16 total banks of several channels used by the other departments. A total of 96 possible channels were available. EMS was equipped with 50 portables, each with a headset for high-noise areas and private discussions in a crowd.

The gates opened on Thursday morning, Aug. 12, 2004. A steady stream of cars with enthusiastic concertgoers started filling the grounds around the airport, staking out dry ground for camping. It had been raining for 24 hours and mud was everywhere. On Saturday and Sunday, the days of the concerts, the weather was beautiful. We treated nearly 6,000 patients over six days, but transported only 22 to outside medical facilities. There were about 33 additional transports from off-site areas around the county that were considered connected to the concert. Thanks to advance planning and thorough preparation, concert-goers were treated to a memorable and safe experience.

—David M. Tauber, NREMT-P, CCEMTP, I/C, is the executive director of the Advanced Life Support Institute of Conway, N.H. He has been in EMS since 1971 and a paramedic since 1980. Tauber serves as a paramedic/firefighter on Conway Fire-Rescue and is a medical specialist on a FEMA USAR team.