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

  • Sheila A. Turris (a1) (a2), Christopher W. Callaghan (a2) (a3), Haddon Rabb (a2) (a4), Matthew Brendan Munn (a1) (a2) and Adam Lund (a1) (a2)...



Music 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.


The 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.


This is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.


On-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.


The 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.


Corresponding author

Correspondence: Christopher W. Callaghan Mass Gathering Medicine Interest Group University of British Columbia E-mail:


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Conflicts of interest: Turris takes on both paid and volunteer roles at special events. She provided medical direction at two of the four music festivals described in this study. She is a shareholder with the medical services company that provided health care services for three of the music festivals. Callaghan was contracted by the medical services company that provided health care services for three of the festivals. He worked at two of the four music festivals in this study. Rabb provided medical coverage for two of the four festivals in 2017. He was contracted by the medical services company that provided service. Munn was the medical director for one of the music festivals described. He has provided paid and volunteer services working as a director and clinician at other events. Lund provided medical direction and clinical care for three of the music festivals described. He is the medical director and a shareholder of the medical services company that provided health care services for three of the festivals in the present study. None of the authors received income for this study.



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