CrowdRx Discusses Medical Safety

But to promoters, that component is vital and one company, CrowdRx, has a unique approach to it. The company, run by Dr. Andrew Bazos, is srongly associated with music festivals and has covered sports and entertainment events for more than 20 years.

CrowdRx is basically an on-site hospital. Fans can be treated on the spot and sometimes sent right back inside to check out more gloving.

This is a dry topic but it’s an essential dialogue.  And Bazos candidly criticized the media’s focus on EDM’s alleged problem with drugs.

What is the difference between CrowdRx and what may otherwise be on site?

Some of these events that have grown quickly could use an onsite emergency medical physician.

In the early days, a promoter would think long and hard about the lineup, the production, ticket sales and even security but, oh, by the way, let’s call up the local ambulance company and get an ambulance there.

That was the extent of the thinking. That led to getting a few EMTs on the grounds. Some may be amazing, but some may be newly licensed and think they can sit around. When you did run into a medical problem, they’d simply take the patient, put him in the ambulance and take him away.

That’s not good. First of all, you lose your ambulance, so you need to have a second ambulance. Maybe you staffed your event with four or five ambulances but, especially in rural settings, five ambulances may tap the town’s supply. The last thing a promoter wants is to go to a town and have a negative impact on the safety of the community. They won’t be invited back and rightly so.

We don’t need to take the patient to the emergency room; we employ an emergency room physician to be on site. That empowers the medical staff to treat on site and he has the jurisdiction and knowledge just as he would if he was in his emergency room. And on site he can say, “Hey, you’re better now. We’ve got you hydrated. You’re safe to walk around and go back to the show.” 

Most importantly we’re not bombarding the local emergency room.

And one physician can save you on ambulances and personnel. And this way we’re getting expertise, seeing every day the problems kids get into at these events.

And they change. When I first started working at Madison Square Garden, I’m embarrassed to say it was 1990 and it was the six-show Grateful Dead run. You can imagine the evolution.

We have specialized approaches that even emergency room doctors aren’t used to seeing.

Can you give an example?

We know some partiers will tend to drink too much water. After eight hours of jumping around in the sun they’ll become dehydrated and fall into the trap of taking too much water. You can actually drop your sodium level, much like a marathon runner will, and make your heart unstable. We now realize electrolytes are a major part of keeping people healthy, especially at these long festivals. We monitor ambient temperatures at the site and in some places employ a device where you can test the sodium level in your blood. We’re ready with IV fluids that have a high amount of saline or salt in them.

Of course, that’s in extreme cases. The easy remedy is to make an emphasis about electrolytes. In the past it was free water; now we’re aggressive about supplying free water with electrolytes. And we have electrolyte products on sale.

I never would have guessed the answer would be “too much water.”

Yeah, it is. The backend of that story is if there are people who are taking other substances that can dilute their system, which can have more of an impact. Even strong young people can get into trouble.

Some of your clients are not associated with SFX.

CrowdRX is a stand-alone company that, under the name Sports & Entertainment Physicians, has done this at venues and festivals around New York City for 20 years. When I was asked to be involved with SFX, we took over more of their events and applied the CrowdRX expertise. Now it’s the go-to provider for many promoters.

Do you have competitors?

We have competitors on a smaller scale, in cities all across the U.S. – for the most part, ambulance companies that have covered a venue for a long time. I really don’t know of a doctor-led event medical specialty company like ours, and certainly nobody who has the knowledge or data for our practices and procedures.

This business has traditionally been driven by the ambulance companies, partly because ambulance licensing in certain cities gives the companies monopolies. Venues tend to keep going back to them. It works in many settings but in medically intense crowds, like we see, you need a higher level of care. It’s much more medically sound to have a physician on site, and to clear a patient to go back to the event or go home. An EMT just doesn’t have that jurisdiction.

Is it true some cities have laws that say people cannot be treated on site?

Yes. I just got back from Amsterdam, a huge country that has made the electronic music world what it is today. That’s one, big country with uniformed policies and procedures, with rules about transportation and ambulance companies.

The U.S. is really 50 countries with 50 sets of rules. Within those countries are cities, which are miniature countries with their own sets of rules.

So one of our challenges has been to stamp out our model across all these jurisdictions without stepping on toes.  Chicago, for example, has a well-entrenched policy. We’ve yet to see it in actual law, but certainly the local municipalities believe that anyone who presents to a medical tent needs to be transported.  Part of that comes from, historically, there’s never been a doctor on site. Part of it is because the ambulance companies want to be in charge. And, pessimistically perhaps, it’s because ambulance transport is a major revenue source for ambulance companies.

There’s an expression: If you’re holding a hammer, everything looks like a nail. If you’ve got an ambulance there, and it’s a billable trip to the hospital and you can get rid of this patient and move on to the next and there’s no doctor on site, it’s a pretty easy thing to do.

It’s not great for the patient or for the event. It doesn’t make you a great host. And it’s not good to the community to tie up hospital beds.

We’re turning it around slowly. We’ve made great progress already in Chicago on the heels of a very successful show at the Navy Piers. We’re chipping away at it.

EDM events aren’t the only events that have problems.  Country music festivals can do with less alcohol.

Yes and I can elucidate. The tendency to come up with anecdotal impressions is easy.

We are going to be seeing a study soon where we looked specifically at deaths that have occurred at concerts across the globe over 15 years. The numbers are absolutely tiny to the order of 15 a year. No death is great but there are deaths occurring, sadly, at forms of entertainment all around our country and the world every night.

Sure, if you look at a drug or alcohol episode at one of our shows, that does get a lot of attention. But if you sit in the emergency room while that show’s going on, say in New York City on a Saturday night, and Bassnectar is playing at Madison Square Garden, there are, in the emergency room, people coming in from all over the city. They’ve been entertaining themselves in other locations. It’s not as high profile if you were at a college frat party or a private home.

So these medical situations are being tagged quite unfairly to the live music industry and, more specifically, to electronic music. It’s a time when EDM is exploding on the music scene in our country, and it’s drawing first-time music aficionados  from14 up. I think our demographic is 14-35 but these are novice partiers. You’re going to pull in some rookies, and we’re seeing it at our shows. At 16-and-over shows you’re seeing kids who don’t know how to have a beer or a drink. They shouldn’t be drinking at all but they’ve made some unwise decisions.  Eighteen-and-over not so bad, 21-and-over not so bad.

But these demographics are getting into trouble outside of EDM events as well.

Still, these are our guests and we treat them that way. We make a big effort to contact parents and they’re very appreciative. They come and get their kids; it’s a lesson for everybody. And they don’t get stuck with an expensive bill from the emergency room.

That’s something a big promoter like SFX can spend money on, to be a great host. On smaller shows, with smaller productions, it’s not so easy. But we’re making an effort to educate new fans so they can be fans for the next 20-plus years.

Once everyone is educated about EDM we’ll be in a better place but right now we’re in year three of this explosion and I’m not surprised we’re having an intense experience medically at a lot of our shows. We’re handling it well and it’s trending better every show. We first adopted our policies at TommorowWorld two years ago to great success. This year we saw a bigger crowd with fewer incidents.

Do you work with the security staff?

That’s another thing that historically has been lacking. Medical and security have been unfairly separated at these events. If we’re not a team, people fall through the cracks.  At our shows, CrowdRX makes it a point to educate security and be alongside them at the gate at the beginning of a show. We’re able to help medically in screening patients who are impaired and unsafe at the door. We want to make them safe, we want to help with any searches. Prescription medicine may be brought in and we want to be sure those who need medicine have it for the show. We also want to make sure people who have medicine that is not prescription stay out of the show.

We’ve also been diligent in promoting the use of drug-sniffing dogs, which act as a visual deterrent and can sniff out small quantities of dangerous substances. We want to make sure that bond with medical occurs and CrowdRx spends a lot of time on the security side.

Does that mean you have a pre-show meeting with security?

Absolutely. Just now, at Madison Square Garden, I asked and was welcome to have our head medical person at the pre-gate meeting – just to say hi. That way, they know they have friends on the medical side and nobody will be strutting his ego out.

And we do that at repeat events – we do 350 events a year – nevermind a new town with a new event.

The last thing we want to hear is that security called for help and nobody showed up, or that security tried to make medical look bad or vice versa. We’re all on the same team.

You told NBC Chicago, “If their parents were there, they would have gone home with their parents. It’s not fair to make the promoter take care of kids who don’t know how to behave. … They’re young, and they’re irresponsible.”

I am a parent of a 16-year-old fan of EDM and I recognize that, when she’s outside my auspices, she may make mistakes. I think that’s part of being a kid, and part of being a parent. I think we’re there to collaborate with parents, but I do think parents should be responsible for their kids and how they’re behaving – certainly when they’re under 18.

That comment was made because if we have a 17-year-old who shouldn’t be on their own, we can’t release them because they’re a minor so we become their babysitter for the show. That means watching them in our medical tent and, if the show’s over and everybody’s going home, sometimes that means taking them to the hospital if we can’t get a parent.

CrowdRX is trying to have extended hours after shows so people can have some extra time to find their parents or get their bearings. And we’re watching people carefully to see they’re going home safely. The tendency is to say, hey, the show’s over, medical is packing up. But it’s just as important to make sure someone is safe leaving as it is coming in. We don’t want them getting hit by a car or getting lost.

Are the patrons you treat appreciative?

Very appreciative. They’re super appreciative of this “ambassador” program, where they can grab someone in one of these friendly shirts and say, “Hey, my friend’s not feeling well. Can you bring us in?”  We will have “ambassadors” milling around the crowd that are peers of the fans, people they can feel comfortable talking to if they’re not feeling well. It’s going to be the most regulated fun event you can have in this industry, and it’s a good introduction for the kids.

And they get actual care rendered on site, then go back to a show. It’s absolutely appreciated. And to me what’s more rewarding is when a 17-year-old kid comes in, maybe had a beer or two, was dizzy and fell down, and we call mom or dad, and they’re overwhelmed that we took the time to do that.

How many people do you employ?

The people on site are generally independent contractors. We try to source the strong medical professionals from the area.

At, say, a 12,000-capacity, indoor show, we’ll typically have 15 medical personnel – minimum one physician and paramedic. Depending on the proximity to hospitals we’ll have an ambulance or sometimes three from a private company. 

Anything you want to stress?

EDM has really caught on and I don’t want to see it tempered by association with illegal activities or drug use that we are seeing, unfairly, in the press. The more we talk about it, the better. I think people who know the business and know the business of medicine realize we’re seeing a small slice of medical issues at EDM events.

They’re unfairly tagging this new industry with that culture.  I prefer people understand that because we’re drawing young, new fans, we’re also drawing the highest maintenance group of fans. Because of that, we’re seeing a number of medically intense shows that we haven’t seen before, but that’s the nature of this – they’re young, stupid kids. And I say that in a nice way. I was one as well. The CrowdRX’s of the world are there so ….

 … so they can become dumb adults.

Exactly. I’d rather have a dumb adult than a dumb 16-year-old. And I’m going through this as a parent. When I take my daughter to see Hardwell next week in New York, she’s going to want to bring a friend. I have control over my daughter but, believe it or not, when my daughter invites a friend – even though the friend knows I do what I do – I still oftentimes have to speak to the mom and explain the event.

We have to learn a lot about entertainment, recreational drinking and other activities and this is one small segment.  I applaud you to recognize this and give us a forum to continue to do it.

I will say that I haven’t seen much attention given to this in the media and I’m surprised.

I kind of am, too. I can tell you that it’s not sexy. I did this big panel in Amsterdam and people would much rather hear about lighting, ticket sale techniques, booking artists and contract negotiations. That’s the sexy stuff. The dry stuff doesn’t hit the radar screen, unless it’s a disaster like ebola or a death at a concert. Nobody wants to talk about the routine stuff. Doctors in general are pretty boring to hang out with and don’t make for good copy.

But we do need to get this out in a proper way rather than when some disaster happens.

People in this industry didn’t find safety to be sexy until the Indiana fair stage collapse.

Exactly. But we’re chipping away. I think it will help if we get publications like yours talking about it, and I think promoters are thinking about this more and more. 

I’ve been so impressed at how SFX has embraced it. They just never worry about dollars or ticket sales. If I say, “Gosh, we should make this an 18-and-over show because that’s the safest way,” they’ll say, “Great. That’s what we’ll do.”  I’ve never had any kickback on it, and that’s the dedication we need from all promoters. If we don’t make it safe for our fan base, it won’t have the longevity EDM has had around the world.

Kids are loving it more and more. The shows are getting bigger and there are more of them. We want to keep the trend going.

(We asked Insomniac if they had a similar program. Spokeswoman Jennifer Forkish replied: “Providing onsite medical services and peer outreach programs are policies that Insomniac has embraced for almost two decades and we are really happy that other companies are joining us and taking this very important issue seriously.  Dance music events are just like any other mass gathering; it would be irresponsible not to provide medical services when you have anywhere up to 135,000 people in one place. When it comes to health and safety it’s not about competition, it’s about putting the fans first.”)