Burning Man 2011: Mass Gathering Medical Care in a Hostile and Austere Environment

Abstract

Burning Man is a weeklong outdoor arts festival held annually on a dry Pleistocene lakebed in the rugged and austere Black Rock Desert Wilderness Area in northern Nevada. The 2011 event presented numerous challenges in the provision of emergency medical services and medical care owing to attendance size, the hostile environment, and distance to definitive medical care. Our purpose was to describe the planning and implementation of medical care at a mass gathering event in a harsh and austere wilderness environment. This was a retrospective, observational review of the preparation, management, and implementation of medical care. Total attendance was 53 375, with a total of 2307 patients. Emergency medical services operations included 6 ambulances, 3 quick response vehicles, 2 first aid stations, and a physician staffed mobile hospital. The hospital had limited diagnostic capabilities and a limited formulary. Most conditions treated were minor, the most common being soft tissue injuries, dehydration, eye problems, and urinary tract infections. Most patients were treated and released. A total of 33 patients was transferred out. Several significant cases were seen, including a patient with a spontaneous subarachnoid hemorrhage who later died; there were several cases of trauma, a traumatic pneumothorax, and a thoracic aortic dissection. The latter patient sustained a cardiac arrest at the event, was resuscitated, flown to Reno, underwent emergency surgery, and survived to discharge. A unique phenomenon called “playa foot,” due to an alkali burn of the feet from constant exposure to the dry lake bed dust, was frequently encountered. Overall, Burning Man 2011 was successful. The goal of providing the highest level of care possible in an austere environment and allowing as many patients as possible to remain at the event was achieved. Our experience can help guide others planning for similar events under similar austere conditions in the future.