title: Observed Benefits to On-site Medical Services during an Annual 5-day Electronic Dance Music Event with Harm Reduction Services.
abstract: BACKGROUND
  With increasing attendance and media attention, large-scale electronic dance music events (EDMEs) are a subset of mass gatherings that have a unique risk profile for attendees and promoters. Shambhala Music Festival (Canada) is a multi-day event in a rural setting with a recognized history of providing harm reduction (HR) services alongside medical care. Study/Objective This manuscript describes the medical response at a multi-day electronic music festival where on-site HR interventions and dedicated medical care are delivered as parallel public health measures.
  
  
  METHODS
  This study was a descriptive case report. Medical encounters and event-related data were documented prospectively using an established event registry database.
  
  
  RESULTS
  In 2014, Shambhala Music Festival had 67,120 cumulative attendees over a 7-day period, with a peak daily attendance of 15,380 people. There were 1,393 patient encounters and the patient presentation rate (PPR) was 20.8 per one thousand. The majority of these (90.9%) were for non-urgent complaints. The ambulance transfer rate (ATR) was 0.194 per one thousand and 0.93% of patient encounters were transferred by ambulance. No patients required intubation and there were no fatalities. Harm reduction services included mobile outreach teams, distribution of educational materials, pill checking facilities, a dedicated women's space, and a "Sanctuary" area that provided non-medical peer support for overwhelmed guests. More than 10,000 encounters were recorded by mobile and booth-based preventive and educational services, and 2,786 pills were checked on-site with a seven percent discard rate.
  
  
  CONCLUSIONS
  Dedicated medical and HR services represent two complementary public health strategies to minimize risk at a multi-day electronic music festival. The specific extent to which HR strategies reduce the need for medical care is not well understood. Incorporation of HR practices when planning on-site medical care has the potential to inform patient management, reduce presentation rates and acuity, and decrease utilization and cost for local, community-based health services.
authors.affiliation: Department of Emergency Medicine,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Matthew Brendan
authors.initials: MB
authors.lastname: Munn
authors.affiliation: Department of Emergency Medicine,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Lund
authors.affiliation: Department of Emergency Medicine,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Riley
authors.initials: R
authors.lastname: Golby
authors.affiliation: Department of Emergency Medicine,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Turris
mesh_terms: D000328:Adult; D002170:Canada; D003441:Crowding; D003615:Dancing; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D040261:Harm Reduction; D006693:Holidays; D006801:Humans; D008297:Male; D009146:Music; D011446:Prospective Studies; D011634:Public Health; D012042:Registries
keywords: ATR ambulance transfer rate; EDME electronic dance music event; Emergency Medical Services; HR harm reduction; IV intravenous; PPR patient presentation rate; PPTA percent of patients transferred by ambulance; TAS triage acuity scale; electronic dance music event; emergency treatment; harm reduction; mass gathering; music festival; public health