Guidelines for Music Festival Event Organisers: NSW Health

 
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) 190XXX
NSW 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                                                 1
Guidelines 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 Reduction
Guidelines 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                                                   3
Guidelines 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                                                   5
Guidelines 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 basins
Guidelines 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 Reduction
Guidelines 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                                                  9
Guidelines 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 Reduction
Guidelines 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                                                11
Guidelines 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 Reduction
Guidelines 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                                                 13
Guidelines 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 Reduction
Guidelines 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                                                    15
Guidelines 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 Reduction
Guidelines 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                                                  17
Guidelines 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 Reduction
Guidelines 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.

Guidelines for Music Festival Event Organisers: Music Festival Harm Reduction                                                19
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