Chi nese Med i cal Jour nal (Taipei) 2001;64:525-530
Original
Characteristics of Patients at A Taipei
Summer Rock Concert Festival
Wei-Fong Kao
Chien-Chun Kuo
Hsing Chang
Wei-Lung Chen
Chien-Hwa Wei
Hsien-Hao Huang
Da vid HT Yen
Jer-Kan Wu
Shune Miao
Chen-Hsen Lee
De part ment of Emer gency Med i cine, Tai pei
Vet erans Gen eral Hos pi tal; Sec tion of
Emer gency Med i cine, Na tional Yang-Ming
Uni ver sity, Tai pei, Tai wan, R.O.C.
Key Words
emer gency med i cal ser vices;
mass gath er ings;
rock con cert
R
Back ground. Rock concerts are popular mass gatherings in Taiwan.
Mil lions of fans par tic i pate in rock con certs in Tai wan each year. However, there were no re ports on the char ac ter is tics of the pa tients seen in
rock con certs in Tai wan.
Methods. Med i cal care for a sum mer rock con cert fes ti val held in an
out door sta dium in Tai pei was co or di nated by emer gency phy si cians of
a med i cal cen ter. About 50,000 at ten dees par tic i pated in the two- night
con cert. Three sta tions were set up to pro vide ad vanced med i cal care.
A stan dard ized form was used to col lect in for ma tion about pa tients.
Results. A to tal of 28 cases vis ited the med i cal sta tions, four teen cases
each day. They were aged from 13 to 40 years, with an av er age of 20.8
± 6.4. Twenty-one cases were fe male and seven were male. Twentytwo (79%) were spec ta tors, five (18%) were on-duty staff, and one was
a by-stander. Based on an estimation of totally 50,000 participants in
the stadium for this two-night festival, the medical use rate was
roughly 5.6 PPTT (patients per ten thousand attendees). The most
common major problem was fainting which accounted for 13 cases
(46%). Of these 13 cases, three cases (23%) lost con scious ness and 12
cases (92%) were fe male. Six teen cases (57%) were clas si fied as requir ing ALS (ad vanced life sup port) and 12 cases (43%) as re quir ing
BLS (ba sic life sup port). Most cases im proved and were dis charged after onsite treat ment. Only one case was trans ferred by am bu lance due
to per sis tent chest pain. How ever, she re cov ered sev eral hours later.
Conclusions. By this preliminary data, first reported in Taiwan, we
found that the most com mon prob lem was faint ing. More than half of
the cases seen at the con cert re quired ad vanced life sup port. A welldesigned emergency medical service (EMS) system is mandatory to
pro vide ser vices for these events.[Chin Med J (Taipei) 2001;64:525-530]
ock mu sic con certs are no to ri ous for large un ruly
crowds hav ing a po ten tially high in ci dence of
med i cal prob lems.1 Many ma jor in ci dents, sim i lar to
di sas ters, have been re ported in the lit er a ture.2-5 Rock
con certs are also pop u lar mass gath er ings in Tai wan.
By es ti ma tion, more than one mil lion fans par tic i pated
in rock con certs an nu ally in Tai wan. There was an
event re ported in news pa per in Tai wan where more
than one hun dred pa tients fainted at a rock con cert.6
Al though med i cal teams have com monly been asked
Re ceived: September 25, 2000. Ac cepted: July 13, 2001.
Cor re spon dence to: Wei-Fong Kao, MD, De part ment of Emer gency Med i cine, Tai pei Vet erans Gen eral Hos pi tal, 201, Sec. 2, Shih-Pai
Road, Tai pei 112, Tai wan. Fax: +886-2-2873-8013; E-mail: wfkao@vghtpe.gov.tw
526
Wei-Fong Kao, et al.
to participate in these mass gatherings in Taiwan,
there was no re port on the char ac ter is tics of the patients seen at the rock con certs. We con ducted a prospec tive study to as sess the char ac ter is tics of pa tients
seen at a sum mer rock con cert.
Methods
Med i cal care for a sum mer rock con cert held at
Tai pei Mu nic i pal Sta dium was co or di nated by emergency phy si cians of a med i cal cen ter. The con cert was
held on the infield areas of the race circuit. About
50,000 at ten dees par tic i pated in a two-night con cert
on July 31 and Aug 1, 1999, from 7 to 10 p.m. The
con cert in cluded a warm-up band, which played each
night from 6 to 7 p.m. The spec ta tors were al lowed to
en ter the sta dium af ter 6 p.m. Three med i cal care stations were set up to pro vide med i cal sup port. Two stations were lo cated out doors, one on ei ther side of the
stage, and one sta tion was lo cated in doors near the entrance. Each station was staffed by one emergency
phy si cian, two to five emer gency nurses, and three to
six other med i cal staff (in clud ing non-emergency doctors, med i cal stu dents, non-emergency nurses, emergency med i cal tech ni cians), and equipped with fa cil ities able to per form ad vanced car diac life sup port. An
am bu lance was wait ing out side at each of the two entrances to the sta dium. Am bu lance trans port was consid ered only when the pa tient pre sented life threat ening con di tions such as al tered men tal sta tus, poor perfu sion, chest pain and short ness of breath and did not
im prove af ter five min utes of the treat ment. Med i cal
ser vices started from 4 p.m. and lasted un til about 11
p.m. on both days. A three-hour medical training
course was de liv ered to the med i cal staff the day before the concert. The courses included emergency
med i cal ser vices for mass gath er ings, com mu ni ca tion
sys tems, tri age cri te ria, the prin ci ple of trans port, the
sce nario of emer gency cases, mass ca su al ties and disas ter re sponse. There were also a brief and ma jor inci dent drill at the con cert sta dium on each day be fore
the fans rushed in.
A stan dard ized form was used to col lect in for mation in clud ing the pa tient’s iden ti fi ca tion and de mo-
Chi nese Med i cal Jour nal (Taipei) Vol. 64 No. 9
graphic data, types and causes of injuries, time of
visit, com plaints, pos i tive phys i cal find ings, ten ta tive
diagnoses, treatments and dispositions. Each chart
was re corded by the med i cal staff and checked by either phy si cians or emer gency nurses. Af ter the concert, each data form was re viewed by the prin ci pal investigator for com plete ness. The lev els of med i cal
care were di vided as ba sic life sup port (BLS) and advanced life sup port (ALS) ac cord ing to the se ver ity of
ill ness or in ju ries ini tially, mod i fied by the clas si fi cation by Sanders et al7 Clas si fi ca tion was first made by
the prin ci pal in ves ti ga tor and then by an other emergency phy si cian. In case of dis crep ancy in clas si fi cation, a third emer gency phy si cian was in tro duced to
review the record and to establish agreement. De scrip tive and sim ple sta tis ti cal meth ods were used in
this study.
Med i cal use rate was de fined as pa tients seen by
med i cal staff di vided by at ten dees, rep re sented by patients per ten thousand attendees (PPTT). Syncope
was de fined as tran sient loss of con scious ness with
postural collapse.8 Faintness was defined as prod romal symptoms of syncope that reflects brain is chemia to a degree insufficient to impair consciousness.8 It rep re sented cases who were un able to
see, had weak ness of the legs, or were un able to stand
but with out al tered men tal sta tus. Fainted, faint ing
and faint ing spells were de fined as rough terms which
in cluded both faint ness and syn cope. Ill ness or in juries rec om mended to be cared by ALS per son nel: Cardiac ar rest, syn cope, faint ness, al tered men tal sta tus,
sei zures, short ness of breath, chest pain, ab dom i nal
pain, vom it ing, in sect bites/stings, anaphylaxis, an imal bites, heat cramps/heat exhaustion/heat stroke,
burns more than 2nd de gree, al co hol/drugs, diz zi ness,
head aches with sus pi cion of intracranial pa thol o gies,
symp toms or signs with sus pi cion of shock, symptoms or signs with neu ro log i cal def i cits, symp toms or
signs with vas cu lar com pro mise, sus pi cion of spi nal
in ju ries, nose bleed ing, GI bleed ing, anal bleed ing,
and vaginal bleeding.7 Illness or injuries rec ommended to be cared by BLS personnel: Lac er ation/abra sion, blunt in jury with out above ALS con ditions, ex trem ity sprains/frac tures, bruises, old in ju ries
re quest ing new dress ing, flu symp toms, head aches,
Sep tem ber 2001
Emer gency Med i cal Ser vices at a Rock Con cert 527
earaches, eye pain, red eye, hoarseness, insomnia,
nau sea, di ar rhea, blis ters. 7
Results
A to tal of 28 cases were taken care of, 14 cases
each day. They were aged from 13 to 40 years, with an
av er age of 20.8 ± 6.4. There were 21 fe male and seven
male cases. Among these cases, 22 (79%) were specta tors, five (18%) were on-duty staff and one was a
by-stander (Table 1). From an estimation of the
50,000 attendees in total, with about 25,000 each
night in the sta dium, the med i cal use rate was roughly
5.6 PPTT. Ten pa tients (36%) were taken care of before 7 p.m., the be gin ning of the con cert. There were
two peak vol ume loads of pa tient vis its (Fig 1). The
most com mon prob lem was faint ing, which ac counted
for 13 cases (46%)(Ta ble 2). Next on the list were six
cases (21%) of abra sion and/or lac er a tion and/or contu sion, three cases (11%) of con junc ti vi tis, and two
cases of ab dom i nal pain. The com mon com plaints included 13 cases of diz zi ness, 12 cases of weak ness
and/ or ataxia and seven cases of head aches. Of the 13
fainting cases, 12 (92%) were female. These cases
were aged from 14 to 24 years, with an average of
17.9 ± 2.7 years and a me dian of 18 years. Three cases
(23%) were of con scious ness loss. Ten (77%) cases
fainted af ter the first hour of the rock con cert (Fig 2).
Of the 28 cases, 16 cases (57%) were clas si fied as requir ing ALS and 12 cases (43%) as re quir ing BLS.
There was no dis crep ancy be tween two re view ers.
Most of the cases im proved and were dis charged af ter
onsite treat ment. Only one case was trans ferred by
am bu lance due to per sis tent chest pain. How ever, she
re cov ered sev eral hours later.
Discussions
Mass gath er ings have been an area be ing stud ied
in creas ingly over the past sev eral years.1 A mass gather ing is de fined as a col lec tion of more than 1,000 people at one site or lo ca tion. 9 The in ci dence of in jury, illness and car diac ar rest at mass gath er ings is higher than
in the gen eral pop u la tion.9 Med i cal ser vice sys tems at
Table 1. Demographics of 28 patients at the rock concert
Age
mean ± SD
median
range
Sex
male
female
Years
20.8 ± 6.4
18.5
13 - 40
No.
Identification
No.
%
spectators
staff
by-standers
22
5
1
78%
18%
4%
No.
%
10
18
36%
64%
Time of patient visit
7
21
Fig. 1. Vol ume of pa tient load at a rock con cert.
before concert
during concert
Fig. 2. Time of visit by faint ing pa tients at a rock con cert.
528
Chi nese Med i cal Jour nal (Taipei) Vol. 64 No. 9
Wei-Fong Kao, et al.
Table 2. Main problems of 28 patients at the rock concert
Main problems
Fainting
Abrasion/laceration/blunt injury
Painful red eye
Abdominal pain
Headaches
Chest pain
Nausea
Upper respiratory infection
Bee-stings
a
No.
a
13
6a
3
2
1
1
1
1
1
%
ALS or BLS
46%
21%
11%
7%
4%
4%
4%
4%
4%
ALS
BLS
BLS
ALS
BLS
ALS
BLS
BLS
ALS
One fainting case had also lacerated wound; ALS = Advanced life support; BLS = Basic life support.
mass gath er ings dem on strate much higher suc cess rates
than even the most ad vanced emer gency med i cal systems (EMS).9 A rock con cert is a mass gath er ing ac tivity of high med i cal use rate. 10 It re quires a spec trum of
med i cal sup port that can deal with an in ci dent from a
cut hand to a car diac ar rest.11 The im por tance of provid ing defibrillators at the sta dium has been rec og nized
for about 30 years.12 It has been re ported that rock concerts had four times the med i cal use rate as bas ket ball
games and three times that of foot ball games.10 There
was a small but sta tis ti cally sig nif i cant in crease in patient vol ume with the in crease of crowd at con certs.10
The pa tient vol ume ranged from 0 to 1000 PPTT.5,13
The mean pa tient vol ume of rock con certs re ported by
De Lorenzo et al was 9.8 PPTT.10 The me dian vol ume
of the pa tient load at rock con certs re ported by Grange
et al was 3.8 PPTT. 5 The vol ume of the pa tient load at
this sum mer rock con cert was 5.6 PPTT, fall ing between the re ports made by De Lo renzo et al and by
Grange et al. In sim i lar ac tiv i ties held in Tai wan, the
pa tient load was com pa ra ble with that of other countries.5,10 However, the range of patient volume was
vari able. Be cause hun dreds fold of pa tient loads and disas ters may oc cur, mass ca su al ties and di sas ter prep ara tion must be con sid ered.
The fact that 36% of cases had oc curred be fore the
con cert started sug gested that med i cal teams should
prepare their services earlier so that medical care
could be pro vided in time.
The common injuries/illnesses reported at the
rock con cert were trauma, head aches, faint ing, syncope, and al co hol or drug re lated in ci dents.1,4,5,12,14 In
our study, faint ing spells, trau mas and head aches were
also com mon com plaints. Al co hol or drug re lated incidents have not been investigated. Lempert and
Bauer have in ter viewed 40 girls who fainted, of whom
forty per cent re ported hav ing lost con scious ness.14 In
our study, three (23%) out of 13 faint ing cases had
con scious ness loss. The per cent age was slightly lower
than re port from Lem pert and Bauer.14 In our study,
12 out of 13 faint ing cases were fe male. The in ci dence
of faint ing spells seemed to be higher in fe males. The
risk fac tors of faint ing spells in clud ing sleep less ness,
fast ing, a long pe riod of stand ing, hy per ven ti la tion,
scream ing, ex ter nal com pres sion of the tho rax by the
push ing masses and stand ing next to the stage where
squeezing is maximal.14 Therefore, the suggested
guide lines for pre ven tion in clude sleep ing, eat ing, sitting, keep ing cool, and stay ing out of the crowd.14
More than half of the cases seen in this summer
rock con cert re quired ALS. At the same time, the poten tial for a ma jor in ci dent al ways ex ists.12 In Tai wan,
doc tors and nurses usu ally par tic i pated in the med i cal
care at the rock con certs. How ever, the prep a ra tion for
emer gency med i cal ser vices such as com mu ni ca tion,
ac ti va tion and re sponse sys tems, tri age cri te ria, training and se lec tion of med i cal per son nel, drills, de sign
for ma jor in ci dents and di sas ter, trans port cri te ria, distri bu tion of re ceiv ing hos pi tals, and in te gra tion into
lo cal EMS were, in gen eral, in ad e quate for most of the
events. From this study, we rec om mend that the level
of care for events such as rock con certs should be set
up to in clude ad vanced life sup port. ALS teams with
ad e quate equip ment should also be ar ranged to prevent de lay ing or miss ing the se vere cases. In con clusion, by this pre lim i nary data, we found that the most
Sep tem ber 2001
Emer gency Med i cal Ser vices at a Rock Con cert 529
com mon prob lem at this sum mer rock con cert in Taipei was faint ing. More than half of the cases needed
ad vanced life sup port. A well-designed EMS sys tem
is man da tory to pro vide ser vices at these events.
Acknowledgments
We thank nurses Miss Shin-Lien Chen, Mei-Hsiu
Shih and I-Fong Huanh, and Mr. Her-I Chen, and doctors, nurses and stu dents who as sisted in the care at the
rock concert. We also thank Miss Traci Loftus for
Eng lish as sis tance.
R eferences
1. Erickson TB, Aks SE, Koenigsberg M, Bunney EB, Schurgin
B, Levy P. Drug use pat terns at ma jor rock con cert events.
Ann Emerg Med 1996;28:22-6.
2. Fulde GW, Forster Sl, Preisz P. Open air rock con cert : an organ ised di sas ter. Med J Austr 1992;157:820-2.
3. Hew itt S, Jarrett L, Win ter B. Emer gency med i cine at a large
rock fes ti val. J Accid Emerg Med 1996;13:26-7.
4. Kerr GW, Jack son AP, Parke TR. The dan gers of tak ing “T in
the Park”. Scot Med J 1996;41:165-6.
5. Grange JT, Green SM, Downs W. Con cert med i cine: spectrum of med i cal prob lems en coun tered at 405 ma jor concerts. Acad Emerg Med 1999;6:202-7.
6. Yang SW. The Lib erty Times 1999, Aug 15.
7. Sanders AB, Criss E, Steck P, Meislin H, Raife J, Al len D. An
anal y sis of med i cal care at mass gath er ings. Ann Emerg Med
1986;15:515-9.
8. Daroff RB, Mar tin JB: Faint ness, syn cope, diz zi ness, and
ver tigo. In Fauci AS, eds. Har ri son’s Prin ci ples of In ternal Med i cine. 14th ed. New York: McGraw-Hill, 1998:
100-7.
9. Mears GD, Yancey AH: Mass gath er ings. In: Tintinalli JE,
eds. Emer gency Med i cine-A Com pre hen sive Study Guide.
5th ed. New York, McGraw-Hill, 2000:32-7.
10. De Lorenzo RA, Gray BC, Bennett PC, Lamparella VJ. Ef fect of crowd size on pa tient vol ume at a large, mul ti pur pose,
in door sta dium. J Emerg Med 1989;7:379-84.
11. Cas tle N. Ma jor in ci dents at large sport ing ven ues. Nursing
Times 1998;94:94-5.
12. Hodgetts TJ, Cooke MW. The larg est mass gath er ing: Med ical cover for mil len nium cel e bra tions needs care ful planning. Br Med J 1999;318:957-8.
13. Streat S, McCallum J, Boswell R, Hunton R. Med i cal services at mu sic fes ti val. N Z Med J 1975;82:76-80.
14. Lem pert T, Bauer M. Mass faint ing at rock con certs. N Engl J
Med 1995;332:1721.
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Wei-Fong Kao, et al.
台北夏日搖滾演唱會病患特質
高偉峰
郭健中
顏鴻章
張 新 陳威龍
吳哲侃 繆 珣
台北榮民總醫院
國立陽明大學
背景
魏建華
李建賢
黃獻白皋
急診部
急診醫學科
台灣雖然常舉辦大型演唱會，每年參與演唱會的歌迷超過百萬人，但在大型演唱
會中，容易發生那些傷病，應如何規劃緊急醫療救護系統，未曾有相關文獻報告。
方 法 於 1999 年夏季，在台北市針對兩場夜間露天演唱會，由預先受過訓練的急診醫
師與護理人員參與可做高級心臟救命術的醫療服務，以預先設計的病患處置表格，記錄
搜集病患資料，以瞭解演唱會時病患的病況、及緊急醫療救護需求，並同時予以積極治
療，以保障歌迷及工作人員的安全。
結果
在 1999 年夏季，兩個晚上的演唱會，每天各接獲 14 位病患，共有病患 28 人，
年齡由 13 歲到 40 歲，平均為 20.8 ± 6.4 歲，其中女性有 21 位。病患以現場歌迷為主佔
有 22 位（79%），醫療使用率約佔現場兩天約有 50,000 位群眾之 0.056%。現場主要問
題診斷為昏倒佔最多有 13 人（46%）
。昏倒的 13 位病患中 12（92%）位為女性，其中
有 3（23%）人有意識喪失。28 位病患中 12（43%）位病患被認為只需要可做基本救命
術的成員 （BLS）處理即可，16（57%）位病患則需要可做高級救命術（ALS）的醫療
團隊照護才安全。
結論
根據國外的報告，大型熱門演唱會是著名高醫療使用率及容易發生失序的活動，
國內演唱會也曾發生百餘人昏倒，40-50 位病患送醫的現象 。從我們初步的資料看來 ，
此次的大型熱門演唱會，最常見的病患也是昏倒而被抬至醫療站。超過一半的病患是屬
於需要可做高級救命術的醫療團隊照護才安全。為確保歌迷及工作人員的安全，國內舉
辦這樣大型的熱門演唱會，也宜有良好緊急醫療救護系統規劃，並有可做高級救命術的
醫療團隊進駐。
關鍵詞
緊急醫療救護、大型活動、演唱會。