It’s a warm summer day in middle Tennessee, a bit muggy with an occasional cool breeze. The skies are a magnificent blue, and the clouds seem all but perfect as we travel into Great Stage Park. Entering the main medical compound, we find a labyrinth of tents around the established landing zones. The EMS tent, main medical tent (an on-site clinic staffed by physicians, nurses, EMS personnel, etc.), shower tents, and many camping tents line the perimeter of the fenced-off compound. More than 80,000 people will attend Bonnaroo.
The main medical area is the culmination of many years of planning and learning from experience how to best serve Bonnaroovians, as they like to be called. National Event Services (NES), the primary medical contractor, works closely with Coffee County EMS Director Michael Bonner, and they’ve prepared together for the most likely scenarios. They also have contingency plans for unlikely events and have positioned medical caches strategically around the complex. EMS providers staff plaza stations and medical tents around the clock. Few patrons leave the venue, choosing instead to camp on site.
The Bonnaroo Music & Arts Festival came to life in 2002 as a recreation of the music festivals of the 1960s, ’70s, and ’80s. In 2003 Rolling Stone named the first Bonnaroo one of the top 50 moments in rock and roll. After 2003 the festival purchased the 650-acre farm where it was held and turned it into Great Stage Park. During Bonnaroo Manchester becomes the seventh-largest city in Tennessee.
Over half the 17 ambulances in Coffee County belong to the primary EMS provider, Coffee County EMS. Needless to say, local resources run thin, but festival organizers work with local EMS providers to assure medical coverage meets the requirement of Tennessee’s mass-gatherings law.
When the initial festival became an overwhelming sellout, organizers realized they would need some additional support for medical, security, and sanitation services. Organizers contacted local officials, as the event has a significant economic impact on the area. Coffee County EMS routinely works with its mutual aid contacts and aeromedical transport services (Vanderbilt LifeFlight and Air Evac Lifeteam) to ensure transport resources are available for the event.
Carl Monzo, president of NES, explains that every venue is unique, and one plan doesn’t fit all situations. “Each community has its own infrastructure and will have different support needs based upon the size and demographics of the crowd,” Monzo says. He believes the best role NES can provide is to support the infrastructure in a way that the event doesn’t overwhelm local resources.
Coffee County EMS works closely with NES to maintain coverage with resources from around the region. State-licensed EMTs, paramedics, nurses, and physicians are brought in by NES to supplement Coffee County EMS providers. They treat as many issues on site as possible, reducing impact upon the local healthcare system. Their dedication to proper patient care is displayed at the entrance to the medical area, where a large sign reads Entering a Safe Haven, and others nearby say You Can Tell Us—No Judgements. These signs echo the sentiments all EMS providers hold. It’s almost a shame it has to be stated. Everyone should free to talk about what is really going on and what happened or is happening to them, allowing us to care for them properly—physically and emotionally.
Security was on the job, and we were not permitted onto the grounds without our credentials. Walking around during the morning, taking pictures and looking inquisitive, I was actually stopped by a supervisor from the NES staff and asked what I was doing. He introduced himself as Josh, and we spoke for a few moments while I rattled off my assignment and plans for coverage. See something, say something—I wasn’t offended, I was reassured they took their jobs seriously.
A couple of the NES medical personnel I spoke with wore different hats than their everyday jobs. A career paramedic from just outside Chattanooga, one woman had over 25 years of primary EMS field experience and had been with NES at Bonnaroo and other events for at least 10 years as a side job. Another young man from Nashville worked as an ER nurse and had only been with NES for a couple of years at Bonnaroo. They both enjoyed the gig and planned to come back as often as their other jobs would allow.
Great Stage Park, at nearly 700 acres, uses a basic system for attendees to seek medical care and report their location: balloons. A large numbered balloon is tethered above the information/help booth in each camping/parking plaza. Patrons need only make their way to the booth and report their need to receive care from the personnel there, or care will be called in as needed. Where needed modified carts whisk the patient to the main medical tent for further care and treatment by a physician. Ambulances and medical helicopters are also available for the rare instances where a patient must be sent to a hospital. The balloons also help patrons navigate their way through the farm to the different stages and offerings within Bonnaroo.
The state EMS office worked with Coffee County EMS officials to implement patient tracking with the use of the Tennessee SMART triage tags and a downloadable smartphone app (GER’s HC Standard) that allows the user to scan the barcode on the tag and input patient data. The tags are scanned if the patient is transported off-site in order to track their flow through the system using the TNCRN (Tennessee Countermeasures Response Network), funded by the Tennessee Department of Health’s Emergency Preparedness Division. The system appears to work well, and the software company had personnel on site last year to assist with questions, demonstrations, and troubleshooting any glitches.
Attendance at events and festivals has been waning in the past few years. Bonnaroo 2019 was a sellout, surpassing most expectations. The high influx of attendees and staff came with the usually increased need for medical care. Medical coverage performed at high levels without overtaxing their resources—a tribute to the professionals who staff the carts, tents, and ambulances.
Attending Bonnaroo was a good reminder that the venue’s infrastructure and demographics of the attendees are paramount in preparing for such an event. It’s a far different crowd at the NASCAR events I’m used to. Bonnaroo’s crowd is much younger and self-expressive, with almost all attendees camping on site for the duration. Around-the-clock medical services at full staff are the norm, rather than peak staffing during the day as at a NASCAR venue.
For more coverage of MCI preparation and response, see EMS World's August issue.
John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office.