Tag Archives: medical

Apr 20 2015

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

crowdrx_small_web

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)?

hgh ems

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

 

Nov 9 2014

What’s In My Baggie?

Be careful Burners. That Molly might be Bath Salts.

“Molly is the moonshine of today”. As the documentary shows, what people think they’re taking, may not be what they’re really consuming at all.

need lsdA recent Reddit thread discussed how a Burner thought she was taking a lazy 3 hits of LSD at once, but it turned out to be designer drug 2C-C-NBOMe – an invention of the late Burner/Bohemian Grover Sasha Shulgin. She flipped out big time, and had to be restrained to a stretcher and treated at the medical tent. According to Reddit, BMOrg had “compassionate and academic medical staff on hand, with a chromatograph mass spectrometer no less”. They were able to analyze was in the drugs, which led to a medical paper being written for the American Journal of Emergency Medicine.

Case Report: A 24 yo female was found to be tachycardic, tachypneic and with agitated delirium after drinking wine, smoking marijuana and ingesting 3 blotter paper doses of what she thought was lysergic acid diethylamide. She thought she was being attacked by invisible assailants. She was transported from her campsite to an on-site field hospital by emergency medical personnel, where she was treated with intravenous normal saline and lorazepam with complete recovery within 10 hours. Leftover blotter paper samples were analyzed using Agilent Liquid Chromatograph-Time-of-Flight Mass Spectrometer (LC1200-TOF/MS 6230). The primary compound detected was 2C-C-NBOMe, with a smaller amount of 2C-I-NBOMe also present…

just lying around in the Medical Tent.

just lying around in the Medical Tent?

Use of designer drugs is increasing, as evidenced by the well-documented rise of synthetic cannabinoids (herbal incense, spice, K2) and synthetic cathinones (bath salts) in Europe and the United States, the pervasiveness of methylenedioxymethamphetamine (MDMA) in pop culture, and the constant detection of novel compounds with high resolution mass spectrometry techniques. The 2C class of psychedelic phenethylamines was first synthesized by Alexander “Sasha” Shulgin in the 1970s and 1980s. They are 5HT2 receptor agonists with variable receptor activity. Although 2C-I and 2C-B are both 5HT2A receptor agonists, 2C-I also has a high affinity to 5HT2C). Sold as “research chemicals”…

image: Pinterest

image: Pinterest

A 24-year-old Caucasian female with no significant past medical history was screaming in her tent while camping at Burning Man in the Black Rock Desert in Nevada, USA. She was agitated and confused, under the impression that she was being attacked. On initial evaluation, her HR was 140 bpm with RR 32 per minute. Her pupils were dilated to 5 mm and her skin was moist and hot to the touch. She was not oriented to person, place or time. Per her boyfriend, earlier that evening she drank wine and smoked marijuana. Thirty minutes prior to evaluation, she ingested 3 doses of “acid” on blotter paper. She had taken acid (lysergic acid diethylamide, LSD) many times in the past without adverse effect. After brief assessment, paramedics physically restrained her to a gurney and transported her via ambulance to the on-site field hospital. Overnight, she was treated with intravenous normal saline boluses and 2 mg intravenous lorazepam, making a full recovery within 10 hours. The following day, she had complete amnesia to the events that had transpired and was otherwise asymptomatic. Seven other people had ingested single doses from the same blotter paper that evening, but none had similar adverse effects. No one had taken more than one dose. All users had received the drug for free from one supplier. A leftover drug sample was obtained from the supplying party, who had obtained it directly from the producer and was under the impression that it was “25C,” telling the patient that the drug was not acid, but “like acid.”

The American Journal of Emergency Medicine Volume issue 2014 – The electric Kool-Aid NBOMe test

However hardcore you think you are, it’s never a good idea to triple-drop. Especially with something you’ve never done before. Triple the drugs doesn’t mean triple the fun. “But they said it was like acid, I’ve done acid before” – that’s not how drugs work. Maybe if they were decriminalized and regulated, all acid would be the same – but even then “this is like acid”, is not the same as “this new thing you’ve never tried is identical to something else you’ve done before”.

People are handing out free designer drugs at Burning Man, and Burners are getting greedy, and getting into trouble. Who wants to go to a party, and end up as a case study in a medical journal? Or beating off in the cop shop?

Although they say “don’t look a gift horse in the mouth”, I think “know what you’re taking before you take three of it” is better. Safety trumps politeness. Dancesafe sell testing kits here.

Aug 21 2014

How Not To Die At Burning Man

Fest300 is a web site that aims to become the Fortune 500 of festivals. It was founded by Burning Man Project Director Chip Conley, a prominent gay entrepreneur who is also on the Board of hippy favorites the Esalen Institute and Glide Memorial Church.

Fest300 today published an article “How Not To Die At Burning Man”, by Joseph Pred. Pred used to be Burning Man’s chief of emergency operations, until he stepped down in 2013 after new operations director Charlie Dolman was brought in to run the Nevada event.

From Fest300:

fest300 safety tips burningman-shorter

image from Fest300

There are some good tips here, like capping rebar – tennis balls work great and are easier to see in low-light conditions.

Almost 60% of patients are there for basic first aid – bring a first aid kit and be radically self-reliant, Burners. Your camp should have at least one fire extinguisher too.

Although it says do not leave fires unattended, there are more rules than that if you want to have a fire at Burning Man.

Sexual assaults probably occur without being reported. Here are the ones that were reported:

2009    5

2010    4

2011    9

2012    10

2013    7

As far as I know, this information has never been made public before. We covered this issue in The Dark Side of Burning Man – Rape on the Playa.

We’ve also looked at injuries on the playa before, in our post How To Get Hurt At Burning Man.

One Medical physician and Veteran Burner Dr Michelle Rhee has 10 Tips for Staying Healthy at Burning Man:

 nurse1. Plan for at least one gallon of water per day.

You’ll be walking, biking, and dancing in desert conditions during the day and night, so Rhee suggests you “double or even triple the amount of water you’d normally drink at home—at least one gallon per day.”

To make sure you’ve got water on you at all times, Rhee recommends a CamelBak. “I love my CamelBak.  It is always on my back and much more difficult to lose than a water bottle,” says Rhee. “My CamelBak Mule holds 3 liters, and I go back to camp at least one to two times to replenish.”

You should also watch carefully for signs of dehydration, including feeling dizzy, weak, or hyperthermic, decreased urination, and increased heart rate. “You are in the danger zone if you stop urinating and have really weak pulses,” cautions Rhee. “If this happens, go immediately to the medical units to get IV fluids. This is the quickest way to hydrate.” On the way over, she recommends that you start drinking coconut water or something that has sugar and salt in it to help keep the fluids in your blood vessels.

2. Bring a spray bottle to mist yourself.

When it comes to sun and heat protection, Rhee also suggests that you bring a spray bottle with a fan or a mister. “Spraying yourself with cool water with a fan will actually cool you down quicker than dousing yourself with a bucket of water,” says Rhee.

Also watch carefully for heat-related distress—if people start acting delirious, they stop sweating or are unconscious, seek immediate help.

3. Pack a basic first aid kit.

While the medical clinics at Burning Man are well stocked with things you might need (Rhee even had a friend get an EKG onsite!), she recommends you that you bring:

  • Band aids of all sizes (and antibiotic ointment like Neosporin)
  • Sports or paper tape with non-adherent pads for larger cuts and wounds
  • Moleskin for blisters
  • An ace bandage for sprains
  • Tylenol/ibuprofen or pain killer of your choice
  • Sudafed/Benadryl for congestion
  • Emergen-C packets for hangovers
  • Tryptophan 500 to 2000 mg or Melatonin 5 mg to help you sleep
  • Inhalers if you are asthmatic or prone to asthma-like reactions
  • Saline drops for your eyes
  • Saline nasal spray for your nose

4. Anticipate UTIs and yeast infections.

Given the very dry and often less-than-hygienic conditions, women may be more prone to urinary tract infections (UTIs) and yeast infections on the playa (in fact, One Medical often sees a spike in UTIs immediately following the event). To prevent lady troubles, Rhee recommends that you take a daily probiotic and cranberry tablets and drink plenty of water, as well as urinating after having sex, always wiping from front to back, and wearing loose, breathable materials like cotton.

“Just in case, I would bring some boric acid (for bacterial vaginosis and yeast infections), Monistat or oral Diflucan (for yeast infections), Azo (for dysuria), and possibly a UTI treatment such as Cipro or Macrobid, if your provider OKs it,” says Rhee.

If you do get a UTI on the playa and you don’t have medication on hand, visit one of the medical clinics—they should be able to help you, says Rhee.

And don’t forget that when you get home, you can use the One Medical mobile app to treat UTIs without an appointment. Like www.fhatscasino.co.za tend to create the need for a larger way to accomodate a marketplace cellular apps.

5. Prepare for dust storms.

Dust storms are a fact of life in the desert, so most people wear goggles and some sort of scarf or bandana to protect their face and nose. If the dust gets to be too much, Rhee recommends flushing your nose/sinuses with a Neti pot and irrigating your eyes with cool water followed by saline drops.

Dust storms can also be disorienting. Rhee suggests bringing a compass to help you know which direction you’re facing… and also keeping a close eye out for vehicles that might not be able to see you. “Accidents are the thing I am most concerned about when it comes to dust storms,” says Rhee. “People still operate their bikes and art cars in the dust storms and can come at you when you least expect it, so be extra vigilant when you’re walking around in a storm.”

6. Avoid “Playa Foot” by keeping feet clean and moisturized.

“Playa foot” is a condition caused by the alkali dust that makes up the desert—essentially, it’s a chemical burn on your feet.

To prevent it, Rhee recommends keeping your feet covered out on the playa, washing your feet well every day, and applying moisturizer before getting in bed and before heading out. If you do notice irritation, soak your feet in water and wash your feet extra well, being careful to remove any dust embedded in the cracks of your skin.

According to the Burning Man prep guide, soaking your feet in water with a small amount of vinegar can also help to neutralize the alkali (1/4 vinegar and 3/4 water is a good mix). When you’re done, make sure to dry your feet very well and check for any errant playa dust. Continue to wash your feet a couple times a day to allow them to heal.

If you see any signs of infection (redness, swelling, increasing pain, red streaks running up your legs), if you develop a fever, or if your feet become so sore that you are no longer able to walk on them, seek immediate medical attention.

7. Don’t wait for blisters to happen.

Walking, biking, and dancing can also take a toll on your feet. To prevent blisters, Rhee urges people to “wear shoes that you can wear all day. And just don’t buy a pair of shoes that you have never walked around in before you get there.  You need to know they are comfortable.”

If you do get a blister on a weight-bearing location, Rhee suggests moleskin cut out in a donut to fit around the blister.

8. Eat hydrating, nutrient-rich foods.

To keep your energy up and your immune system strong, eat meals that include a protein, a complex carb, and healthy fat.

“A common dish I like to make is quinoa, chick peas, green onions, spinach, walnuts, dried cranberries, and feta with a honey, grainy mustard and red wine vinegar dressing,” says Rhee.

Rhee also recommends bringing lots of “simple things you can just pull out and eat,” such as Odwallas, cut-up fruit, raw energy bars such as Kind bars, or a smoothie that has proteins, greens, and immune boosters. “I also like to bring something warm for the evening when it gets cold, such as soup with some spice,” adds Rhee.

9. Party smart.

While overindulging in alcohol and taking drugs isn’t something Rhee condones, she does acknowledge that “lots of people party on the playa.”

To avoid trouble, Rhee recommends the following:

  • Eat something that is nourishing and lines your belly before you go out.
  • For every unit of alcohol, drink 8 ounces of water. In fact, Rhee suggest you “double fist” your drinks—water in one hand and the drink in the other.
  • Before you go to sleep, drink a good amount of water with electrolytes and take some ibuprofen.
  • Always have a buddy—someone who knows you and can help if you’ve had one too many.
  • Never mix alcohol with drugs (or mix drugs).

10. Know how to get emergency help.

“If you’re suffering from serious dehydration, if you think you might have an infection, or if someone is bleeding or unconscious (or in danger of harming themselves or others), it’s time to stop the party and get professional help,” says Rhee.

Black Rock City’s Emergency Services Department (ESD) operates two medical stations on the 3:00 and 9:00 plazas, and behind the Center Cafe at 6:00. Look for the neon blue cross on top of the buildings. These stations are staffed by emergency health care providers (doctors, nurses, medics, etc.) who donate their time and medical expertise; they’re also set up to provide rapid first-response medical care anywhere within Black Rock City.

If you’re not close to one of these stations, look for a paramedic wearing a yellow T-shirt with the ESD logo—they can be found walking around some of the more popular sites. You can also get help from the khaki-clad Black Rock Rangers, who are trained to respond to emergencies and will know how to get the appropriate resources to the scene.

Be well, be safe, and see you on the playa!

Take care, Burners! Your ticket entitles you to medical insurance that covers on-Playa treatment, the situation is less certain for those who have to be medivacked to Reno.