In this study of the sanitary services at the Quart festival in 2004, 2005 and 2006 no deaths, cases of cardiac arrest, respiratory collapse or serious penetrating trauma were recorded. Serious medical occurrences and occurrences with a fatal outcome are very rare in large music events for youth. Grange and collaborators reported no cases of cardiac arrest or respiratory collapse in an overview of more than 1.2 million onlookers at 653 rock concerts (2). Articles from large events such as Toronto Rocks! reported the same (3). A tragic exception is the Roskilde accident the summer 2000 when nine young men died of asphyxia on the main stage during a concert after lying on the ground in a crowd in front of the stage (8).
There were 65 patient contacts per 10 000 participant in our study. This corresponds to the mean at similar rock arrangements abroad, but there is a large variation (1, 3, 4, 9, 10). Studies confirm that substance abuse problems are a smaller medical problem in festival areas than the media tend to present. This also applies to other Nordic festivals (9). Reports from concerts and festivals outside of the Nordic countries show a somewhat higher occurrence of substance abuse-related patient contacts (1, 3, 4). Suy and collaborators reported intoxication as contact cause for 17 % of all patient contacts and 81 % of patient contacts with a doctor during a large rave event in Antwerpen in 1999 (6).
The occurrence of violence-related episodes at rock concerts and rock festivals varies, but especially violence associated with the use of alcohol is mentioned as a potential problem in many review articles (1,2). We recorded 18 injuries caused by deliberate violence in the festival area during three festival weeks. With 13 000 participants per day, a heated atmosphere, crowds and serving of alcohol we consider this to be a low number. At the Midfyn festival in 1988, 5.2 % of the injuries were caused by violence (11). In reports from the Roskilde festival in 1985 (11) and the US festival in 1982 (4), the incidence of violence is said to be low, but no exact numbers are given.
The pattern of injuries in our study corresponds with similar studies abroad, with an overweight of small and uncomplicated injuries where most were treated locally without further referrals. Also the types of complaints were the same as for other festivals: uncomplicated pain problems, some allergies and infections. Dehydration and heat-related complaints are frequent causes in other studies (1) - (3, 5), but the Quart festival had sufficient water and access to fluid, open air stages, closeness to the sea and sufficient space for the public, so this was not a problem there.
Stage squeeze was the most important diagnosis during the main concerts. It may seem dramatic when unconscious adolescents are dragged over the barricades in front of the stage and carried into the sanitary area on a stretcher. Over-heating is a common cause for problems in an international perspective, but it was not an important factor at the Quart festival, with cool Nordic evening temperatures and good ventilation. Correct evaluation and observation of the patients with stage squeeze during difficult light and noise conditions is one of the most important tasks for doctors and nurses. All such patients need to be attended to by a doctor or nurse. According to our routines all should have water, crackers, glucose and warm carpets and should be under continuous surveillance by assisting personnel. They can only be discharged by a doctor or nurse. No acute referrals were needed for this patient group.
The sanitary personnel available were able to provide the needed treatment to most patients with injuries or other medical problems. Five ambulance transports were necessary for acute hospitalization, all in 2004; i.e. 0.24 per 10 000 participants. In a large material from 201 Australian mass gatherings of several types, the number of ambulance transports to hospital was 0.27 per 10 000 participants (12), at a rock festival in Toronto in 2003 the number was 0.5 (3) and in Monster Rock, Leicerstershire, England in 1992 it was 1.6 (10). The number of external referrals was 49, i.e. 2.4 per 10 000 participants (3.1 if all personnel are excluded) during the Quart festivals, 6.2 at the Roskilde festival in 1992 (10) and 12.9 per 10 000 participants during the Midtfyn festival in 1988 (13). The number of ambulance transports and external referrals at the Quart festival corresponded with or was lower than that for larger mass gatherings abroad. This indicates that the Quart festival’s primary health service preparedness and approach was adequate and sufficient. We also consider the availability of treatment personnel in three competence areas to be adequate. Internal (114) and external referrals confirm the usefulness of having an on-duty-physician as the main responsible for mass gatherings of a certain size (5, 11, 14).
65 of the patient forms had an unknown or other injury/disease status. This may lead to misinterpretation of the results. The proportion is low compared to the total material. We have chosen to include these, as the total number of patient contacts was important for assessment of several variables. 13 of the patient forms had unknown treatment status. This also opens up for misinterpretation of the results. None of these patients were however referred to outside the festival area.
Our study has several limitations. Most forms were completed and signed by assisting personnel without diagnostic competence beyond first aid training and corresponding experience. The injury categories were broad and did not adhere to any standardized diagnostic classification system. The beginning darkness, high activity and noisiness during the last hours of a festival day may have increased the risk of misclassification. The Quart festivals had a special southern touch, and our findings may not be relevant for festivals in other places. Our results are strengthened by the following: stability of personnel (same during the entire study), one appointed secretary was responsible for controlling and collecting all the forms, the personnel had sound festival experience, a simple registration form was used and this was improved after a pilot project in 2003.
There is no international consensus on necessary medical preparedness and equipment for this type of mass gathering. Local and national guidelines have been made (1,7), but not in Norway. We believe that Norwegian guidelines should be made for medical preparedness and quality assurance for recording of patient information during this type of mass gathering.