AFTERBURN REPORT 2011
EMERGENCY SERVICES DEPARTMENT
This was a year of highs and lows for the Emergency Services Department (ESD). It was an amazing year thanks to Humboldt General Hospital's integration into Black Rock City's emergency services, and it was one of our worst years due to radio technical problems that we were unable to fix adequately for the Department of Public Works.
Given that medical services are critical, it was imperative that HGH had a successful first year. ESD managers spent a considerable amount of time in the planning phase in meetings and mentoring HGH managers about what to expect and how to handle working in the unique environment that is Black Rock City. Likewise, on playa, ESD managers continued to spend time supporting HGH to ensure they had the information and resources they needed to succeed. The result of all the time and effort to integrate HGH into ESD and Burning Man was a resounding success. The addition of new clinical resources (x-ray, ultrasound, and laboratory) reduced transports off playa significantly compared to previous years. This reduction was almost entirely due to being able to rule out medical conditions to avoid needing to refer the patient to Reno for diagnostic follow up. Over 200 x-rays were taken on playa that eliminated many unnecessary trips via ambulance or other means. This has several distinct benefits to not only Burning Man participants, but to area residents as well. First off, Reno hospitals reduced their patient load by eliminating these nuisance transports or referrals to the emergency department and urgent care clinics, which directly benefited Reno citizens visiting a hospital with shorter wait times. By ruling out medical conditions on playa, patients at Burning Man didn't have to pay for ambulance transport and ER visits. Significantly this helped reduce the need for helicopter transports by 55% which typically costs a patient $25,000 if they have no insurance. Finally both ESD and participants benefit by having advanced life support units more available on playa for critical needs. This last benefit allowed for more effective use of the EMS system and effectively functioned as a resource force multiplier.
The entire ESD management team was pleased to welcome Humboldt General Hospital (HGH) to the playa to provide our advanced medical care at the Rampart clinic (a homage to the old EMS television series "Emergency!" from the 1970s) in 2011. For the first time, medical was equipped with laboratory, radiology, and ultrasound services. This had a positive impact on decreasing the numbers of people requiring medical transport to Reno to rule out a condition or injury.
ESD and HGH together logged 5,748 patient contacts in 2011, 1,048 (19%) more patients than in 2010, with a peak combined patient volume of 1,125 patients (25% increase over 2010) seen on Saturday, September 2. Most of these patients were walk-ins with minor medical issues.
Of the 5,748 patient contacts, 5,011 presented themselves to ESD or HGH for medical care while 737 required emergency response units from ESD and HGH to respond in the field, a 31% increase over 2010. This total averages to one EMS call in the field approximately every 20 minutes. We posit that the increase in call volume was only partially due to anticipated annual increases but also partially due to having HGH fully integrated into our dispatching system which allowed for capturing more accurate statistics than in the past.
Approximately 38% of the total patient volume involved minor injuries such as blisters or cuts. Other less common patient categories included dehydration (6.1% of total patients), orthopedic injuries (6.9%), wound rechecks (2.8%), and eye problems (5.3%). Other medical care categories included urinary tract infections (3.6%), difficulty breathing (1.2%), abdominal pain/diarrhea (2.6%), burns (2.1%), allergies/insect bites (3.3%), headaches (1.8%), and lacerations requiring sutures (2.1%). All other chief complaint categories were at or below 1%. The numbers for alcohol- and drug-related patients continue to be remarkably low for an event of this size. In 2011 ESD and HGH treated a total of 57 drug related patients (0.9%), and 85 total alcohol-related patients (1.6%). These numbers do not necessarily represent drug and/or alcohol overdoses, only patients for whom drugs or alcohol were the primary reason for seeking medical care.
Of the 33 patients transported to Reno hospitals for additional care in 2011 (a decrease of 27% from 2010), 28 were stable patients transported by ground ambulance, and 5 (a 55% decrease from 2010) were deemed critical enough to be flown out by helicopter. The decreased need to transport patients off playa can be attributed at least in part to the availability of diagnostic equipment such as lab tests, x-ray, and ultrasound on playa, services previously unavailable on playa.
Unfortunately, in a city of over 50,000 people, unwanted outcomes are inevitable. There was a single cardiac arrest but with swift intervention a return of spontaneous circulation was achieved. The patient was transported to a hospital in Reno and showed signs of having a positive outcome 24 hours later. Another participant who sought treatment for a headache was ultimately transported to Reno and diagnosed with an acute subarachnoid bleed. It was reported that the patient expired after life support was discontinued.
Communications Branch, Dispatch Group
The ESD Emergency Dispatch center handled 1149 calls for service in 2011, an increase of 38% from 2010. Call types include everything from requests for traffic control or public assistance to fire and emergency medical calls. This averages as one new logged dispatch incident once approximately every 13 minutes during the event operational period. In addition to new calls, dispatchers have the task of managing initial requests for Black Rock Ranger or Law Enforcement response, all active ESD calls, and all of the ESD response units in the field, which during peak hours can be as high as 30 EMS, Fire, Mental Health, and command resources.
We posit that the increase in call volume was only partially due to anticipated annual increases but partially due to having HGH fully integrated into our dispatching system, including unit dispatching and resource tracking, something that wasn't done in the past. As part of this integration ESD Dispatch also handled all communication with and requests for, air ambulance units. This responsibility furthered our role as the central point of contact for emergency service resources.
Mental Health Branch
The Mental Health Branch responded to 48 calls in 2011, which represents a 45% increase over the running average. Just like medical, temperature and environmental conditions can affect client volume, but the correlation is much weaker, so the numbers tend to vary as the human factors involved in mental health are obviously less predictable. The breakdown by case type includes 23 psychiatric clients, eight cases related to domestic violence, nine sexual assault cases and five 'Legal 2000' evaluations (to determine if there is a danger to self or to others as a result of a mental illness). Two of the sexual assault cases merited evidence collection exams in Reno and one Legal 2000 warranted transport to a facility in Reno. The Mental Health team coordinates these transports and works closely with law enforcement, the sexual assault response team in Reno, and other agencies to support clients once they leave the playa. Additionally there were two on playa follow-up and five post event follow-ups.
The team increased in size this year and as a result the increase in call volume was handled without straining available resources. Additionally the team continues to expand the department specialties to include more service providers who have a specific professional skill set with children and adolescents. The mental health and medical branches of ESD continue to integrate with and support Sanctuary, and this increased coverage will continue to evolve into 2012 with 24 hour coverage of ESD resources to support the Rangers working there.
The Fire Branch responded to 28 fire-related calls for service in 2011, which represents a 8% decrease over the running average.
The integration of ESD Fire personnel, including all of the Burn night incident commanders at the daily meetings with Fire Arts Safety Team (FAST) were productive and a positive collaboration. This allowed ESD Fire to proactively create a response plan and the Circle of Regional Effigies (CORE) was an example of such integrated planning. The CORE was a challenge to plan contingencies for as the Man was clearly identified as an exposure or threat to conflagrate when surrounded with 23 burning structures. The early advantage of information allowed ESD fire to prepare the standard ESD Rapid Intervention Team response to an art burn, and provide a task force prepositioned and equipped to prevent the Man from ignition on Thursday. The primary expected threat to the Man would be from hot embers carried by the wind and providing ignition points on the Man and the proximal structures. ESD fire marshaled technical equipment to detect and extinguish any ember ignitions before they could cause significant damage. Using a Forward Looking Infra-Red (FLIR) monitor, fire fighters were able to locate small collections of embers or "hot spots" and extinguish them with small amounts of water. Several contingencies were in place should ember cast be greater than what a small extinguisher could suppress, and prepared to go all the way up to using master stream "water cannons" on the dedicated fire engines. Fortunately all of our planning and contingencies were favored by very pleasant weather and no wind. All of the other art burns were planned for and supervised with sufficient personnel and equipment to the degree that it all seemed very "normal". Performing a safety walk-through of structures prior to burning was aided by using the FLIR to assure no personnel had managed to hide interior of a burn structure.
ESD Fire responded to three significant fire incidents in 2011. Two were RV fires, one involving an engine, and the other an interior compartment. Quick and professional response achieved a quick control of both incidents. Self Contained Breathing Apparatus (SCBA) was used in the interior compartment as it was inundated with smoke. A third incident involved an art car and trailer that had a fire start from the electrical equipment and quickly carry to the decoration materials. Participants evacuated the vehicle, however the first responding fire engine experienced a pump failure and the second due engine attacked the fire to effect. The failure of the first engine was found to be from contamination in the fuel, and the wash-boarded streets of Black Rock City resulted in the tiny "floats" in the carburetors bobbing and flooding the gas engines that run the fire engine's water pump. A procedure to mitigate this was developed and it's now a standard operation to close the fuel valves to prevent this from reoccurring.
The firefighters who participate with ESD in both fire and medical capacities bring vast professional experience to the playa regardless whether they come from rural or the largest urban agencies. We believe that part of what makes them successful is teamwork and familiarity with using an Incident Command System (ICS). ICS provides a flexible response and common terminology to ensure that many different components can be brought together for life-safety, stabilization of events, property conservation, and minimal impact on the environment. It is also a credit to many seasoned BRC veterans who understand the infrastructure and the culture to be responsive when it counts and to guide new volunteers towards successful participation at the event.
Communications Branch, Technical and IT Groups
Upgrading multiple radio systems this year was challenging, but when the system that was most crucial to the DPW wasn't performing as expected, it took a huge toll on the technical team to attempt to mitigate and solve both the symptoms and the cause in real time. Implementation of new systems requires extensive tuning that often takes several years to polish to the point of optimum system performance. This has happened with every major system introduction on playa and while we will continue to diligently evolve the system the only way to test it is under the load of the event itself. Unfortunately that means certain classes of problems found during an event cycle can't be resolved until the following year.
On a related note: The laws of physics are one of the main limitations on radio equipment. Some people see radios as being "black boxes" that "automagically" work without any understanding of the underlying technology or how physics affect the performance of the system. As such understanding shadows, impacts of temperature and metal shielding (for example, standing next to or inside tractor trailers and containers) is a key part of end users successfully using radio equipment. Another key impact that affected system performance was the extreme solar flare interference on the radio system. At its peak, the level of solar activity at "X7" (that's 25 out of a possible 27 point scale, see http://www.nasa.gov/mission_pages/sunearth/news/X-class-flares.html for more details). These solar flares affected communication systems all over the globe and caused a number of problems, including affecting range, signal mixing or other unpredictable issues that could cause two different systems that normally don't interfere with each other to do so.
Despite problems with implementing some of the new technologies and solar flares, a number of successes were also noted:
- Implemented new digital trunking and conventional radio systems.
- ESD Computer Aided Dispatch software had 4 major and 16 minor feature updates and 12 bug fixes (864 lines of code added and 1042 lines deleted, resulting total 15718 lines.)
- ESD Paging software had 2 major and 14 minor feature updates and 5 bug fixes (337 lines of code added and 84 lines deleted, resulting total 9644 lines.)
- Redesigned and replaced fiber optic data cable runs and console data cable runs (25-pair cable).
- Replaced ESD servers and related uninterruptible power supplies (UPS).
- Added a fourth dispatch console and computer to expand the capabilities of ESD dispatch.
- Implemented auxiliary air conditioners for the radio and server equipment racks.
- Implemented barcode inventory and management for pagers, speeding workflow by at least 400%.
ESD continues to provide, under the leadership of ESD Deputy Chief Penny Stone, an out-reach program coordinated with Kidsville to provide a day of outings and visits to all the operational areas of ESD for a large group of kids and the Black Rock Scouts. This was the second year of this activity, and it was a huge success for our responders and the kids. Our volunteers feel this is a special gift that they can provide to our youngest participants.
As the city becomes larger and more populated, and the art potentially more hazardous, and the wear and tear the environment imposes on equipment, ESD leadership will be looking at trends and methods that will allow us to keep pace with the event's needs. Riding the edge of risk is an exhilarating experience, however the participant community will likely expect that when things go astray there are prepared and well-equipped response services on scene in case of emergencies. The responders of ESD truly embrace the core values of our department and the culture of the event. They gift their skills and training as their concerted participation to Black Rock City. They also very much want to express their creativity and camaraderie through the 10 Principles. The complexity and maturity of the ESD theme camps shine brightly in their efficiency, especially in regards to recycling and MOOP (Matter Out of Place) control. For the first time in 2011 our volunteers presented a burlesque show to showcase their otherwise unrecognized talents to the citizens of Black Rock City.
For more information about ESD please refer to the ESD history page and the ESD sub-domain at http://911.burningman.com.
Joseph Pred, with contributions from Kate Gonnella, Anna Duffy, Humphrey Ogg, Hugh Kane, Dave Spencer