Concert medicine: spectrum of medical problems encountered at 405 major concerts.

OBJECTIVES: To identify factors predictive of patient load at major commercial concert first-aid stations, and to characterize the spectrum of presenting injuries and illnesses at such events. METHODS: This study was a retrospective case series of patients presenting to on-site first-aid stations at five major concert venues in southern California over a five-year period. The authors compared the number of patients per ten thousand attendees (PPTT) with four potential predictors (music type, overall attendance, temperature, and indoor vs outdoor location) using univariate techniques and negative binomial regression. The spectrum of chief complaints observed is described. RESULTS: There were 1,492 total patients out of 4,638,099 total attendees at 405 separate concerts. The median patient load per concert was 2.1 PPTT, ranging from 0 PPTT at 53 concerts to 71 PPTT at a punk rock festival that turned into a riot. Patient load varied significantly by music category (p = 0.0001) but not with overall attendance, temperature, or indoor vs outdoor location. Median PPTT by music category ranged from 1.3 PPTT for rhythm and blues to 12.6 PPTT for gospel/Christian, with negative binomial regression indicating that rock concerts had 2.5 times (95% CI = 2.0 to 3.0) the overall patient load of non-rock concerts. Music type, however, was able to account for only 4% of the variability observed in the regression model. Trauma-related complaints predominated overall, with similar rates at rock and non-rock concerts. Four cardiac arrests occurred at classical concerts. CONCLUSION: Rock concert first-aid stations evaluated 2.5 times the patient load of non-rock concerts overall, although there was substantial concert-to-concert variability. Trauma-related complaints predominate at both rock and non-rock events. These data may assist individuals and organizations planning support for such events.

Exposure of prehospital care providers to violence.

OBJECTIVE: To evaluate the experience of prehospital care providers with violence. METHODS: A survey addressing experiences with prehospital violence was administered to a convenience sample of emergency medical services (EMS) providers in a southern California metropolitan area. Descriptive statistics are reported. RESULTS: Of 774 EMS providers surveyed, 522 (67%) returned the questionnaire. Members of law enforcement were excluded because their experience with violence, weapons, and tactics is not typical of most paramedics. This left a sample of 490 for further analysis. These prehospital care providers had a median of ten years' experience on the job. They tended to be male (93%) and white (80%). All together, 61% recounted assault on the job, with 25% reporting injury from the assault. Respondents reported a median of three episodes, and the number of assaults for each individual was unrelated to the number of years of experience on the job (r = 0.068). Of those injured, 37% required medical attention. On the other hand, 35% reported that their company had a specific protocol for managing violent situations and 28% stated ever having received formal training in the management of violent encounters. This limited training notwithstanding, nearly all (95%) providers described restraining patients. Use of protective gear was reported (73%), and some (19%) admitted to ever carrying a weapon on the job. CONCLUSIONS: By their own report, EMS providers encounter a substantial amount of violence and injury due to assault on the job. Formal training and protocols to provide a standardized safe approach for such encounters are lacking. Although the limitations of survey data are recognized, further research characterizing the level of violence and potential interventions seems warranted.