Guidelines for Music Festival Event Organisers: NSW Health
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Guidelines for Music
Festival Event Organisers:
Festival Harm Reduction
February 2019
These Guidelines will be reviewed at least annually to reflect updated information and feedback
from music festival event organisers and other stakeholders.
For more information, including contact details for local health districts, or if you wish to provide
feedback on these guidelines, please email MOH-musicfestivals@health.nsw.gov.au
SHPN (XXX) 190XXXNSW Ministry of Health 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.nsw.gov.au Produced by: NSW Ministry of Health This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health 2019 SHPN (CPH) 190123 ISBN is 978-1-76081-096-2 Further copies of this document can be downloaded from the NSW Health website www.health.nsw.gov.au February 2019
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
There has been a recent, substantial change in the In addition to these Guidelines, NSW Health has
pattern and severity of drug related harms at developed other resources to support music
some music festivals in New South Wales. festival organisers and their health and medical
service providers:
The Guidelines for Music Festival Event Organisers:
Music Festival Harm Reduction have been written • A social media campaign has been developed
to support event organisers to deliver safer music in consultation with festival goers that helps
festivals. They bring together existing event them recognise the signs and symptoms of
planning guidelines and incorporate strategies drug related illness and reminds them to seek
based on information from events where a help quickly. The campaign is available online
number of festival goers died, or presented with and can be accessed freely from the Your
serious drug related illness that required Room website.
immediate and intensive medical management • Interim Clinical Guidelines for the Management
prior to and during transfer to hospital. of Drug Associated Hyperthermia have been
circulated so that clinicians have up to date
The Guidelines describe harm reduction strategies
advice on pre-hospital and emergency
and risk management approaches, with checklists
department management of patrons who
and instructions to support implementation. All
present with elevated temperatures associated
music festival organisers are encouraged to use
with drug use and who are at risk of serious
the Guidelines to plan their events. For those
illness and death.
festivals requiring a music festival licence, event
organisers can use the Guidelines to: Additional clinical guidance in relation to
management of acute illness (including reduced
• Consider the site infrastructure and site
consciousness, dehydration and behavioural
environment to promote the health and
disturbance) is also in development.
amenity of patrons;
• Plan peer support and harm reduction NSW Health will continue to actively support
messaging; and music festival event pre-briefs and de-briefs as
• Develop the event medical plan. needed, to bring together all of the relevant
partners for important discussions about harm
NSW Health will use the Guidelines to assess reduction, managing serious illness, emergency
festival safety management plans. response protocols, and communication and
escalation pathways.
The Guidelines were developed by the NSW
Ministry of Health, following consultation with
NSW Ambulance, local health districts, NSW
Poisons Information Centre, peer based harm
reduction programs, event organisers and private
onsite medical providers.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 1Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
Contents
1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5 Emergency escalation protocols . . . . . . . . . . . . . . 17
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5.1 Key emergency definitions . . . . . . . . . . . . . . . . 17
1.2 Key definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5.2 Health emergency escalation and
1.3 Drug and alcohol use at music festival . . . 3 management plans . . . . . . . . . . . . . . . . . . . . . . . . . 17
5.2.1 Health emergency escalation . . . . . . . 17
2 Pre-event considerations . . . . . . . . . . . . . . . . . . . . . . . . 5
5.2.2 Evacuation and movement
2.1 Risk assessment and risk of patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
management plans . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.2 Factors associated with drug-related 6 Harm reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
health harms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6.1 Alcohol management . . . . . . . . . . . . . . . . . . . . . . 19
2.3 Local consultation and stakeholder 6.2 Identification and management of
pre-briefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 intoxicated patrons . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.3 Peer-based harm reduction programs . . . . 19
3 Health considerations for general event
planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6.3.1 Peer-based harm reduction
program planner . . . . . . . . . . . . . . . . . . . . . 19
3.1 Site infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
6.3.2 Sexual health . . . . . . . . . . . . . . . . . . . . . . . . 20
3.1.1 Emergency vehicle ingress and
egress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6.4 Chill-out spaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.1.2 Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6.5 Targeted education and messaging . . . . . . 21
3.1.3 Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6.5.1 Timing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2 Communication processes . . . . . . . . . . . . . . . . . 8 6.5.2 Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3 Water provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6.6 Safe drug and needle disposal . . . . . . . . . . . . 21
3.4 Shade and active cooling measures . . . . . . . 9 6.7 Management of prescribed
medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.5 Food safety and provision . . . . . . . . . . . . . . . . . . 9
3.6 Management of sexual assault . . . . . . . . . . . . 10 7 Post event considerations . . . . . . . . . . . . . . . . . . . . . . 23
7.1 Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4 Onsite medical service provision . . . . . . . . . . . . . . 11
7.2 Post-event debrief . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4.1 Medical centre location, access,
signage and security . . . . . . . . . . . . . . . . . . . . . . . . 11 Key reference documents . . . . . . . . . . . . . . . . . . . . . . . . 24
4.2 Expected presentations . . . . . . . . . . . . . . . . . . . . . . 11
8 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Type 1: Minor presentations . . . . . . . . . . . . . . . . . 11
Type 2: Major presentations . . . . . . . . . . . . . . . . 11 9 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4.3 Event medical plans . . . . . . . . . . . . . . . . . . . . . . . . 12 9.1 Appendix A: Interagency Briefing
4.4 Medical treatment protocols . . . . . . . . . . . . . . 12 Participants, Role and Agenda . . . . . . . . . . . 26
4.5 Onsite medical staff . . . . . . . . . . . . . . . . . . . . . . . . 13 9.2 Appendix B: Event Medical Plan
4.5.1 Definitions, roles and capabilities Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
of onsite medical staff . . . . . . . . . . . . . . . 13 9.3 Appendix C: Example of onsite
4.5.2 The onsite medical team medical provider personnel . . . . . . . . . . . . . . . 28
capability and skill mix . . . . . . . . . . . . . . 14 9.4 Appendix D: Triage and initial
4.6 Onsite medical operations . . . . . . . . . . . . . . . . 15 treatment protocols . . . . . . . . . . . . . . . . . . . . . . . . 29
4.6.1 Onsite medical team briefing . . . . . . . 15 9.4.1 Triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.6.2 Triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 9.4.2 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.6.3 Monitoring and management . . . . . . . 15 9.4.3 Other vital signs: suggested
actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.6.4 Transfer to hospital . . . . . . . . . . . . . . . . . . 16
9.5 Appendix E: Harm Reduction
4.6.5 Documentation . . . . . . . . . . . . . . . . . . . . . . . 16
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
1 Background
1.1 Introduction and risk management. Event organisers are
required to plan for and respond to medical and
other emergencies affecting their event.
The Guidelines for Music Festival Event Organisers:
Music Festival Harm Reduction have been written
to support music festival event organisers to 1.2 Key definitions
deliver safer music festivals in NSW.
There has been a changing pattern to the profile The Liquor Regulation 2018 defines a music
of drug related harms at music festivals and NSW festival as ‘an event, other than a concert, that:
Health will work together with event organisers to a. is music-focused or dance-focused, and
respond to these changes.
b. has performances by a series of persons or
These Guidelines, developed by the NSW Ministry groups that are engaged to play or perform to
of Health, in consultation with NSW Ambulance, live or pre-recorded music, or to provide
local health districts (LHDs), NSW Poisons another form of musical or live entertainment,
Information Centre, peer-based harm reduction and
programs, event organisers and private onsite c. is held within a defined area, and
medical providers describe harm reduction d. is attended by 2,000 people on any day, and
strategies and support risk management.
e. is a ticketed event (including a free ticketed
They also support NSW Health and other event) or otherwise requires payment to access
government agencies to assess the planning the event.’
documents produced by music festival event
For the purposes of this document ‘harm
organisers when applying for relevant licences or
reduction’ encompasses:
authorisation to hold the event.
Approaches that seek to minimise or eliminate the
Event organisers must address a broad range of
impact of illness and injury associated with drug
risks in order to support safer music festivals.
and alcohol use upon individuals, families and
The Australian Disaster Resilience Safe and Healthy
communities. Harm reduction strategies seek to
Crowded Places Handbook and associated
create safer settings and encourage safer
checklists provide an effective structure for event
behaviours.
organisers to use as a framework for risk
management, communication and emergency
planning. Event organisers should use this
Handbook as the primary guidance document to
1.3 Drug and alcohol use
address the broader health and safety risks posed at music festivals
by their event. These Guidelines also refer to
advice and frameworks to address other risks. In people aged 20-29 years in NSW, recent drug
use (defined as use in the last 12 months) has
The International Organization for Standardization
decreased from 27% (2013) to 24% (2016)
(ISO) ISO 31000:2018 Risk Management
(National Drug Strategy Household Survey, 2016).
Guidelines identifies that event organisers own
A similar downward trend was also seen in the
the risks associated with their events. NSW Health
14-19 year old group. Young people in NSW are
staff and other agencies can provide support and
initiating drinking alcohol at a later age and
identify strategies to control the risks associated
drinking at less hazardous levels than previously
with the event. Event organisers must incorporate
(NSW Ministry of Health, 2016).
consideration of all health risks into their planning
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 3Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction However, music festival patrons report higher Drug and alcohol related harms make up the levels of illicit drug use compared with the general minority of medical presentations in the music population (Day et al., 2018). A survey conducted festival setting. A study of four Australian music at a major music festival in 2016 found that 60% festivals found that 15% of all presentations to of patrons had taken ecstasy in the last 12 months onsite medical centres were associated with (Day et al., 2018). Some subsets of events, for alcohol and substance use (Hutton et al., 2014). example Electronic Dance Music (EDM), heavy However, drug and alcohol related presentations metal and rock genres, may be further associated can include a number of seriously ill patients. with increased rates of medical presentations These patients place significant demands on the (Westrol et al., 2017). This shows that drug and resources of festival onsite medical services. alcohol use at festivals requires a tailored harm reduction approach. Recent studies of ‘party drug’ use (i.e. those drugs routinely used in the context of entertainment venues such as nightclubs or dance parties) show that ecstasy and cannabis were the drugs of choice (Peacock et al., 2018). Use of ecstasy pills has declined while use of ecstasy in capsules and crystal form has increased (Peacock et al., 2018). Drugs of choice may constantly evolve due to the regular introduction of novel substances and changing patterns of substance use in the community. 4 Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
2 Pre-event considerations
2.1 Risk assessment and 2.2 Factors associated
risk management plans with drug-related
health harms
All music festivals and similar events should
undertake a risk assessment, and have appropriate
Based on recent experience in NSW, factors
risk management in place. The extent, severity
associated with a higher likelihood of drug-related
and exposure to risk will vary depending on the
harm at music festivals include:
circumstances of the event and the degree of
preparation and risk management undertaken by • whether the festival has a predominant target
event organisers. demographic of people aged between 18-29
years
Effective risk management involves the following
steps (ISO31000:2018): • the size of the event (8,000 patrons or more);
and
1. Identify hazard and risk: the aim is to identify • the music type being high energy or electronic
all hazards and associated risks, regardless of dance music.
whether they are within the control of the
organisation. Other considerations that may increase risk
2. Analyse the risks: determine the likelihood of include:
the risk and its potential consequences. This
• the event is held over a long period (i.e. eight
involves determining the level of each risk.
hours or more), and/or extends past midnight;
3. Evaluate the risks: using the resulting risk
• anticipated weather conditions, such as high
levels, rank those risks and develop a
temperature, particularly if the event is to be
prioritised list of risks requiring attention. This
held outdoors; and
supports allocation of resources to those risks
of greatest priority. • distance to a tertiary health facility is more
than an hour by road.
4. Manage, treat or control the risks: Risk can be
controlled in a number of ways, and the first
objective should be to avoid or eliminate the 2.3 Local consultation and
risk entirely. Where elimination is not possible,
exposure to risk should be reduced as much as stakeholder pre-briefing
is reasonably practicable.
As local health district input may be required to
The Australian Disaster Resilience Safe and
support the event, it is important for event
Healthy Crowded Places Handbook and
organisers to involve the relevant local health
associated checklists provide an effective
districts and NSW Ambulance in the early stages
structure for event organisers to use as a
of pre-event planning. This ensures the potential
framework for risk management, communication
impact of the event on local resources can be
and incident and emergency planning. Event
considered and planned for.
organisers should use this Handbook as the
primary guidance document for addressing the
broader health and safety risks posed by their
event when developing their risk management
plans.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 5Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction In addition to pre-event planning, event organisers and onsite medical providers should arrange a briefing with local health stakeholders. This ensures event organisers and onsite medical providers are aware of local processes and escalation procedures. It also informs local health staff and NSW Ambulance about the event and the potential impact on their usual work. This briefing should occur in the week to days before the event, to provide opportunity to address any evolving factors that may contribute additional health risk (for example, changing weather, fire danger). Appendix A describes interagency briefing participants and roles with an example agenda for the meeting. 6 Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
3 Health considerations for
general event planning
3.1 Site infrastructure the event and in the immediate post-event period.
These dedicated emergency vehicle corridors are
vital to ensure that vehicles do not pose additional
Whether an event is indoors or outdoors, the risk to event patrons and to facilitate urgent
venue’s onsite infrastructure must be assessed to response and transfer where required.
comply with the minimum standards of the Building
Code of Australia. A thorough assessment of the 3.1.2 Sanitation
site must be undertaken to identify any hazards
Inadequate toilets at an event may contribute to
associated with the location. This must include
patrons limiting their oral fluid intake, which
consideration of crowd control and crowd safety
increases their risk of dehydration.
mechanisms.
The following tool from the Event Starter Guide,
3.1.1 Emergency vehicle ingress and NSW Department of Premier and Cabinet (2018)
egress can be used to estimate the number of sanitation
Ingress and egress describe the action of entering facilities required for events where alcohol is
and leaving a location. In this context, it relates to available.
emergency vehicle access to and from the event.
For events where there is insufficient existing
This includes to specific locations within the
sanitation infrastructure, temporary toilet facilities
event, such as the onsite medical centre.
are required. In areas where patrons are expected
The transfer time of patients will depend on local to queue for long periods, temporary toilet facilities
site factors as well as distance to hospital. The should be co-located in the vicinity of the queuing
festival site map should clearly highlight access areas. Event organisers must seek approval from
corridors to provide ingress and egress for the landowner to install portable toilet facilities on
emergency vehicles within the event area. These their land.
corridors should remain clear during the course of
Table 1: Recommended number of sanitation facilities for events where alcohol is available
Males Females
Patrons WC Urinals Hand basins WC Hand basinsGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
All toilet facilities must be: emergency services, for example, when arranging
ambulance transfer.
• well lit, including the surrounding area;
• provided with waste receptacles for sanitary Event organisers are required to have back up
products and paper; radio-based communication services available in
the event that telecommunication systems are
• provided with hand sanitiser or soap and hand
overwhelmed. In remote locations, satellite
drying equipment;
telecommunications may also be required. Event
• maintained in a clean and workable condition, organisers are expected to create an Event
with cleaning and restocking; performed at two Control Centre. This is a central interagency
hourly intervals at a minimum; and communications hub with an interagency
• located away from food storage and food presence. The Control Centre’s purpose is to
service areas. respond to and manage incidents as they arise.
Syringe disposal units should be available within Event organisers should liaise with Local Health
freestanding toilet blocks, and/or some of the Districts and NSW Ambulance staff to determine
portable toilet facilities. They should be easily the most effective local approach for
accessible, with clear signposting. communication. It is important to ensure effective
communication channels exist to support:
All wastewater products must be disposed of safely
to sewer, septic tanks/leach drain, holding tanks • onsite medical providers arranging expedited
or other local government approved methods. transfer of patients via NSW Ambulance; and
• information sharing between hospital staff and
3.1.3 Tobacco the onsite medical staff of relevant clinical
In NSW there are smoke-free laws banning smoking information for transferred patients and for the
and the use of e-cigarettes in all enclosed public management of further onsite presentations.
areas and certain outdoor public areas under the
Smoke-free Environment Act 2000 and the
Smoke-free Environment Regulation 2016. These bans 3.3 Water provision
protect people from second-hand tobacco smoke.
Dehydration and heat exhaustion are key
Section 11 of the Public Health (Tobacco) Act
contributing factors to drug and alcohol related
2008 prohibits the retail sale of tobacco products
harm. Under the legal requirement of Responsible
and electronic cigarettes from any mobile
Service of Alcohol it is mandatory to ensure free
structure, vehicle or vessel.
drinking water is readily available when selling
Event organisers must ensure their site alcohol.
infrastructure complies with NSW smoke-free laws
Potable water must be freely available for
and support the promotion of smoke-free festivals.
drinking, hygiene and cooling purposes.
For single day events, there should be:
3.2 Communication
processes 1. a minimum of 2 litres of free drinking water
available per person or at a rate calculated at
500mL per hour, whichever is greater; and
Communication technology and processes may 2. one water outlet per 500 people. A water
require special consideration. Mobile phone outlet is an access point to a drinkable water
connections may be compromised when many source. For example, there may be multiple
users are trying to access the network within water outlets per water source.
close proximity or in regional areas. Increased
demand on telecommunications infrastructure It is important that these water outlets are
may lead to delays if events are solely dependent separate and independent of bars and other
on dialling Triple Zero (000) to contact alcohol service areas. If not from a piped town
8 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
supply, the event organiser will need to develop a Active cooling measures include misting stations,
water quality assurance plan and the LHD public cooling tunnels, temperature controlled locations
health unit should be approached for advice. and fans in crowded areas.
Water outlets must be checked and maintained in
a clean and uncontaminated state, to avoid any The free provision of SPF 30 or higher broad
public health risk. Hand washing basins are not spectrum, water-resistant sunscreen to patrons is
acceptable drinking water outlets. also encouraged. Further harm reduction
approaches regarding sun safety at events can be
For events where patrons are prohibited from found in Cancer Council Victoria’s Sun Smart
bringing their own food and drink into the site, Festival Checklist.
patrons should be permitted to bring their own
clear or visibly empty plastic containers to
support use of the free water refill outlets. 3.5 Food safety and
Exceptions may also be made for plastic bottles
of proprietary brand labelled water with unbroken
provision
manufactured seals.
Proper sanitary measures must be applied to food
For overnight or camping events, suggested storage, preparation and distribution. Failure to
requirements are 20 litres of water per person, adequately enforce food standards can contribute
per day, 4 litres of which are specifically potable to contamination and pose a danger to public
water for drinking. These requirements may vary health. Provision of food can assist to engage
depending on previous experience and weather. patrons in activities other than drinking, which can
In locations where potable water supplies are help to reduce the potential for intoxication.
limited, non-potable water may be utilised for
toilet flushes, and signs should reflect this so Food should be available for the duration of all
patrons are aware. events. Event organisers are encouraged to
consider the pricing of food and non-alcoholic
beverages to support accessibility by patrons.
3.4 Shade and active Any business offering food for sale (regardless of
cooling measures setting) must comply with the Australia New
Zealand Food Standards Code (FSANZ) Food Act
High ambient temperatures and humidity, and 2003 (NSW). For further information, refer to the
physical exertion, such as dancing for long NSW Food Authority’s Guidelines for food
periods, can increase the risk of drug related businesses at temporary events and Guidelines
harms. Temperature and humidity can also add to for Mobile Food Vending Vehicles. These guides
the risk of dehydration. All events need to plan for include a self-checklist for businesses, based on
extreme weather conditions and consider the requirements in the Food Standards Code.
providing shade and active cooling measures that Event organisers must ensure that relevant food
can mitigate these risks. businesses at their event have appointed a
Events should provide readily accessible shaded certified Food Safety Supervisor (FSS), that safe
areas within the festival site. These shaded areas food handling is practiced by all operators and
should ideally be separate from bars and alcohol food handlers have appropriate food safety skills
serving areas and in addition to the chill out and knowledge.
spaces described in Section 6.
Use of existing shade should be factored into the
design and layout of the site. The position of
stages, merchandise tents and stalls should take
advantage of any shade created over the course
of the event. Where existing natural shade is limited,
structures to create shade should be provided.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 9Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
3.6 Management of sexual
assault
There can be increased sexual health risks at a
music festival. This can include the impact of drug
and alcohol misuse on risk behaviour.
Patrons or staff reporting sexual assault should be
provided with the opportunity to report to
medical services and/or Police. A person who has
experienced sexual assault should be offered
expedited transfer to an appropriate hospital
facility, along with a clear explanation of the
services available there to assist them, such as
access to medical care and counselling and
forensic services. Individuals cannot provide
informed consent to either accept or decline
transfer to hospital without this information.
NSW government health services will provide care
for people reporting sexual assault in a manner
consistent with the Sexual Assault Services Policy
and Procedure Manual (Adult) 2005 PD2005_607.
10 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
4 Onsite medical service
provision
4.1 Medical centre location, 4.2 Expected presentations
access, signage and
Event organisers must articulate the expected
security type and number of medical presentations and
have in place emergency management protocols
Onsite medical centres need to be highly visible and escalation pathways, including urgent transfer
and accessible to patrons. A single, central onsite procedures to address the emergency care needs
medical centre should serve as the primary site of festival goers.
for initial triage and management of medical
For events that require a music festival licence,
presentations. The onsite medical centre should
early identification, and immediate and intensive
be readily accessible by ambulance vehicles to
management of serious drug related illness must
support expedited transfer of patients to hospital,
be planned for. This may include ensuring there is
and should have access to appropriate, dedicated
one or more resuscitation doctors and nurses on
toilets for the use of unwell patrons.
hand with capability to intensively manage more
Additional first aid posts may be required for than one extremely unwell patron concurrently, as
events in large venues. However, the process for recent events have shown that a number of
transport of patients from all areas of the event to festival goers may need urgent and expert
the onsite medical centre should be clearly medical care at the same time.
articulated. Staff members who are roving the
The event organiser must ensure the onsite medical
festival may require buggies or stretchers to
provider can provide a minimum standard of
urgently transport patients from crowded
pre-hospital emergency medical care to address
locations.
the following range of presentations.
Event medical providers should work with event
There are two main types of medical
organisers to ensure there is adequate and
presentations that should be anticipated:
appropriate signage to direct patrons requiring
medical assistance to the medical centre and first
aid posts, while directing patrons who are not Type 1: Minor presentations
unwell to other appropriate areas. For example: mild dehydration, mild allergic
reactions, headaches and minor injuries such as
Police should not routinely be in the vicinity of the sprains, cuts, abrasions and simple fractures.
medical centre to support open disclosure by
patients in relation to their substance use. Police Type 2: Major presentations
may attend the medical centre as requested by
Major presentations may be event specific, or
medical staff. Security staff should instead be
exacerbations of pre-existing general medical
present in these areas to support medical staff.
conditions.
Serious event specific presentations may include:
serious drug or alcohol toxicity; sexual assault;
assault or falls with serious complications
including head injury; compound or major
fractures; crush injuries; near-drowning and other
serious presentations including delirium, agitation,
reduced consciousness or hyperthermia.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 11Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
Serious presentations that are exacerbations of • Function and physical layout of the onsite
pre-existing medical conditions may include medical centre and first aid posts.
seizures, diabetic presentations (hypo or • Departmental processes in the onsite medical
hyperglycaemia), and acute coronary syndromes. centre including:
For all-ages events, the likelihood of paediatric – command and control;
presentations should be considered a specific risk – triage;
as they require specialised age-appropriate – monitoring and treatment protocols;
equipment, treatment and management.
– record keeping; and
For most events, the majority of medical – transfer processes, including from within
presentations to onsite medical services are minor the event to the medical centre and from the
(Type 1 above). In addition, a large portion of medical centre or other locations within the
presentations to onsite medical providers may be event to hospital.
simple requests for supplies (e.g. sunscreen, • Type and amount of equipment and medical
Band-Aids), rather than an actual medical illness. supplies.
These simple requests would be best managed
• Distance from and ease of transfer to
well away from the medical centre and medical
appropriate hospital facilities for further
triage area, using clear signage to direct patrons
medical management
who are not seeking or needing medical care to
the appropriate area. • Surge capacity and escalation processes
including protocols for emergencies.
Serious and potentially life threatening
presentations can also occur (Type 2 above). When an event is considered to have a significant
risk of serious drug and alcohol-related
Reporting on the number of presentations to presentations (Section 2.2), onsite medical
onsite medical providers should clearly distinguish providers should describe their proposed
true medical presentations (whether minor or approach to managing simultaneous serious
major) from non-medical presentations such as medical presentations.
requests for sunscreen and Band-Aids.
4.4 Medical treatment
4.3 Event medical plans protocols
Event organisers may choose for their Event
Medical Event Plans should include standard
Medical Plan to be prepared by their third party
protocols to manage common presentations in
onsite medical provider. The nature and detail of
the festival setting, such as dehydration,
an Event Medical Plan will vary. A checklist of the
hyperthermia and reduced consciousness.
key components of the Event Medical Plan is
Additional clinical guidance for onsite medical
included in Appendix B. The Event Medical Plan
providers is provided in Appendix D.
must articulate the onsite medical provider’s
capacity to meet the anticipated profile of NSW Health is progressively developing guidance
presentations for the event. This capacity will be and resource materials to support event medical
determined by a number of factors, each of which providers in developing treatment protocols for
should be specifically addressed, including the: music festivals. These will be made available to
event organisers to include in their medical event
• Qualifications, skills, experience, number and
plans as they are developed.
rostering of medical, nursing, paramedic, first
aid and support staff. The designated roles and
responsibilities of each of these staff should be
explicitly articulated alongside the description
of their qualifications, skills and experience.
12 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
4.5 Onsite medical staff Medical practitioner: a qualified medical
practitioner with current unconditional general
registration through the Australian Health
4.5.1 Definitions, roles and capabilities Practitioner Regulation Agency (AHPRA). Medical
of onsite medical staff practitioners employed in the music festival
The capabilities of onsite medical staff must be setting should have experience in critical care
such that they are able to appropriately respond medicine (emergency medicine, intensive care or
to the expected number and type of medical anaesthetics), management of serious drug and
presentations for the specific festival event being alcohol related toxicity, and pre-hospital or
serviced. For events that require a music festival retrieval medicine, and should be at least capable
licence, this includes appropriate consideration of of independently performing the role of
the need for independent resuscitation capability, resuscitation doctor.
and senior medical supervision. A thorough
assessment of the capabilities required for safer Resuscitation doctor: a medical practitioner
festival outcomes is essential. allocated to the role of resuscitation doctor must
have independent resuscitation skills, including
All onsite medical, nursing, paramedic, first aid advanced airway and rapid sequence induction
and harm reduction staff should: (intubation) skills. This may be demonstrated by
progression to an advanced level of specialist
• have no other duties or responsibilities;
training (accredited ‘advanced trainee’) through
• have relevant experience or training in the Australasian College of Emergency Medicine
providing care at major events; (ACEM), the College of Intensive Care Medicine of
• wear identification, protective clothing and Australia and New Zealand (CICM), or the
appropriate personal protective equipment; Australian and New Zealand College of
• be physically and psychologically equipped to Anaesthetists (ANZCA).
carry out their assigned roles; and The terms: interns; resident medical officers;
• be at least 18 years old. house officers; career medical officers, registrars
or junior medical officers relate to roles in the
The role and professional descriptions for onsite
hospital system where the expectation is to work
medical provider staff should be limited to the
under the supervision of specialist medical
terms defined below to clearly describe the
practitioners. In general, doctors who are not
capability and qualifications of onsite medical
specialist medical practitioners (that is, they have
provider staff.
not achieved Fellowship of a relevant specialist
Terms such as emergency medical technician medical college) should be considered junior
(EMT), medic, or advanced responder should not doctors, particularly when providing critical care
be used. These terms do not adequately describe in a pre-hospital setting. This should be considered
the registration status, professional qualifications in managing the skill mix of any onsite medical
or capability of health service staff. team as these junior doctors would not be
expected to manage the evolving resuscitation
Peer-based harm reduction team member: needs of a large scale event in an independent
certified as competent by a registered training manner. Junior doctors in the festival setting
organisation in the unit of competency should be employed with appropriate onsite
HLTAID003- Provide First Aid or equivalent. All senior medical supervision.
team members are required to have additional
training that includes knowledge of drugs and Senior doctor: a specialist critical care physician,
their effects and interactions, identifying signs who has achieved Fellowship of a relevant college
and symptoms of intoxication and harm reduction (ACEM, CICM or ANZCA). The senior doctor should
strategies. also have substantial experience in pre-hospital
and/or retrieval medicine, and an understanding
of the management of serious drug and alcohol
related toxicity. Trainees undertaking specialisation
or other non-critical care specialist physicians
should not be considered a senior doctor in the
music festival setting.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 13Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
The role of the senior doctor in this setting is First Aider: A person who holds a current
primarily to provide specialist medical expertise certificate of first aid competency through a
and skills to support the operation of the onsite registered training organisation. They should also
medical centre, and should be distinct from the have experience in providing first aid at large events
role of the resuscitation doctor(s). In the case of and receive additional training in recognising
simultaneous serious medical presentations, the common drug-related presentations and the signs
senior doctor’s experience in identification of and symptoms of more serious illness.
serious illness, clinical prioritisation, rapid decision
making, and concurrent management of multiple When medical, nursing and paramedic students
patients is needed to best coordinate the onsite contribute to onsite medical provider staffing,
medical capacity and transfer arrangements. they should only be assigned to a first aid (if first
Their core role is to supervise and direct the aid certified) or support role, as they are not
medical management and clinical decision making registered and/or qualified to provide care as a
for the medical team. doctor, nurse or paramedic.
Nurse: a registered nurse, with unconditional 4.5.2 The onsite medical team capability
registration through AHPRA. They should have at and skill mix
least two years full-time nursing experience in The number, capability and skill mix of onsite
addition to the graduate year, and recent experience medical staff required will depend on the
(within one year) working in a pre-hospital or expected type and number of medical
emergency department environment. They should presentations for the specific event.
hold current Australian Resuscitation Council Multidisciplinary approaches to staffing are
Advanced Life Support certification. It is recommended.
additionally preferable they have successfully
completed the NSW Health Transition to Practice, Where an event requires a music festival licence,
Emergency Nursing Program or equivalent the onsite medical provider should strongly
transitional program. Where a nurse is undertaking consider engaging the services of a senior
the triage role in an event setting, they should doctor or at least one resuscitation doctor to
have significant triage experience, as demonstrated enhance the capability of the onsite medical
by recent employment in this capacity in an team to manage serious medical presentations.
emergency department.
Where the event is anticipated to have multiple
Paramedic: a registered paramedic, with serious presentations requiring critical care
unconditional registration through AHPRA. There transport to a hospital, a senior doctor as well
are further specialist pathways in paramedical as at least one resuscitation doctor, and nurses
science, such as Intensive Care Paramedics who or paramedic is required.
have additional accredited training and experience,
for example through the NSW Ambulance Consideration should also be given to surge
Education Centre. However, the ‘scope of paramedic capacity and safe rostering hours for events
practice’ is not specifically defined or described longer than 12 hours.
for the paramedicine profession in the National Event Medical Plans must explicitly outline the
Law. An individual paramedic practitioner’s scope capability of the onsite medical team, by
of practice is determined by their individual skills, describing the roles, qualifications, skills,
training and competence and may also be described registration status, experience, number and event
as part of their employment. Paramedics rostering of all medical, nursing, and paramedic
employed in an onsite medical provider team staff, using appropriate terminology as described
should demonstrate a scope of practice suitable above.
for providing care in the music festival setting.
An example has been provided in Appendix C.
14 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
4.6 Onsite medical 4.6.3 Monitoring and management
People with drug and alcohol related toxicity and
operations other serious illness in the music festival setting
can rapidly deteriorate.
4.6.1 Onsite medical team briefing
Effective patient management is dependent on Regular vital sign monitoring and medical
multidisciplinary teams working together to reassessment supports:
ensure appropriate care is provided to all patients • Early identification and management of
at the appropriate time. critically ill patients
Patterns of drug-related toxicity in the festival • Detection of acute deterioration
setting can change rapidly, particularly as novel • Prioritisation of patients requiring transfer.
substances enter the market or patterns of use
change. The evidence in relation to best practice Regular vital sign monitoring and clinical
pre-hospital management of serious drug-related reassessment of patients who are not improving
illness is also continuously evolving. or who are deteriorating should be a core part of
the medical management of patients in this
Event organisers should ensure that their onsite setting, in accordance with good clinical care.
medical provider coordinates internal pre-event
briefings with all onsite medical staff. This supports If patients have vital signs outside the conservative
team based approaches to the management of normal ranges described in Appendix D, particularly
complex patients likely to occur in this setting. if this persists following a period of initial
monitoring, this should trigger urgent escalation
This briefing should review: for onsite medical practitioner review.
• triage; Depending on patterns of drug use, crowd
• treatment and transfer protocols; behaviour and the general medical condition of
• documentation processes; event patrons, complex and severe presentations
can occur which can become rapidly life-threatening.
• escalation and communication processes;
• recent drug use patterns, novel substances and In this situation, the principles of onsite medical
other potential serious illness related to the management are as follows:
event’s target demographic and the style and
For all events without expert onsite medical
location of the festival; and
capability (such as an onsite medical team with
• space/equipment for medical retrieval and/or a specialist critical care doctor, and/or a
LHD resuscitation teams if required. pre-deployed specialist medical retrieval team):
Multidisciplinary simulation sessions should occur 1. Ensure early and rapid identification of patient
as part of this briefing for the members of the deterioration which may become life threatening
resuscitation team. This allows the team to model
2. Immediately provide life-saving medical
what they would do when managing a critically ill
intervention as required, while expediting
patient. This would support the identification of
urgent transfer to hospital for definitive
appropriate clinical roles (e.g. Team Leader,
medical management.
Resuscitation Doctor, Circulation Nurse etc.);
location of equipment and medications; and For events where there is expert onsite medical
review of communication processes for facilitating capability (such as an onsite medical team with a
escalation and transfer to hospital. specialist critical care doctor, and/or a pre-
deployed specialist medical retrieval team):
4.6.2 Triage
1. Immediately provide appropriate, intensive
An adequate triage capability using qualified staff
medical management before transport, such
with appropriate recent experience and a triage
as sedation, rapid sequence intubation and
tool tailored to the festival setting is essential.
aggressive cooling in cases of drug-related
Additional information about triage processes is
hyperthermia.
at Appendix D.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 15Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
2. Transport to a tertiary hospital as soon as These factors may impact on the capacity of
possible, with medical retrieval team escort ambulances to transfer ventilated patients. It may
if available. be most appropriate for an intubated patient to
be ventilated by the onsite medical practitioner
Complex, severe presentations can also occur to expedite transfer. However, this has major
simultaneously, which can rapidly consume or implications for the ongoing provision of onsite
even overwhelm the onsite medical response medical care if the medical practitioner leaves the
capacity. In this case, activate emergency event to facilitate transfer. Hence risk
escalation protocols immediately (Section 5), management decisions will need to be made.
while continuing to reassess and re-prioritise the
delivery of onsite clinical care according to the Early communication with the NSW Ambulance
acuity of the medical condition of all seriously ill Forward Commander is recommended when an
patients. invasive procedure, such as intubation, will take
place. This early communication will support the
4.6.4 Transfer to hospital effective and urgent transfer of critically ill patients.
Once the decision to transfer a patient has been
made, onsite medical staff should work with 4.6.5 Documentation
deployed NSW Ambulance staff to support The following should be documented for patients
coordination of resources and prioritisation of of onsite medical services:
patients awaiting transfer.
• Basic demographic information
The time required for transfer will depend on • Clinical information including:
factors including access, egress and distance to
– presentation and triage note;
appropriate hospital facilities. NSW Ambulance
has existing processes to liaise with hospital – relevant past medical history;
emergency departments regarding the acuity of – examination findings;
their transfer patients. – management provided; and
While awaiting transfer, clinicians are encouraged – outcome (e.g. discharge destination or transfer).
to call the NSW Poisons Information Centre. A As with any medical record, this information
priority contact line can be provided through should be kept securely to protect patient privacy
LHDs to provide rapid access to tele-health and confidentiality.
support from a senior toxicologist. This can
support the delivery of best practice interim Telecommunications systems may be overwhelmed
management of toxicology cases while awaiting by increased demand during an event. Where
transfer, including those related to drugs, alcohol electronic medical record systems are used for
and snake and spider bite. record keeping, a back-up paper-based system
should be in place.
During pre-planning, event organisers and onsite
medical providers should consider the local
capabilities of NSW Ambulance, the onsite
Ambulance crew (if any) and their paramedic level
and accreditation status, as this has implications
for initial management of patients. For example,
only NSW Ambulance intensive care paramedics
can intubate unconscious patients. Intensive care
paramedics can also ventilate patients, including
for the purpose of transferring patients who are
already intubated.
16 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
5 Emergency escalation
protocols
5.1 Key emergency Through early consultation with LHD staff and
NSW Ambulance, event organisers should confirm
definitions the level of NSW Ambulance service provision
onsite during the event. NSW Ambulance may
allocate a senior onsite paramedic to the role of
Event organisers need an understanding of
Forward Commander. Processes for arranging
emergency management protocols. The following
medical transfers through NSW Ambulance may
terms are from the NSW Health Plan:
include communication to their Forward
A health incident is a localised event, either Commander or other representative at the Event
accidental or deliberate, which may result in death Control Centre via radio in the first instance.
or injury, which requires a normal response from
Event organisers or onsite medical providers may
an agency, or agencies from one or more of the
recognise a need to escalate beyond the resources
components of NSW Health.
available onsite. The decision to escalate may
A major incident is an incident involving, or also be made independently by the NSW
having the potential to involve, a large number of Ambulance Forward Commander or other NSW
casualties which can be adequately managed by emergency services. This is important as onsite
the available resources but which requires a medical personnel may be overwhelmed by the
significant and coordinated response involving demand arising from a major incident or health
those resources. emergency.
A health emergency is as an emergency, due to If a health incident occurs, the NSW Ambulance
actual or imminent occurrence, which endangers Forward Commander has scope to escalate the
or threatens to endanger the safety and health of situation initially to the NSW Ambulance
persons in the state of NSW, and requires a Commander or via the NSW Ambulance Control
significant and coordinated whole-of-health Centre. If appropriate, they will further contact
response. the LHD Health Services Functional Area
Coordinator (HSFAC) or their delegate.
5.2 Health emergency If a major incident or health emergency occurs or
is evolving, the NSW Ambulance Forward
escalation and Commander will escalate to the NSW Ambulance
management plans Commander, who may contact the State HSFAC.
The State HSFAC is responsible for the
management of health emergencies, as described
5.2.1 Health emergency escalation
in the NSW Health Plan.
In the event of a health incident, major incident or
health emergency (as defined above), the NSW In the case of a major incident or health
Health Plan and NSW Emergency Management emergency, the NSW Ambulance Forward
Plan (EMPLAN) should be used to maintain Commander will assume onsite command of the
consistency with existing state wide processes. medical response under the delegation of the
This provides clear command and control structures State HSFAC. This is to support coordination of
to NSW Health and emergency services, including resources and effective management of the
NSW Ambulance. These structures support the emergency.
mobilisation of resources to respond to
emergency events.
Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction 17Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction
If there is clinical disagreement between the
NSW Ambulance Forward Commander and the
onsite event medical provider’s medical
practitioners, this could be resolved by:
• The NSW Ambulance Forward Commander
should contact the on-call State Aeromedical
Retrieval Consultant via 1800 650 004.
• This Retrieval Consultant can provide clinical
advice to both parties to support the
effective triage and transfer of patients to
definitive facilities.
• Where the situation is a major incident or
health emergency, the NSW Ambulance
Forward Commander will take full control of
the medical response.
5.2.2 Evacuation and movement of
patients
Event organisers should consider:
• Transfer from within the event venue for health
incidents, for example, movement of injured or
sick patients to the onsite medical centre or
via NSW Ambulance to appropriate hospital
services.
• Large scale evacuation due to major incidents
or health emergencies, including mass casualty,
natural disaster or fire.
The evacuation component of the Risk Management
Plan should include resources, training, allocation
of specific responsibilities to event staff and
communication processes between event organisers
and NSW emergency services, as ingress and
egress for emergency vehicles is critical.
18 Guidelines for Music Festival Event Organisers: Music Festival Harm ReductionGuidelines for Music Festival Event Organisers: Music Festival Harm Reduction
6 Harm reduction
6.1 Alcohol management The licensee and those serving liquor are required
to hold a valid, approved RSA competency card.
This applies to those serving liquor in a voluntary
Liquor licensees have legal and social obligations capacity as well as any security officers with
to ensure alcohol is served responsibly to help crowd control duties.
minimise alcohol-related harm. This includes:
Event organisers should ensure that due diligence
• ensuring bar staff and security officers have is used when ejecting an intoxicated individual
their current Responsible Service of Alcohol from an event. It may be more appropriate for the
(RSA) card and/or Security Licence on them, individual to be transferred to the onsite medical
trading hours are adhered to, and RSA signs centre or chill-out space rather than be ejected
are clearly displayed; from the festival.
• training on recognising and responding to an
alcohol or drug overdose or related distress for
all event, bar and security staff; 6.3 Peer-based harm
• proof-of-age checks and procedures, including reduction programs
providing wristbands for over-18s;
• whether alcohol and/or glass can be brought Event organisers should engage a peer-based
into the venue by event patrons; harm reduction program early in their pre-event
• procedures for security checks, such as bag planning, such as DanceWize NSW, Save a Mate or
checks; other providers. Provision of a peer-based harm
• secure areas for the storage of confiscated reduction program at an event contributes to the
goods; health, safety and well-being of patrons. Peer
educators can effectively disseminate information
• provision of clear signage showing where
on drug and alcohol harms and harm reduction to
alcohol can and cannot be served;
patrons. The program can also facilitate
• any limits on the number of alcoholic communication between patrons and service
beverages that can be purchased at once; providers during an event.
• whether alcohol will only be sold in non-glass
containers; 6.3.1 Peer-based harm reduction
• provision of free drinking water both at and program planner
away from points of alcohol sale; and The level of risk, duration of event and number of
• availability of low alcohol beverages, food and patrons will inform the number of harm reduction
non-alcoholic beverages. staff required. Peer-based harm reduction
programs should operate throughout the duration
of the event. Table 7 provides a tool for estimating
6.2 Identification and the number of staff required for an event by a
management of peer-based harm reduction program.
intoxicated patrons There should be a mix of roles, including: a
coordinator; team leaders; and peer educators.
The coordinator and team leaders receive
All event, security, and bar staff are required to
additional training in first aid and the management
undertake training on recognising and responding
of drug related harms. The coordinator and team
to alcohol and other drug harms or related distress
leaders need to be identifiable and all members of
within a harm management framework by an
the harm reduction team are required to wear
approved registered training organisation.
uniforms, for example, high-visibility vests.
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