Tag Archives: ems

Apr 20 2015

Local Medics Ditched for Festival Specialists – Permit Now In Jeopardy?

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hgh winnemucca

Last month we brought the news that BMOrg had cut out early from their half-million dollar annual contract with Humboldt General Hospital. Now we know why: they have ditched the local medical facility for CrowdRX, who specialize in providing medical services to festivals like Coachella and Bonnaroo.

From the Reno Gazette-Journal, Burning Man Chooses New Medical Provider, BLM Concerned:

Burning Man has chosen a new, out-of-state medical support services provider to care for patients after considering the public health and safety concerns expressed by the Bureau of Land Management following last year’s Burn.

While glad to see that Burning Man is taking the initiative to make changes to address the BLM’s concerns, the concerns are not gone.

“I’m somewhat apprehensive with a new medical provider coming on with only four months before implementation,” said Gene Seidlitz, district manager for the BLM office based out of Winnemucca.

It’s a big deal that the BLM are apprehensive, because with just a few months to go until the start of the event, the Special Recreation Permit has still not been approved. It’s on Seidlitz’ desk, but he’s not signing…yet.

The BLM will not issue a special recreation permit to Burning Man until all concerns pertaining to public health and safety are addressed within the contract with CrowdRx, the new provider, Seidlitz said.

Burning Man has some time, as the permit is usually issued in June, according to Seidlitz.

“They have a permit in front of me, but it’s unsigned,” he said.

The BLM report addressing public health and safety during the 2014 Burning Man was not immediately available Wednesday for review. Seidlitz said it covered issues like the poor portable toilet sanitation and the lack of communication between Burning Man’s own emergency support staff and staff employed by the medical support services provider

No big deal, at least BMOrg have locked in the new provider…right? Wrong.

On Wednesday, Burning Man announced that it reached an agreement with CrowdRx, but no contract is in place since all of the “numbers” still have to be figured out, according to Burning Man spokesman Jim Graham. Officials have not revealed the contract amount or if it will be a one-year or multi-year contract.

What do they need to do to figure this out? Haven’t they been doing it for 30 years? What happens if they can’t negotiate a fair contract (something BMOrg are not exactly renowned for)?

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Humboldt General Hospital spokesman Pat Songer said that while the hospital won’t suffer financially from the loss of the contract, it is a disappointing blow to the local community.

“It’s disappointing that Burning Man chose to work with an out-of-state company that’s unlicensed in Nevada. It’s disappointing for the state of Nevada,” Songer said. “They’re not licensed to provide ambulance services, they’re not licensed as a hospital in Nevada.”

BM CEO Marian Goodell is not concerned.

CrowdRx currently serves nearly 20,000 events nationwide, including a variety of musical festivals such as Coachella and Bonnaroo. Other clients include major athletic events, including the U.S. Open and various all-star major league events.

“CrowdRx has an excellent reputation for providing medical support for large public events across the country,” said Burning Man CEO Marian Goodell. “We’re looking forward to working with them now and into the future as Burning Man evolves and grows.”

Large public events across the country, huh? Is that where Burning Man is evolving and growing to?

Last year more than 4500 emergency calls were processed and over 6100 patients were treated medically, almost 10% of the total population. Black Rock City may have less crime than other places, but it sure seems to have more injuries and accidents. Most of the treatment was for dehydration, scrapes and cuts, or intoxication/overdose.

CrowdRX do not have any ambulance facilities in the area, and HGH won’t be making theirs available to the rival that cut their lunch. It doesn’t sound like CrowdRX have been to Burning Man, or really know much about what’s in store for them.

Burning Man will be a different animal for CrowdRx.

“Nevada is a new venture for us. We will look and see what we need,” [CrowdRX’s new president Carl] Monzo said.

The most rural environment the company had worked in its 23 years of experience was a Phish concert held in a rural part of New England in the 1990s, he said.

“When we’re dealing with something like Burning Man, I think we need to double and triple check because it’s not like there’s resources around the corner,” Monzo said. Black Rock City is located about two hours north of Reno in the Black Rock Desert.

It is possible that CrowdRx will reach out to local ambulance and hospital entities for collaboration, according to Monzo. Humboldt General Hospital is not interested in working with CrowdRx, according to Songer, the hospital’s spokesman

So they haven’t even looked to see what they need yet, let alone negotiated a contract – either for a year or multiple years? And they’re just assuming it will be no problem for them to collaborate with the local resources that they just screwed out of a contract? This does not sound very positive.

EMS1 has further details:

“Burning Man is a premier event with an outstanding level of service to its participants,” said CrowdRx President Carl Monzo. “We have decades of experience in live event medical care at large gatherings around the country and are excited to bring those skills to Burning Man.”

BMOrg spokesman Jim Graham is characteristically upbeat:

CrowdRx will be providing essentially the same services that Humboldt General Hospital did, though perhaps on a larger scale. Basic first aid will be available in more locations, according to Graham, and a central clinic will provide for more serious needs, such as broken bones, detoxication and dehydration…While Burning Man would like to make it as viable as possible for participants to stay on the playa while being treated, Graham said critical injuries will be treated at the nearest hospital to the playa: Renown Regional Medical Center in Reno. [Source]

What has triggered this? There was a rumor last year that EPA had to be called to the site due to a biohazard problem that was so serious they were considering shutting the event down. I have not been able to substantiate that rumor, perhaps someone else can…or suggest another reason why BMOrg would ditch a local service provider who by all accounts has provided excellent service for the last four years.

In the comments at RGJ, RT insists there were no problems on the turf of “Poopervisor” Robbi Dobbs:

RT: Why on earth would they say that the porta potti service was anything other than exceptional? The trucks come by and powerwash them. They service each of the units 4 times a day. There are well over 1,000 units and they are overseen by the very efficient staff and volunteers on potti patrol. (Led by Robbi Dobbs the Poopervisor), Nearby camps, (Potti friends), stock the paper as needed and zip-tie the ones with accidents inside. Our camp, Sporks Are For Pussys, vowed to keep them clean and stocked but the USS crew did such an excellent job that we barely got a chance to do anything extra. Why was that in their article on medical services anyway?

Is this about health and safety concerns? Politics? Trying to maximize how far their tax-exempt dollars go? Or part of the strategic vision of Burning Man’s expansion over the next century?

From Reddit, we get some speculation about the case “for” the switch:

neil801:

Based on some experiences in 2014 and in talking with a number of friends and acquaintances:

Yellow Shirts, Medical staff at 3:00 & 9:00 = awesome!

Blue shirts, Humboldt = awful!

I speculate this was so because Yellow shirts are Burners, are passionate volunteers, and are experienced medical professionals in the default world. While blue shirts are paid individuals just going through another day at the office. I’m optimistic that CrowdRX will do a good job due to their festival experience – they might just ‘get’ Burning Man. Good-bye and good riddance to shitty Humboldt.

luvmuppet:

…the RGJ is pretty clueless on this one too. CrowdRX is basically providing stuff, but a lot of the very same people are going to be there anyway. HGH hired from all over the place, this isn’t going to be any different. In fact it might be better.. There were a lot of first timers that HGH had hired that were there for the money only. As in, had no ties to anything burner whatsoever, never been to the event, etc. were only there for one shift and that’s it. Rumor is that crowdrx is wanting to help hire on many of the ESD folks for a few shifts. So, in a sense, CrowdRX would be providing a WAY better service by bringing on veteran burners instead of putting an ad on Facebook/JEMS (HGH did this!) and hiring random people.

Burner Claire Gilles has been the lead nurse at Burning Man with HGH for the last several years. She has  raised her concerns with the BLM, and encourages the rest of us to do the same:

To whom it may concern,
I am very concerned about the BM. Org choice of new medical management for Burning Man 2015. I am an emergency room RN in Reno and I have volunteered for the last several years with HGH at Burning man as their lead RN. This new medical Management company is and will not be prepared to treat the high volume of critical patients that this event produces on a daily bases. They are unable to provide critical care or acute cardiac and trauma life support , not do they possess the transport equipment or staff to transport these patients off of the playa . Which means they will be utilizing 40-50 percent of our local EMS . When our local EMS is out of service running extended time transports back and forth between the Event they are unable to provide care in our community and our community will suffer for it. Because Crowd RX is not able to care for critically ill patients they will be transporting off playa significantly more people, this will add additional strain to our ER ‘s and hospitals ( which are already at max capacity ). Burning man takes place during an extremely busy time for Reno and sparks , the Rib cook off and our annual motor cycle jamboree to name just two. HGH provided consistently excellent , swift and skilled care not only on site but also managed transports for the patients that needed to be moved to a higher level of care . HGH is able to provide Critical care management on site, and frequently able to even treat and discharge some of these patients back to their playa homes. The staff at ramparts even managed to make sure their discharged patients had follow up care while at the Burn. Because HGH is local and respected within Northern Nevada they had the ability to connect with critical care air services and local physicians outside of Black rock city. They even provided limited medications for patients on a daily bases while on playa . Due to their proximity to Gerlach , HGH was able to restock any supplies and medications daily and maintain consistent quality care and service. HGH is local and loved and understands not only the needs of black rock city but of the hospital systems in Reno and sparks and was able to provide excellent care without overwhelming our local ER’s and staff. I ask you as a native Nevadan , a long time Burner and a medical professional to restrict Crowd RX from providing care for this event. The residents of Black rock city and Reno, sparks, Fernely and Fallon deserve better…

I’d like to add one more item to ponder with regards to the new Medical management at Burning Man. Crowd RX is an out of state corporation. They are providing care at Burning man simply to make a profit. Do they care about the reputation of Nevada ? Our local economy thrives on tourism. Who better to provide care for tens of thousands of guests in our state than the people who live and take pride in Nevada. Why should we allow an outside agency with no experience and no ties to our community be paid to provide what will likely be poor care for the biggest annual revenue generating event in Northern Nevada? Keep Health care at the burn Local! Support HGH and tell BLM Nevadans should be taking care of our welcomed Guests !! Because we quite frankly do it better and we want them to return to their homes across the U.S. and the globe enthusiastic praise for this great state!

This is contact info the BLM who will be determining if Crowd RX meets the expectations needed for safe care during this event. Please email or call with your opinion! 

Winnemucca District Office
5100 East Winnemucca Blvd.
Winnemucca, NV 89445
Phone: 775-623-1500
Fax: 775-623-1503
Email: wfoweb@blm.gov
Office hours: 7:30 am-4:30 pm, M-F

 

Feb 21 2014

Help the Helpers

Humboldt General Hospital’s Emergency Medical Services department is the primary medical services contractor to Burning Man. We’ve covered them before, in our story Behind The Danger.
Employees of Humboldt General Hospital staff  a comprehensive on-site medical clinic and an elite high performance ALS ambulance service over the course of the week long event. Each year, they require 300+ temporary employees. Physicians, nurses, paramedics, EMTs and non-clinical support staff treat nearly 3000 injured and ill event participants – almost 5% of the population. The ambulance is called out more than 50 times per day.
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Humboldt General Hospital is currently recruiting potential employees to staff the 2014 event.
What sort of perks do you get?
  • Humboldt General Hospital maintains a camp area (Theme Camp) available to HGH staff 
  • Employees working three or more shifts will be provided lodging during their “shift cycle”
    (lodging will not be provided once all shifts worked, or during non-scheduled days).
  • In addition employees will receive a shower pass.
  • Work 3+ shifts: 3 meal vouchers a day, per shift worked.
  • Work 6+ shifts: 3 meal vouchers a day, per day spent on playa.

You can find out more here.

Oct 22 2013

Behind the Danger

hgh emsBurning Man is a dangerous place. People die there, get robbed and raped, get injured. Whistleblowers report major safety issues. BMOrg can’t afford to do anything about it other than give us some health hints, even though now the party is taking in $25-50 million per year. And the cops don’t seem to be able to do much to help the safety of Burners, even though their take from the party is now upwards of $2 million/year (plus citation revenues).

Luckily we have an experienced, dedicated, mostly volunteer crew of Emergency Services and medical professionals out there to help us. Medical care on the Playa is free, covered by insurance that comes with your ticket. If you want more coverage, you can also buy special Burning Man insurance.

The Humboldt County EMS team sees half as many people in a week at Burning Man, as they do in an entire year. They manage the staffing of 300-350 employees, who see around 3200 patients in a week from almost 400 ambulance calls. Pat Songer from Humboldt General Hospital EMS, NV, shares some of the stories behind the scenes at Burning Man:

From EMS World:

IMinolta DSCt’s difficult to to schedule 20 people on a spreadsheet, calendar or whiteboard.  Imagine trying to schedule hundreds of people with one of these  antiquated methods of scheduling.  Large scale events require a great deal of support personnel…including security, food service, volunteers, and EMS staff. How to manage, schedule and keep track of all these people is a huge undertaking.

Each year, the last Monday of August signals the start of largest outdoor art festival in North America…Burning Man. A “city” covering seven square miles is built each year in the Black Rock Desert about 120 miles north of Reno, Nevada. Burning Man has been referred to as the largest, planned, mass casualty event in history.

Humboldt General Hospital, in nearby Winnemucca, is the contractor for the massive medical and EMS requirements for Burning Man. “We provide a mobile hospital, a mobile medical unit, and a full ALS ambulance response system for the event. There are about 70,000 participants in the city for the one week festival and we provide all the medical care. We see about 3,200 patients each year at Burning Man so we staff anywhere from 300-350 temporary employees. It’s an enormous scheduling issue dealing with how we schedule the people out there. We use EMS Manager at Humboldt General Hospital and we use it to coordinate all the physicians, administrators and EMS staff at Burning Man.  EMS Manager provides online access so the contract workers can place their availability right from their home months before the event and then we manage the system from our location.  Staff can also login to EMS Manager at the event to pick up more shifts due to no-shows or when people drop shifts.  EMS Manager is excellent.  It’s a very efficient tool for us,” explains Pat Songer, Administrative Director, Humboldt General Hospital, Winnemucca, NV.  

Others responsible for large functions choose to use staff from neighboring EMS agencies.  Scheduling personnel from various agencies and coordinating them into a cohesive team for the duration of the event is a challenge.

Biggest problem? Blisters and cuts. Followed by Dehydration, exhaustion, heat stroke. OK, they have free bandaids. Some Burners didn’t bring enough, or didn’t have them in their pockets when their boo-boo happened. But, can someone explain this to me? Why sell ice and boiled water (coffee/tea), but not sell drinking water? Or, provide water fountains for the public, like most cities do. How much load on the medical system do we need to have, is it going to take someone dying, before BMOrg decides it makes sense that people in a party in the desert should have clearly visible water stations they can go to? We’re human beings, water should be free to begin with.

Although the EMS system can’t help with waters, or sexual assaults, it’s great to know there are so many professional medical people at Burning Man, rostered on to keep us safe. It seems incredible to me, that they have 350 trained medical personnel on the Playa, and at least 130+ Federal and Pershing County Law Enforcement officers – and yet, we are supposed to believe that not one of those nearly 500 is able to use a rape kit on a patient? The nurse or doctor just needs to hand the sealed rape kit to a police officer, thus keeping the chain of evidence sufficiently intact if a case ever went to trial. Is this because it’s the Wild West out there – there are so many crimes being committed, everywhere by everyone, cowboys and sheriffs – that, hey, what’s a few more? Or is it just that this EMS system needs to be improved to schedule in some SANE nurses ? If there aren’t enough trained medical personnel for a city of 70,000, then maybe BMOrg can invest some of those tens of millions into the 40-60 hours of training required by nurses. Seriously: train one nurse, what’s the big deal? Or, even better, train all 350 medical personnel.

The medical staff at Burning Man certainly seem extremely competent to me. Let’s wrap up on a more positive note, with a story about how they saved the life of a guy who had a heart attack out there.

Black Rock City operates as a functional geopolitical entity with fire, police and EMS systems. Each is dispatched from a manned communications center that’s constructed and deconstructed annually.

stretcher patientIn 2011, Humboldt General Hospital EMS in Winnemucca was contracted to provide medical care for Burning Man. Medical care included a fully staffed and operational EMS system, as well as a field hospital called Rampart General and two BLS aid centers.

A total of 2,307 patients were treated. Three-hundred and eighty-two requests for ambulances were made, with 185 patients being transported to Rampart General. Only 33 patients were transported out of the desert for care. The following highlights one of those cases that took place during the event.

On the final day of the Burning Man event, EMS is summoned to a chest pain call in a trailer within the encampment. On arrival, paramedics find a 60-year-old male in acute distress. He’s pale and diaphoretic and in extremis. The patient describes the pain as “tearing” and can’t get into a comfortable position. The EMS crew extricates him from his trailer and moves him to the awaiting ambulance for a more detailed assessment.

He becomes unresponsive shortly after they place him in the ambulance. Paramedics check his pulse, take a quick look at the monitor, and note the patient is in a non-perfusing v tach. On a hunch, they administer a precordial thump, and it works. The patient converts to a sinus rhythm. He’s transported to Rampart General in Black Rock City. Once the patient arrives at the field hospital, the emergency staff rapidly assesses him. He’s alert and oriented, but his blood pressure is undetectable. He’s writhing in pain on the stretcher. IV fluids are given, and his blood pressure is finally detectable at a systolic pressure of 72 mmHg and then up to 76 mmHg. He remains mildly tachycardic. He receives IV fentanyl for pain. Rampart General has X-ray capabilities and a stat chest X-ray is obtained. The emergency physician notes that the mediastinum is wide at 10.5 cm—consistent with a thoracic aortic aneurysm and dissection. A medical helicopter is summoned and the patient is closely monitored and stabilized by the emergency staff.

As soon as the helicopter arrives, the patient is moved to the aircraft and transported to a major medical center about 150 miles away. Once he arrives, he undergoes a computed tomography angiogram (CTA) that confirms the suspected aortic dissection. The patient is emergently taken to surgery where the aneurysm is repaired. The operation is successful, and the patient is moved to the intensive care unit (ICU). Following surgery, the patient suffers a second cardiac arrest and is taken to the cardiac catheterization lab for evaluation and subsequent stenting of a coronary artery lesion. He’s returned to the ICU and remains stable. He’s discharged home with appropriate provisions for follow-up. Despite his ordeal, he’s already planning his next trip to Burning Man.

First, this is not a true “case from University Medical Center” because it didn’t happen at UMC. However, emergency physicians, emergency medicine residents and medical students from the University of Nevada School of Medicine provided much of the medical care at Burning Man. As you can tell, this patient had all the cards stacked against him. He had a critical thoracic aortic dissection, and he was in the middle of a Nevada desert more than 150 miles from a medical facility with cardiothoracic surgery capabilities. Furthermore, he suffered a cardiac arrest. Yet despite all of this, he survived.

“Radical Self-Reliance” doesn’t really capture the essence of Black Rock City. We rely on each other. A big thank you to all the volunteers and contractors who provide the medical, fire, and physical safety for us out on the Playa. BMOrg, buy ’em some freaking radios.