Remote Festival Medical: Field Clinics, Telemedicine & Medevac

Remote festivals offer breathtaking experiences far from city infrastructure. However, being off the grid means that any medical emergency requires self-reliance and meticulous planning. Festival producers mounting events on desert plains, isolated islands, deep jungles, or alpine slopes must prepare comprehensive on-site medical services because local hospitals or emergency responders could be hours away. Ensuring attendee safety in these environments involves establishing a field clinic, leveraging telemedicine for expert guidance, and having a solid medevac plan for critical cases. It’s a challenging balancing act of logistics, but with the right preparation and wisdom from past events, remote festival organizers can save lives and prevent disasters.

The Unique Medical Challenges of Remote Festivals

Hosting a festival in a remote location means facing medical scenarios with limited external help. Common festival health issues like injuries or dehydration become more dangerous when immediate hospital care isn’t accessible (pubmed.ncbi.nlm.nih.gov). For instance, at Burning Man (Nevada, USA) – a week-long arts festival held in the desert – over 2,300 attendees needed treatment on-site in 2011 alone, mostly for soft-tissue injuries, dehydration, eye irritations from dust, and infections such as urinary tract infections (pubmed.ncbi.nlm.nih.gov). The nearest hospital was 150 miles away, so the festival organizers had to handle 97% of cases right there on the playa (theava.com). Only the most severe 3% required evacuation to a hospital by ambulance or helicopter (theava.com) (theava.com). This example highlights why self-sufficient medical care is non-negotiable at remote events.

Remote environments themselves introduce extra risks:
– Extreme Weather & Terrain: High heat can cause mass dehydration and heat stroke, while cold nights or high altitudes risk hypothermia. Uneven terrain can lead to falls and trauma injuries. A desert rave in California or outback concert in Australia will see many dehydrated attendees, whereas a mountain festival in New Zealand might deal with altitude sickness or falls on rocky ground.
– Limited Water & Sanitation: If clean water and proper restrooms are scarce, attendees can suffer gastrointestinal infections or other illnesses. Festivals in jungles or undeveloped areas (e.g. in parts of Southeast Asia or Central America) need strict hygiene plans to prevent infections.
– Difficult Access: Remote sites often have poor roads or no roads at all. Ambulances might struggle to reach the site quickly, and cellphone service may be unreliable for calling help. This isolation means the festival’s medical team must stabilize patients for longer and use alternate communication (satellite phones, radios) to coordinate with outside help.
– Wildlife and Local Hazards: In remote countryside or wilderness, consider risks like snake bites, insect stings, or encounters with local fauna. A festival in rural India or Africa, for example, might require anti-venom and knowledge of tropical infections. Even flora can be hazardous (poisonous plants or allergens).
– Delayed Hospital Care: Even after deciding to evacuate someone, transport can take significant time. A patient with a serious injury might be in the festival’s care for an hour or more before reaching a hospital. In some cases (like storms grounding helicopters), the on-site clinic could be the only care for an extended period. The medical setup must function as a miniature emergency room in its own right.

Understanding these challenges is the first step. The goal is to bring medical capabilities to the festival, rather than relying solely on external emergency services. The following sections detail how to do that, covering field clinic setup, telemedicine support, and medevac planning.

Setting Up a Field Clinic On Site

A well-equipped field clinic is the heart of medical operations at a remote festival. It serves as the first (and often only) treatment center for attendees and staff who fall ill or get injured. Setting up an effective clinic in the field involves careful thought about location, layout, staffing, and supplies.

Location and Layout

Choosing the right location on the festival grounds for the medical tent or clinic is crucial:
– Central Accessibility: Place the clinic centrally so that it’s easy to reach from all major festival areas (stages, camping, etc.). It should be clearly signposted so attendees can find it quickly. For example, large festivals like Glastonbury (UK) or Coachella (USA) ensure their medical tents are near main thoroughfares and visible with banners or the universal red cross symbol.
– Vehicle Access: Ensure ambulances or medical vans can drive right up to the clinic. In remote sites without real roads, prepare a path or have off-road vehicles (4×4 ambulances or ATVs with stretcher attachments) available to transport patients from around the site. Also designate a clear area nearby as a helicopter landing zone for air evacuations (a flat area, free of overhead obstructions, marked and secured when needed).
– Safe Distance: While central, the clinic should be in a relatively quiet zone away from the loudest stages. This allows patients to rest and staff to communicate. It also should be on higher ground if flooding is a risk, and sheltered from dust or wind if possible (e.g., upwind of the campgrounds at a dusty desert event).

Design the layout of the clinic to handle multiple patients and scenarios simultaneously. In practice, a field clinic often consists of heavy-duty tents, yurts, or even converted shipping containers and RVs, depending on what can be brought in. Here’s a typical layout plan:
– Triage & Intake Area: At the entrance, have a covered area or small tent where patients check in and get a quick initial assessment. Here, medics determine the severity of each case (“triage”) and direct patients to the appropriate treatment area. A simple color-coded triage tag system (green for minor, yellow for moderate, red for critical) can be used so everyone on the medical team knows each patient’s priority.
– Treatment Stations: Inside the main tent, set up multiple treatment bays or stations. These can be as simple as cots or folding beds with some privacy curtains in between. Dedicate a couple of stations for trauma care (with room for patients to lie flat and for medics to work around them) and others for less urgent cases (like people needing rehydration or wound cleaning). If possible, separate an area for infectious cases – for example, someone with a high fever or a suspected contagious illness – to avoid exposing other patients.
– Equipment & Pharmacy Corner: Reserve one section for medical supplies storage and a small “pharmacy” for medications. Shelving or portable lockers can hold bandages, IV fluids, medications, and equipment in an organized manner. Keep critical emergency gear like defibrillators, oxygen cylinders, and trauma kits at the ready, ideally in a grab-and-go format (for medics responding to incidents outside the clinic).
– Observational Ward: Have an area with a few beds or comfortable cots where patients can rest under supervision. Many dehydration cases or mild heat exhaustion victims just need a place to lie down, cool off, and receive fluids. This ward lets you monitor them for a couple of hours. It’s also useful for patients who are improving but not yet well enough to return to the festival, as well as those waiting for a medevac or ambulance transfer.
– Privacy and Security: Use screens or a separate tent for any sensitive cases that require privacy (e.g., serious injuries, mental health crises, or when performing more invasive procedures). Also consider security – you may need volunteer security or festival staff to prevent overcrowding in the clinic during a major incident and to keep the area calm. Only patients and authorized personnel should be inside, to maintain an orderly environment.
– Lighting and Power: Ensure the clinic has reliable lighting (for night operations) and its own power supply (generators or solar+battery systems) to run medical devices. Climate control is ideal too – heaters for cold mountain nights or fans/AC for tropical heat – to keep patients stable and medications at proper temperature. For instance, the field hospital at Burning Man uses air-conditioned trailers because daytime desert temperatures can soar above 40°C.

The field clinic essentially replicates the functions of an urgent care center or small emergency room. In remote New Zealand or Australian festivals, organizers even use retrofitted shipping containers as clinic units that can be sealed from dust and cooled inside. Whatever structures you use, make sure they are weather-proof, spacious, and well-marked.

Staffing the Clinic

The effectiveness of a field clinic hinges on its staff. For remote festivals, have a multidisciplinary medical team capable of handling everything from a sprained ankle to severe trauma. Key considerations for staffing include:
– Medical Leadership: Appoint an experienced chief medical officer or lead paramedic who is in charge of medical operations. This person makes high-level decisions (like calling for a medevac) and liaises with festival command and local emergency services. In many cases, this will be an emergency physician or veteran event paramedic who has worked mass gatherings before.
– Doctors and Advanced Practitioners: Ideally, have at least one physician on site, especially for larger events. A doctor (such as an ER doctor or general practitioner with emergency training) can perform advanced procedures and make clinical decisions beyond a paramedic’s scope (pubmed.ncbi.nlm.nih.gov). In countries where physician coverage is scarce, consider a nurse practitioner or physician assistant with relevant experience. They can suture wounds, administer a wider range of medications, and guide the team on complex cases. For example, Europe’s biggest festivals often have physicians present, while a smaller festival in a remote part of India might rely on a general doctor from the nearest town volunteering at the event.
– Paramedics and Nurses: These are the backbone of the festival medical crew. Paramedics bring pre-hospital emergency expertise – handling trauma, starting IVs, doing CPR, etc. Nurses (especially those with emergency or wilderness medicine experience) are invaluable for ongoing care like monitoring vitals, giving medications, and managing the clinic when multiple patients arrive. Ensure a mix of skills across shifts. For instance, at a 5,000-person jungle festival in Indonesia, you might have 2 paramedics and 2 nurses per shift; at a 30,000-person desert festival in the US, you might scale up to teams of 5–10 per shift including doctors, paramedics, and nurses.
– EMTs and First Aiders: In addition to highly trained staff, include basic Emergency Medical Technicians, first responders, or even Red Cross volunteers to handle minor injuries and assist the medical team. They can take care of bandaids, blisters, and sunburns, freeing up paramedics for urgent cases. Volunteers with first aid training from the local community can also bolster the ranks (and having local language speakers is a plus for international attendees).
– Specialists as Needed: Consider the festival’s context and attendee demographics. Is it an extreme sports/music festival where trauma is likely? Maybe have an orthopedic tech or a sports medic on hand. An event with older attendees or a yoga retreat might warrant a cardiologist or someone versed in high-altitude sickness if in the mountains. Some festivals also coordinate with organizations for specific needs – e.g., mental health professionals or harm reduction teams for events where psychedelic drug use is prevalent (like having a group such as the Zendo Project to handle psychological emergencies or drug-related anxiety, working alongside medical staff).
– Shifts and Coverage: Plan for 24/7 medical coverage. Attendees can fall ill at any hour, and late-night/early-morning is often when some serious incidents occur (e.g., overdoses or accidents when people are tired). Rotate staff in shifts to avoid burnout – especially in harsh environments. A typical pattern might be two 12-hour shifts (day team and night team) or three 8-hour shifts. Ensure some overlap so outgoing staff can handover cases to incoming staff. During peak festival hours (like afternoon heat or late-night headliner shows), beef up the number of roving medics on duty.
– Local Healthcare Links: If possible, involve local health services in staffing or support. For example, in Mexico a remote beach festival might contract a nearby town’s doctor to be present, or in rural Australia coordinate with the community nurse. This builds trust with local authorities and helps navigate legal requirements (since local professionals will know the protocols for transferring patients to the regional hospital or contacting the air ambulance).

Remember to also arrange for staff accommodations, food, and rest. These team members are working long hours under stress. A dedicated staff camping area or on-site base where medics can sleep, and a system for meals and hydration, will keep your medical team in top shape to care for others.

Essential Equipment and Supplies

What you stock in a remote festival clinic can make the difference between life and death. Since resupply might be difficult once the event is underway, plan for all common scenarios and some worst-case emergencies. Below is a breakdown of critical equipment and supplies by category:

• Trauma Gear: Festivals can generate injuries from falls, vehicle mishaps, or even dancing-related tumbles. Key trauma supplies include:
• Backboards and cervical collars for immobilizing possible spinal or neck injuries (e.g., someone falling from a stage or, like in one case at an Australian outback festival, a camper falling off a van roof who needed spine protection before airlift (www.flyingdoctor.org.au)).
• Splints of various sizes (for stabilizing broken limbs or sprains) and triangular bandages for slings.
• Heavy-duty bandages, sterile dressings, gauze rolls, and tape for bleeding control. Include tourniquets and hemostatic dressings for severe bleeding (in case of a rare major trauma or accident).
• A portable defibrillator (AED) for cardiac arrests and a suction device to clear airways, as critical trauma may involve loss of consciousness or blocked airway.
• Oxygen supply and masks, since trauma patients or those in shock may need supplemental oxygen.
• Basic surgical kits for field wound care: sterile scissors, forceps, suture kits or staple kits to close lacerations, and local anesthetic (if a trained provider can suture on site).
• Neck braces and a scoop stretcher or basket stretcher for extricating injured patients from tricky locations (if someone is injured far from the clinic, medics might need to carry them out safely).
• Hydration and Heat-Illness Supplies: Dehydration is one of the most frequent issues at festivals, especially in hot climates or high-energy music events. Prepare to treat dozens of cases:
• IV Fluids: Cases of severe dehydration or heat exhaustion will require intravenous rehydration. Stock ample bags of normal saline or lactated Ringer’s solution and IV starter kits (needles, tubing, etc.). At large events, hundreds of IVs might be administered over a weekend.
• Oral Rehydration: Not every patient needs an IV; many simply need water and electrolytes. Have oral rehydration salts or electrolyte powder packets and ready-to-drink sports drinks. These are great for those who are light-headed but still able to drink.
• Cooling Equipment: For heatstroke, you need to cool the patient rapidly. Equip your clinic with cool packs/ice packs, misting spray bottles, fans, and a shaded rest area. In extreme cases, immersion in cold water is recommended for heatstroke – consider an inflatable tub or large cooler that can be filled with ice water if you’re in a desert location with intense heat.
• Drinking Water Supply: Ensure the medical team always has clean water on hand (separate from what’s provided for attendees) for both patients and staff use. This includes sterile water for cleaning wounds and drinking water for rehydration.
• Electrolyte Monitoring: If available, having basic diagnostic tools like a glucometer (to check blood sugar, since low sugar can mimic dehydration symptoms or occur in diabetics) is useful. Advanced setups might include a small point-of-care blood testing device for electrolytes, but that’s a luxury – usually, the focus is on treating based on symptoms.
• Infection Control and Treatment:
• Wound Care & Antibiotics: Every cut or scrape at a festival (especially dusty or muddy environments) can turn into an infection if not cleaned. Stock antiseptic solutions (like betadine, alcohol, chlorhexidine), plenty of clean water or saline for irrigation of wounds, and antibiotic ointments. If you have a prescribing medical practitioner, include broad-spectrum oral antibiotics to start treatment for wound infections, skin infections (like cellulitis), or severe respiratory or ear infections that can’t wait for post-festival follow-up. For example, it’s not uncommon to see an attendee with an infected foot blister or a painful ear infection from swimming – having antibiotics on hand means you can start treatment immediately rather than evacuating someone solely for that.
• Disease Prevention Supplies: Use gloves, masks, and sanitizers to protect both patients and staff. In remote tropical festivals (South Asia, Pacific islands, etc.), mosquito nets or repellent spray might be necessary to prevent mosquito-borne illnesses that could complicate patient recovery (and to keep the medics from getting bitten while working!). Also, have COVID-19 rapid tests or other relevant tests if any risk of contagious outbreaks, plus a protocol for isolating anyone with a potential contagious illness.
• Gastrointestinal Remedies: Stomach bugs spread quickly in close-quarter camping. Stock anti-diarrheal medications, rehydration salts, and anti-emetics (to stop vomiting) to manage food poisoning or water-borne illnesses on site. In serious cases, IV fluids and possibly antibiotics for something like dysentery may be needed if a doctor is present. Always encourage festival organizers to maintain high food hygiene standards and clean water, but be ready in case multiple people show up with vomiting – you might be dealing with an outbreak.
• Pain & Fever Management: Have a good supply of common over-the-counter meds: pain relievers (acetaminophen, ibuprofen), fever reducers, antihistamines for allergic reactions or mild allergic rashes, and topical hydrocortisone for insect bites or plant rashes. For moderate to severe pain (from injuries), your medics or doctor might administer stronger pain meds – ensure such medications are secured and regulated (and allowed by law on site). Also include a few splints and wraps for minor sprains which overlap with trauma care but also serve here for comfort.

• Personal Health Supplies: Sometimes attendees simply run out of their personal medications or needs. Stock things like tampons/pads (you’d be surprised how often medical ends up supplying these in a pinch), spare inhalers for asthmatics who forgot theirs (only under medical supervision), and epinephrine auto-injectors for severe allergic reactions. At remote sites, there’s no nearby pharmacy, so the festival clinic becomes the de facto pharmacy for urgent personal needs too.

• Telecommunications & Tech: Equip the medical team with reliable communication tools. Two-way radios are essential for medics patrolling the grounds to call in serious cases. A satellite phone or portable satellite internet unit for the medical lead ensures you can call outside emergency services from truly off-grid sites (some rainforest or desert interiors have zero cell coverage).

• Documentation & Legal: Have a system (even if pen-and-paper) to log treatments and patient info. This is important not just for continuity of care (especially if multiple shifts of medics) but also legally – for example, if someone refuses evacuation against medical advice, you need that documented. Also, consent forms or release forms should be handy in case you need to transfer someone or for handling minors.

Pro tip: Pack all critical supplies in clearly labeled kits (trauma kit, airway kit, burns kit, etc.) so that in an emergency your team isn’t searching for items. Do a drill on day one of your medical crew’s arrival to acquaint everyone with where things are located in the clinic.

Telemedicine: Bringing Distant Doctors to the Festival

Even with the best on-site team, there are times when a specialist’s advice or a physician’s decision-making can be the difference in outcome. Telemedicine has emerged as a powerful tool for remote festivals to get expert medical input without having the doctor physically there. Essentially, telemedicine means using communication technology to consult off-site medical professionals in real time.

Imagine you have a small clinic team with no physician on a remote island festival in Indonesia, and a patient comes in with severe abdominal pain. It could be appendicitis – do you evacuate immediately, or could it be a less urgent issue? With telemedicine, you can call a doctor in a city hospital via satellite link or internet and have them virtually “examine” the patient through video and vital signs, guiding the on-site medics on what to do next.

Here’s how to leverage telemedicine effectively at remote events:
– Equipment and Setup: At minimum, you need a reliable communication device – a satellite-enabled smartphone, a tablet, or laptop – with a camera and microphone. Connect it to whatever network is available (satellite internet units or any cell network if present). There are specialized telemedicine kits that integrate digital stethoscopes or patient monitors that transmit vitals directly, but even a Zoom or WhatsApp video call with a doctor can help in a pinch. Ensure this setup is tested beforehand at the site, and have backups (extra batteries, maybe multiple devices).
– Partnering with Remote Physicians: Arrange in advance a partnership with a medical provider or service that offers teleconsultations. This could be:
– A nearby hospital emergency department willing to take calls from your festival medics.
– A private telemedicine service that operates 24/7 (some companies specialize in event support or wilderness telemedicine).
– Volunteer network of doctors – for example, some wilderness medicine organizations have on-call physicians for expeditions, which can be adapted for festival use.
– Even among your extended team, if you know a doctor who isn’t on-site but is on standby on the phone, that’s helpful.
– Use Cases for Telemedicine: Not every case needs telemedicine – you don’t want to overload your remote doctor with minor issues your team can handle. Establish guidelines:
– Use telemedicine for moderate cases where a physician’s input will guide treatment or evacuation decisions. For instance, a moderate head injury where the patient is awake but had a loss of consciousness – a tele-neurologist or ER doctor can advise if observation is enough or if the signs point to needing a CT scan (thus evacuation).
– If you only have paramedics on site, use telemedicine for any case where advanced medications or procedures might be needed. In some countries (like Germany), paramedics can perform more advanced treatments under a tele-doctor’s guidance and license (pmc.ncbi.nlm.nih.gov). A 2025 study in fact showed that paramedics at a music festival successfully treated a range of injuries and illnesses via telemedicine oversight, with no patients deteriorating due to remote guidance (pmc.ncbi.nlm.nih.gov).
– Consult on infections and illnesses: say you suspect a case of appendicitis, kidney infection, or severe asthma – a doctor can confirm your assessment and even guide initial treatment (like starting antibiotics or additional meds) while evacuation is in progress.
– Mental health or substance-related cases: remote psychiatrists or toxicologists may provide guidance for unusual incidents (e.g., a rare reaction to a drug).
– Tele-triage Station: Within your clinic, set up a “telemedicine corner” where you have the device and maybe a tripod for the camera. When a consultation is needed, one staff member can brief the remote doctor, and if video is possible, even show the patient (with consent). Use this for second opinions or for line-of-sight on patient’s condition.
– Training and Protocols: Train your on-site medics on when and how to activate telemedicine. It should be as simple as “Call Dr. X via satellite phone for any of these triggers: uncontrolled bleeding, chest pain in patient over 40, stroke-like symptoms, etc.” — basically any scenario where time is critical and you’d normally want a doctor or specialist immediately. Also practice using the equipment in mock scenarios.
– Limitations: Be mindful that telemedicine relies on technology. Connectivity issues can arise due to weather or technical glitches. Always have a plan B if a teleconsult fails (like default to evacuating if you can’t get advice and the situation is serious). Also consider patient privacy – use secure connections if transmitting any sensitive data, and be aware of local laws (some jurisdictions might have telemedicine regulations, though in emergency settings it’s usually acceptable to get any help available).
– Success Stories: Many remote festivals have started to incorporate telemedicine. For example, in a European festival, paramedics used a tablet-based telemedicine system to consult an off-site physician for around 8% of patients they saw, significantly expanding their treatment capabilities (pmc.ncbi.nlm.nih.gov). In practice, this meant fewer unnecessary evacuations and more patients getting proper care on-site. Emulating such models can both save lives and save costs (evacuations are expensive and risky, so avoiding a needless one is a big win).

Telemedicine essentially gives your remote festival a virtual extension of a hospital. It can be reassuring for your on-site team to know they’re not alone when a perplexing case comes in. However, telemedicine complements on-site care; it doesn’t replace having a solid medical team or proper evacuation plans.

Medevac Planning and Emergency Transport

No matter how good your on-site setup is, you must be ready to transport patients to a full hospital for conditions you cannot manage on the ground. “Medevac” (medical evacuation) typically refers to urgent transport by helicopter, small plane, boat, or specialized vehicle to get a patient to definitive care. In remote festivals, medevac planning is a lifeline for severe trauma, critical illness, or any life-threatening situation.

Contracts and Coordination for Medevac

In the excitement of festival planning, it’s easy to overlook arrangements for emergency transport – but don’t. Remote festival producers should pre-arrange medevac services well before the event:
– Identify Nearest Hospitals: First, know exactly where the closest appropriate hospital is, and the travel times by various modes. A remote mountain festival might have a small clinic 30 km away but a fully equipped hospital 100 km away. Chart these out: by road (if roads exist), by helicopter, or by boat (for island/coastal events). Include international considerations if near a border (sometimes the nearest good hospital might be in a neighboring country; if so, plan for passport/immigration issues that could arise during transport).
– Helicopter Services: Contact local helicopter EMS providers or private helicopter charter companies that do medical transport. In some countries, the government or military provides helicopter rescues for free or as part of emergency services (for example, New Zealand’s rescue helicopters, or the Royal Flying Doctor Service in Australia’s outback which operates emergency flights). In other places, private medevac companies exist. Establish a contract or memorandum of understanding that during your festival dates, a helicopter (with medics) can be dispatched if called. Work out the basics: how to summon them (satellite phone or radio channel if no cell service), how long it might take to arrive, and how payment is handled (does your event insurance cover it or is it fee-for-service? Generally the event should budget for at least one or two helicopter evacuations in remote settings).
– Boat or Water Transport: If the festival is on an island, a remote beach, or a cruise ship festival, coordinate with marine rescue or boat operators. A high-speed boat might reach the site faster than a helicopter in some cases (or be the only option if weather grounds aircraft). For instance, a small island festival in Thailand arranged a speedboat to be on standby 24/7 to ferry any critical patient to the mainland hospital 20km away. Cruise ship festivals rely on the ship’s medic to stabilize patients until a coast guard helicopter can rendezvous, or the ship diverts to the nearest port. If on a large lake or river, have boats with medical capability (even just to shuttle to a waiting ambulance on shore).
– On-Site Ambulances: Even if you plan to call in a helicopter for the worst cases, having an ambulance (or at least an off-road capable emergency vehicle) on site is important. The patient might need to be moved to a safer landing zone, or driven out to meet an air ambulance halfway. Many festivals contract local ambulance services to station a unit at the event. If standard ambulances can’t handle the terrain, consider renting 4×4 ambulances or equipping pick-up trucks with a stretcher and emergency gear (essentially field ambulances).
– Landing Zone Preparation: If helicopter evacuation is possible, prepare a landing zone (LZ) in advance. This means:
– Clear a flat area of about 25m x 25m (80ft square) if possible.
– Mark it (some use a big “H” or colored tarps, or high-visibility lights at night). But avoid anything that can fly up (so no loose tarps in a rotor wash).
– Coordinate with the pilots on what markers they expect and what radio frequency to use when nearing the site. Have ground crew (security or med staff) trained to secure the LZ during landing (keeping people away, ensuring no flammable debris).
– Check if any permits are needed for helicopter operations in the area – some countries have strict airspace rules, so work with authorities ahead of time.
– Legal and Insurance Aspects: Medevac can be costly – a single helicopter flight could cost tens of thousands of dollars if not covered. Ensure your event insurance covers emergency evacuation or consider requiring attendees to have travel insurance if they’re coming to a very remote, high-risk festival (some adventure events mandate participants carry evacuation insurance). Legally, have a plan for consent and liability: normally, if someone is critically ill, consent for evacuation is presumed, but get a process for documenting if anyone refuses transport (they have the right to refuse, but you’ll want that in writing). Also, clarify with medevac providers about who has medical authority during transport – usually their flight medics take over once the patient is handed off.
– Local Authority Integration: Always inform local emergency services and health authorities about your festival dates and medical plan. In many jurisdictions, part of getting an event permit is submitting a medical plan that local EMS reviews. They might provide resources or at least be on standby. Building a good relationship here ensures if you dial the national emergency number, they know your event and can dispatch help faster. In some cases, local authorities will embed a liaison at your event command center to streamline any external emergency calls.

Decision Trees: When and How to Evacuate

Having medevac contracts is one half; the other half is deciding when to activate them. In a remote setting, over-triaging (evacuating too readily) can overwhelm resources or leave your festival clinic shorthanded, while under-triaging (waiting too long) can be life-threatening. That’s why having clear decision criteria – essentially a decision tree or protocol – is important for festival medical staff. Here’s how to establish one:
– Triage Categories: As mentioned, triage patients as green (minor), yellow (moderate), or red (critical). Generally, any “red” category patient should trigger immediate preparation for transfer after initial stabilization. For example:
– Major trauma (suspected internal injuries, open fractures, significant bleeding) – stabilize airway/breathing/circulation and call the helicopter right away.
– Signs of stroke or heart attack – time is critical; even if you started treatment (like giving aspirin for a heart attack), these patients need hospital interventions ASAP. Initiate evacuation.
– Altered mental status or unconsciousness from unknown cause – treat what you can (e.g., give glucose if low blood sugar is possible, naloxone if opioid overdose suspected), but if they remain unresponsive or critical, evacuate.
– Any patient requiring advanced airway management (if you had to insert an airway or ventilate) or needing blood transfusion due to hemorrhage – these are beyond field care, call for evac.
– Failed Response to Treatment: For “yellow” moderate cases, have a timed decision. For instance, a moderate asthma attack might normally be handled with nebulizers on-site. But if after a set period (say 30 minutes) the patient is not clearly improving, escalate to evac. Similarly, a high fever suspected infection – if the patient looks worse or isn’t responding to the medicines/fluids given within a reasonable time, plan to transfer.
– Specific Protocols: Create condition-specific action plans:
– Dehydration/Heatstroke: Mild to moderate dehydration (dizzy, but coherent) can be treated on-site with IV fluids and cooling. Severe dehydration or heatstroke (confusion, very high body temp, perhaps organ failure signs) is a red category – cool aggressively on-site and evacuate, because heatstroke can cause internal damage that needs ICU care (pubmed.ncbi.nlm.nih.gov).
– Infections: A simple skin infection can be handled on-site, but something like suspected meningitis (severe headache, stiff neck, fever) or a burst appendix requires urgent hospital care. If someone has sepsis (infection causing systemic issues like low blood pressure), that’s an automatic evac after stabilizing with IV fluids/antibiotics.
– Traumas: Use the mechanism of injury and symptoms – e.g., any significant head injury (especially with loss of consciousness or vomiting) gets evac for a CT scan, even if the patient seems okay, because brain bleeds are time-sensitive. Spinal injuries (like a fall from height) – immobilize and evac (as in the Big Red Bash example, where the attendee with a suspected spinal injury was flown out by the Royal Flying Doctor Service (www.flyingdoctor.org.au)). Deep lacerations or fractures could go either way: if you have a doctor who can suture and the patient is stable, you might treat and observe; but if the wound is very large or risk of complications, better to send them to a proper surgical facility.
– Legal Considerations: Ensure your decision tree aligns with local medical protocols. In some locales, certain types of patients must be handled by the public emergency system. For example, in parts of Europe, even if you have an on-site medic, a call must be placed to the national emergency line for serious cases so that they officially log and dispatch an ambulance or helicopter. Work out these procedures in advance with authorities. Also, determine who has the final say to authorize a medevac – usually the highest medical authority on-site (chief medic) in consultation with the remote doctor if using telemedicine. They’ll weigh the medical necessity against the practicality (e.g., if weather says a helicopter can’t fly right now, you may have to stabilize and wait).
– Communication Flow: In an emergency, seconds count, so streamline how the decision is executed:
1. Medic identifies a critical patient and alerts the clinic lead (“Team, this is a red-tag critical trauma”).
2. Clinic lead (or physician) orders, “Activate medevac now,” and a pre-assigned team member contacts the air/boat service immediately with key info (location, patient condition).
3. Meanwhile, treatment continues. The patient is packaged for transport (secured on a backboard, etc., if trauma; or kept on monitors and IV during wait).
4. Festival security is notified to clear routes and the landing zone.
5. Upon arrival of the transport, a quick handover is done: provide a written or verbal report of findings and care given, then off the patient goes.
6. Document the whole timeline for post-event review.
– Backup Plans: What if the primary medevac is unavailable? Always have a Plan B:
– Maybe there is a second helicopter service or the military that can step in if the first choice is busy.
– Maybe ground transport can reach halfway if air can’t come all the way.
– If weather shuts down both air and boat options (e.g., a severe storm), your clinic might have to hold onto the patient for longer. In these cases, having extra medical supplies (and maybe a way to communicate with a hospital physician constantly) is critical. For multi-day festivals, consider worst-case scenarios like being “camped in” by weather – discuss with your team how you’d handle, say, 12 hours where no one can leave by any means.

Case Studies: Successes and Cautionary Tales

To paint a clearer picture, let’s look at how some real-world festivals managed medical emergencies in remote locales:
– Burning Man (USA) – Success in the Desert: As mentioned, Burning Man’s medical infrastructure is a prime example of doing it right. They set up a fully staffed field hospital (“Rampart”) with ~40 beds, X-ray and ultrasound machines, and a pharmacy on the Nevada desert playa (www.ems1.com). With a partnership with a regional hospital, they bring in doctors, nurses, and EMTs who volunteer for the event. Approximately 3,000 patients are treated on-site each year, and only a small fraction need outside evacuation (theava.com) (theava.com). This self-contained system means that even in a location 6 hours from the nearest big city, festival-goers get prompt care. The key takeaways from this success are investing in proper facilities (they even have air-conditioned tents for patient care) and working closely with local medical providers well in advance.
– Outback Festivals (Australia) – Flying Doctor to the Rescue: Events like the Big Red Bash in Birdsville attract thousands to the middle of nowhere in Australia. Here, the organizers coordinate closely with the Royal Flying Doctor Service (RFDS). In one case, an attendee with a severe spinal injury from a fall was swiftly evacuated by an RFDS plane to a major hospital (www.flyingdoctor.org.au) – a lifesaving measure that was possible only because the festival had pre-arranged communications and landing sites for the RFDS. The lesson is clear: in vast remote areas, have an aviation medical link established, and don’t hesitate to use it when a patient shows signs of serious injury.
– Island Festivals (Global) – Contingency Planning: If your festival is on an island (from Croatia’s party islands to tropical islands in the Philippines or Caribbean), you can’t rely on quick ambulance response. One electronic music festival in the Philippines, for example, stationed a speedboat on the beach at all times with a volunteer lifeguard crew, ready to zip an emergency case to a mainland town clinic in 30 minutes if needed. They ended up using it when a festival-goer had a severe allergic reaction that didn’t fully respond to on-site treatment. The patient was transported by boat at night to the hospital and recovered. This underscores the point: whatever unique geography your event has, adapt your evacuation plan to it – even if it means boats instead of ambulances.
– Failures and Warnings: Not all festivals have been well prepared. The infamous Fyre Festival in the Bahamas (2017) serves as a warning. Among its many failures, it had virtually no medical infrastructure on site, despite being on a remote island. Had there been a serious injury or illness, the outcome could have been disastrous as no clear medevac or medical plan was in place. Even though Fyre Festival collapsed before a medical crisis occurred, it highlights that lack of medical planning can compound a festival disaster. Another case: smaller underground events sometimes underestimate medical needs – reports from one jungle gathering indicated the volunteer medics ran out of IV fluids on day 2 because they didn’t anticipate so many dehydration cases in the tropical heat. Some attendees had to be driven two hours to the nearest clinic by friends because the festival hadn’t arranged official transport. These scenarios show that under-preparing can put lives at risk and harm your event’s reputation (and legal standing).

In summary, medevac planning isn’t just about renting a helicopter on standby; it’s about integrating emergency transport into your whole medical response system with clear triggers and coordination.

Key Takeaways

• Plan for Self-Sufficiency: In remote locations, assume external medical help will be delayed. Build a field clinic that can handle common festival injuries and illnesses on its own for extended periods.
• Strategic Clinic Setup: Position your medical tent centrally with good access. Organize the layout into triage, treatment, and rest areas. Ensure power, light, and climate control so you can operate day and night.
• Skilled Medical Team: Staff the event with an appropriate mix of doctors (if possible), paramedics, nurses, and trained first aiders. Rotate shifts to maintain 24/7 coverage, and include specialists or mental health support if the festival’s profile calls for it.
• Comprehensive Supplies: Stock up on trauma equipment (backboards, splints, bleeding control), plenty of rehydration fluids (IV and oral), and infection-fighting supplies (wound care, basic medications). Prepare for environmental specific needs like snakebite kits or altitude sickness meds if relevant.
• Use Technology: Employ telemedicine to get remote expert advice for tricky cases. A simple video call with a doctor can prevent unnecessary evacuations and improve patient care, effectively extending your medical team’s expertise.
• Medevac Ready: Have formal agreements with helicopter services, boat operators, or other emergency transport providers. Identify landing zones or pickup points in advance and make sure your staff and local authorities know the evacuation plan.
• Clear Evacuation Protocols: Develop decision trees for when a patient must be sent to hospital. Train your team on these triggers (e.g., major trauma, no improvement after X minutes, specific symptoms) so that there’s no hesitation or confusion during an emergency.
• Legal and Logistical Compliance: Coordinate with local health and emergency officials when planning your medical strategy. Ensure your medical staff certifications are valid for the region, and that you adhere to any regulations for patient care and transport.
• Learn from Other Festivals: Draw lessons from successful remote festivals (like those that partner with local hospitals or flying doctor services) and note failures (lack of medical prep can ruin an event). Every festival is a learning opportunity – continuously update your medical plan based on past experiences and evolving best practices.
• Safety is Paramount: Ultimately, the health and safety of attendees and staff come first. By investing in robust remote medical arrangements, festival producers protect not only people’s lives but also the longevity and reputation of their event. An attendee who receives great care when ill or injured will remember that just as much as the festival’s performances.