NFPA Journal

IN THE WEE HOURS of Sunday, May 29, Nancy Bermudez received a horrifying call from a social worker at St. Joseph’s Hospital in Tampa, Florida. Katie, Bermudez’s 21-year-old daughter, was in the hospital and the outlook was dire. When Bermudez arrived, according to the Tampa Bay Times, she found her daughter unconscious and clinging to life with help from tubes and machines. “Katie, you have to fight,” Bermudez whispered to her. The next day Katie was dead.

The medical examiner’s office has yet to rule on a cause of death for Katie Bermudez or Alex Haynes, 22, who both died over Memorial Day weekend after being rushed to the hospital from the Sunset Music Festival, an electronic dance music (EDM) event at Raymond James Stadium in Tampa. Fifty-seven other festival attendees were also brought to the hospital over the weekend with various ailments, and 25 more were charged with felonies, activities that taxed the resources of local first responders.

Neither Tampa police nor Mayor Bob Buckhorn waited for the toxicology reports to make their assessments of what happened. “These types of festivals attract this type of drug use and these types of drugs. You combine that with the heat in the stadium, it really made a perfect storm of bad things to happen,” the mayor said in a statement to local news outlets shortly after the Sunset festival, which drew an estimated 30,000 people. “Clearly that’s an event that we as a community need to reconsider.”

Detailed information on injuries and deaths at festivals is difficult to find, but in a typical year dozens of people across the globe die at music festivals, and hundreds more are injured. Often, fatalities involve drugs and follow similar scripts: someone takes too much of the wrong drug or combination of drugs, they become dehydrated, or overhydrated, or overheated, then unresponsive. Following the death of a 20-year-old woman at the Electric Daisy Carnival in Las Vegas in June, the woman's father acknowledged there were drugs in his daughter's system and that they contributed to her death. "But it was not just the drugs that killed her," he told the Associated Press. "She was at the EDC Las Vegas for the whole three days in the record-breaking hot weather. That alone could kill anyone."

Drugs and the elements aren’t the only dangers. A man died in May after a fatal assault at a California festival. Crowd crushes can kill dozens or more, such as the 21 people who died in 2010 at the Love Parade electronic dance festival in Germany. Then there are the truly unlucky, such as the 28-year-old woman who died when lightning struck her tent at a music festival in Louisiana in March.

Especially when drugs are involved, festival incidents draw intense public reaction and media focus, and have caused some of the world’s largest festivals, from Los Angeles to Kuala Lumpur, to shut down. Twice Los Angeles County has temporarily banned raves—large electronic dance parties—following events where deaths occurred, the first when a teenage girl died of a drug overdose at the Electric Daisy Carnival in 2010, and again last year after two girls, ages 18 and 19, died at the Hard Summer Music Festival in Pomona.

High-profile tragedies, though, can also obscure the fact that the vast majority of festivals take place without incident, thanks in part to a host of new and emerging measures festivals and nonprofit organizations employ to improve crowd safety. Some of those efforts fall under the category of “harm reduction,” and include strategies such as onsite volunteer outreach teams, dedicated safe spaces for women and people who need to escape the crowd, and onsite labs where attendees can bring their drugs to be tested for adulterants. Meanwhile, onsite first response, crowd management, medical, and emergency management has grown more robust and sophisticated. The measures complement the life safety evaluation, a feature of NFPA 101®, Life Safety Code®, that is applied to assembly events such as festivals to ensure that the necessary elements to protect attendees’ safety are present. All of these steps have become increasingly important as festivals have grown larger and more complex, often located in isolated settings that require a high degree of self-sufficiency.

Some of the largest festivals are held in aggressively out-of-the-way locations, which can present challenges in the event of emergencies. Left, the Burning Man Festival, which annually attracts about 70,000 people to the Black Rock Desert in Nevada. Right, the scene at Bonnaroo, an annual four-day music festival held on a farm in Manchester, Tennessee. Photograph: Burning Man, Kyle Harmon; Bonnaroo, Getty Images.

“Compared with 10 years ago, today more events are better organized, have a higher level of requirements and oversight, and demonstrate better planning and coordination with local agencies,” said Joseph Pred, who was emergency services operations chief at the Burning Man festival for 18 years and now owns Mutual Aid Response Services, a consulting firm that works with festivals around the world. “As soon as you get outside of an urban festival environment and are unable to rely on fixed resources, you get into a different category of festival. The tremendous growth in the festival market has resulted in more events being held in more remote locations, and festivals are realizing that [to attain the highest degree of life safety] they need that high level of sophistication.”

Industry demands

Pred isn’t overstating the dynamics of the festival market—music festivals around the world are enjoying unprecedented levels of popularity and profitability. According to a 2015 report by the consumer data company Nielsen, about 32 million people attend at least one music festival in the United States each year, with a third of fans attending more than one. The study also found that festivalgoers are passionate, traveling on average 903 miles to attend a festival. Musicfestivalwizard.com listed 17 major music festivals in the United States over Memorial Day weekend alone, and the site counts 174 U.S. festivals annually, likely many fewer than the true number. In Europe the festival craze has soared to even greater heights. A 2013 LA Weekly article pegged the number of annual festivals on the continent at between 2,500 and 3,000, with 670 in England alone, a 73 percent increase between 2003 and 2013.

Revelers at the Coachella Valley Music and Arts Festival near Palm Springs, California. Photograph: AP/Wide World.

The growth is a function of culture and economics. With record sales down significantly in the digital age, the music industry and artists are relying increasingly on live events to make up the difference. In part because of intense competition to book top acts, headliners can make up to $4 million per festival, according to Rolling Stone, while lesser-known acts can play to bigger audiences and receive more exposure than they could working the club circuit. Promoters and host cities stand to gain as well, with patrons willing to shell out $300 or more per ticket. According to Forbes, ticket sales at the top five largest festivals in the U.S. were a combined $183 million in 2014, and that’s before adding in substantial revenue from corporate sponsorships and sales of food, alcohol, and merchandise. A 2015 study by Beacon Economics, paid for by Insomniac, one of the world’s largest EDM festival promoters, found that the 48 events Insomniac held from 2010 to 2014 generated more than $3 billion for the U.S. economy, and created more than 25,000 jobs. Insomniac’s Electric Daisy Carnival in Las Vegas alone boosted the local Nevada economy by $1.7 billion over that period, the study found, when factoring in taxes and spending by attendees on hotels, food, transportation, and other expenses.

The potential economic payoff is just one reason why festival promoters and host cities are under pressure to keep the industry chugging along, and to keep attendees healthy and happy. Devoted music fans, drawn to the shared social experiences and camaraderie that festival culture promotes, also have a stake in keeping the music going and are volunteering in greater numbers to help with harm-reduction programs at festivals. As a result, an entire cottage industry, both for-profit and nonprofit, has grown in lockstep with festival attendance, built around festival safety and characterized by innovative new strategies and an ever-growing sophistication.

It wasn’t always that way, according to Andrew Bazos, a surgeon who started working at large music festivals in New York City in the early 1990s. Back then, promoters were obsessed with lineups, sound production, and security—medical concerns were often an afterthought, he said. “In those days the promoter would call up a local ambulance company and arbitrarily ask amateurs to come by, find a tent near the stage, and bring whatever supplies they deemed appropriate. It didn’t go much further than that,” he said.

Bazos is now the chairman of CrowdRx, one of the industry’s largest event medical providers. Last year, CrowdRx handled medical services for dozens of eclectic events, including Lollapalooza, Coachella, Bonnaroo, Burning Man, and several EDM festivals including Mysteryland and Electric Zoo. Each event presents a host of unique challenges and considerations, Bazos said, and medical planning goes well beyond grabbing a roll of gauze and hitting the road. “Data now drives everything we do,” he said. “We’re using data to both predict the volume and types of incidents we’ll see so we can be prepared on the supply side. At this point we can identify what the transport rate [to the hospital] will likely be based on four or five different key data points.” Variables such as music genre, whether camping is allowed, whether alcohol will be sold, the expected number and demographics of attendees, geographic location, and proximity to hospitals can all greatly alter the supplies, equipment, and staffing required for an event, Bazos said.

CrowdRx provides medical services for a variety of large events, including the Mysteryland USA festival, an EDM event organized by the Dutch promoter ID&T. Photograph: CrowdRx.

Crowd demographics might be the biggest factor of all, according to Steve Adelman, an event safety expert and founding member of the Event Safety Alliance, a nonprofit trade association of live-event industry professionals. “English soccer supporters are going to be much different in foreseeable activity than Newport Folk Festival attendees, and much different than Jimmy Buffet fans,” he said.

Among event safety experts, country music festivals are notorious for heavy alcohol consumption, so more intravenous fluid stations are lined up. EDM events have more issues with club drugs such as MDMA—commonly known as “ecstasy” or “Molly”—and its host of chemical cousins, and doctors must be prepared with medication and treatment plans specific to those substances. Outdoor festivals in the desert with high heat and sun exposure necessitate more cooling beds. Many of the safeguards are intuitive, but anything overlooked can mean tragedy. Planning often begins a year or more in advance.

Prefestival stakeholder meetings are held to review logistics and response plans, which often include tabletop exercises. Cooperation and open lines of communication are critical before and during an event, said Connor Fitzpatrick, director of operations at CrowdRx. “Nothing is done in a vacuum, and everything is interdisciplinary,” he said. “Fire, medical, security, operations—all the stakeholders have to be involved because everything affects everything else. If the promoter is charging $10 for water, for instance, that will impact medical concerns.”

The bones on which much of the planning and life safety requirements hang comes from the life safety evaluation process included in NFPA 101. The code mandates an extensive evaluation and review for all assembly events exceeding 6,000 people, and includes detailed consideration of everything from crowd density and movement to seating, crowd characteristics and behavior, use of alcohol, and potential group conflicts, and even looks at relationships among facility management, event participants, emergency response agencies, and more. NFPA 101 also mandates at least one trained crowd manager—the people wearing “Guest Services” shirts—for every 250 attendees. Generally, authorities having jurisdiction undertake the review based on information provided by the promoter and dictate to the festival what measures and precautions need to be met for the festival to gain permitting. In most cases, many other local ordinances and regulations also apply.

While NFPA 101 can ensure minimum requirements, a few festivals are so distinct in their needs, and their locations so austere and remote, that they require their own special infrastructure and procedures. Burning Man, for example, is held each September in a remote patch of the Black Rock Desert in Nevada, where more than 70,000 people trek each year to build and live in a temporary city, erect large experimental art pieces, dance, and burn a large wooden man. To keep everyone safe, an entire sophisticated first-response network, exceeding the capabilities of those found in some small cities, must be assembled in the middle of the desert. In his nearly two decades as Burning Man’s emergency services operations chief, Joseph Pred saw the festival’s safety apparatus expand from an informal network of security and medical services to a highly structured department with EMS, fire, mental health services, and emergency communications, all coordinated through a unified command structure and a high-performance response model built using guidance from no fewer than 60 NFPA codes and standards. Pred introduced the use of 911-style computer-aided dispatch software to manage resources, and incidents, and to create a definitive record in real time. The festival’s fire department operates under a single command with three stations and nine pieces of apparatus. All told, when Pred left the festival in 2013, Burning Man’s emergency operations department had 18 senior and deputy chiefs, each with their own command, along with about 80 officers and more than 750 responders. While not all festivals can boast that level of response sophistication, Pred said, the gap is closing all the time.

Medical capabilities have followed a similar trend, Bazos said. Last year, for the first time, CrowdRx won the contract to provide medical services to Burning Man. Onsite facilities included a full-fledged emergency room staffed with doctors, nurses, emergency medical technicians, ambulances, fixed-wing transport, and a helicopter. The facility doctors at the festival had access to X-ray machines, ultrasound, cardiac monitors, a lab, and a pharmacy.

Harm reduction: Meeting people where they are

While response systems and strategies evolve to ensure better outcomes for festivalgoers if something bad happens, an army of nonprofits and volunteers is championing efforts to prevent anything bad from happening in the first place.

“You cannot just have medical services and police—those are reactive strategies,” said Stefanie Jones of the Drug Policy Alliance, a group advocating for drug law reform. “You can have all the cops and searches you want and there will still be drugs at a festival. That’s why instead we promote more resources, more education, and harm-reduction services.”

Harm reduction, as advocates are fond of saying, is the practice of “meeting people where they are.” It’s the acknowledgment that no festival can hope to prevent people from choosing to do something risky, like take drugs, so the festival might as well do everything it can to mitigate the harm. In that way, harm reduction can take many forms, from the noncontroversial—such as offering free water and earplugs, or a safe space for women who feel threatened or have been assaulted—to practices that raise eyebrows, such as offering free drug-checking services so attendees know if the pills they intend to swallow are actually the drugs they think they are.

The gold standard of harm reduction, according to many in the festival world, is the Shambhala Music Festival in British Columbia, Canada. For five days and nights each fall, Shambhala transforms the bucolic Salmo River Ranch, a farm situated in southeastern B.C., into the largest city in the West Kootenays region. More than 10,000 electronic music fans flock to the site to dance under six stages and camp alongside the river. Last year five of those attendees were taken to the hospital; the year before it was 13. The festival has had one fatality over its 19-year history.

Harm reduction at the Shambhala Music Festival in British Columbia takes many different forms. In addition to drug testing, there's a "sanctuary tent" with 26 beds where visitors can get away from the crowd and talk to mental health councilors; a women's safe space; an outreach team that patrols the grounds 24 hours a day as the eyes and ears of the security and medical teams; free sexual-health products; and a section of campsites set aside for "sober camping." Photograph: ANKORS

Aiding the festival’s safety record is its longtime ban of alcohol consumption onsite, however, other factors, such as the festival’s length, remote location, EDM orientation, and the availability of camping would suggest a higher risk profile. The big reason there aren’t more incidents on the ranch, festival organizers say, is Shambhala’s extensive use of harm-reduction programs and strategies. Those include a sanctuary tent with 26 beds where visitors can get away from the crowd and talk to mental health councilors; a women’s safe space; an outreach team that patrols the grounds 24 hours a day as the eyes and ears of the security and medical teams; free water; a plethora of harm-reduction literature; free sexual-heath products; a section of campsites set aside for “sober camping”; and a drug testing facility.

While large festivals in Canada and Europe have embraced the principles of harm reduction, most festivals in the U.S. remain cool to the idea, especially where drugs are concerned. Part of the resistance is legal, and part of it is cultural, said Jones of the Drug Policy Alliance. “Many local law enforcement and public health agencies still believe the main priority is to prevent people from using drugs, and are not interested in anything but enforcement strategies,” she said. “Festival producers are often more open, but they have to deal with the realities of getting an event licensed and approved. They don’t want to trigger anything that puts an event at risk going forward.”

A big part of promoters’ fears, advocates say, stems from the Illicit Drug Anti-Proliferation Act, a 2003 U.S. law better known as the RAVE Act. Passed during the height of the MDMA backlash in the U.S., the law holds event producers criminally and civilly responsible if they are found to be “knowingly” operating “a drug-involved premise.” It’s a widely held feeling among promoters that even by allowing organizations to distribute information on drugs, or by providing a “chill-out space” for attendees, they could be construed as knowingly operating an event where drugs are condoned. The law has seldom if ever been applied, though its shadow persists. Pred likens it to “the boogie man,” and Cameron Bowman, an attorney and festival aficionado who speaks out frequently against the RAVE Act, described it in a recent interview as “the Keyser Soze of laws—everyone is afraid of it, but no one can recall any time it was actually used."

Photograph: Getty Images

Whether it’s the RAVE Act, community resistance, or worries over permitting, many events in the U.S. have politely declined to allow groups like DanceSafe, one of the first and best-known harm-reduction organizations, to provide services at festivals. "I’ve actually had DanceSafe at our events a while back, but when the venue, the local authorities, and the insurers are opposed to it, you won’t have that city or location as an option,” Insomniac Events CEO Pasquele Rotella wrote on his Reddit “Ask Me Anything” page last year in explaining why DanceSafe is not allowed at Insomniac events such as Electric Daisy Carnival. “It’s already hard enough to find venues where I can organize events. Unfortunately, some people view partnering with DanceSafe as endorsing drug use rather than keeping people safe, and that can prevent producers from getting locations and organizing events.”

However, advocates agree that attitudes may be shifting in the U.S., partly because of tragedies like the deaths of Katie Bermudez and Alex Haynes in Tampa in May. In the wake of two drug-related fatalities last year, Los Angeles County formed an electronic music festival task group, and in March the county’s board of supervisors unanimously accepted the group’s recommendations, which included some harm-reduction strategies. Seattle has also hosted several music safety summits to bring stakeholders together to devise more innovative solutions for keeping people safe at festival events.

“The more deaths you see, the more open people are to different strategies,” Jones said. “There's an increasing openness to drug education and harm reduction, slowly but surely.”

“Even if it saves just one life,” Pred added, “it’s worth it.”

JESSE ROMAN is associate editor of NFPA Journal. Top Photograph: Newscom