Peter Carlo recalls the first time he was asked to provide medical staffing for a rave – he had had never heard of a rave before. “I was like, a rave? Explain.”
But this wasn’t just any rave. This was the Electric Daisy Carnival, or EDC. It is one of the largest electronic dance music festivals in the world. Its flagship event is held each year in Las Vegas. The last one, in May 2018, attracted more than 400,000 people over three days.
Carlo, who lives in Las Vegas and is currently Director of APPs for USACS East & Mountain regions, has been staffing the festival for the past eight years. Together, Dr. Dale Carrison and he partnered in a company that provides medical oversight for events around the country, including last Summer’s Pride Parade in Los Angeles.
But EDC is the biggest of his responsibilities, and also the most interesting.
“There are a lot of docs who want to do this, and think they can do it,” Carlo said. “But it takes a certain individual.”
Let’s begin with the crowd: 150,000 ravers each day, most of them dancing on little to no sleep, and many of them on some kind of recreational drug. Carlo said the most common was MDMA, commonly known as ecstasy, or “E.”
Then there’s the team: Carlo typically employs 40-50 nurses and PAs, and 10-12 physicians over the course of the event. He also routinely hosts a handful of emergency medicine residents from University Medical Center of Southern Nevada in Las Vegas. “They have a blast. They love coming out there,” Carlo said.
The venue is the Las Vegas Motor Speedway, a 1,200-acre complex about 15 miles northeast of the Vegas Strip. During the event, Carlo transforms an area where NASCAR drivers normally park their cars into a primary treatment area with about 60 beds, 40 fast track chairs and beds, a waiting room and a registration area. NASCAR also has a fixed care center for drivers who get hurt – Carlo uses that area to set up a mobile ICU.
In 2018, the carnival provided approximately 2,500 tents to patrons and allowed them to camp; this area had roughly 30,000 patrons. EDC also allowed people in RVs to camp outside the venue, so Carlo’s operation went to 24 hour a day coverage, with another 20-25 beds outside for the campers. He also sets up an occupational health center just for the five or six thousand workers who staff the event.
The most serious medical emergencies are nearly always related to festival goers on MDMA, Carlo said, or MDMA-associated hyperthermia. “Is it the drugs, is it the dancing, is it something in their brains? We don’t know, and the reason why is because we see the same core body temperatures in patients at our California shows, but in October, inside an air-conditioned venue.” There is some research to suggest that some people simply cannot metabolize MDMA, with potentially fatal consequences.
A few years ago, there was a death at the event – someone on MDMA. After that, Carlo went deep into research with Dr. Carrison and started using a drug called Dantrolene. “There’s only one indication for this and it’s malignant hypothermia in surgery,” Carlo said. Nevertheless, Carlo created a protocol and began keeping the drug on hand at the events. He says it’s been incredibly successful. Dr. Carrison and he have been to conferences and spoke with toxicologists, all of whom said Dantrolene would not work. However, with patients having core body temperatures upwards of 108 degrees, Dantrolene alone was administered and reduced the temperature to somewhat normal within 30-45 minutes.
One year there were nine people whose core body temperatures were 106 to 109.8 degrees. “These people essentially shouldn’t be living,” he said. The protocol in these cases calls for them to receive the medication, be intubated, put into cold water, and transferred to a hospital. The protocol has unquestionably saved lives, Carlo said.
The working environment is not for the faint of heart. “You have to think outside the box,” Carlo said. “All of us who work here have some prior experience working in an austere environment where you have to work with what you have. You have to think on your feet. Because in the end, this is it, you’ve got one chance, once shot to make sure everyone goes home.”
Staffing the carnival takes its toll. Plus, Carlo said he has no love for electric dance music: “By the end of three days I really never want to hear it again. Then, about two weeks later, I’m like, ok when’s the next one.”