Burning 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:

It’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.

In 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.