CrowdRX At Burning Man

Pollstar featured the medical team CrowdRx approximately a year ago. Recently, we were offered the opportunity to visit the team onsite at Burning Man. Why not? 
at Burning Man 2015

The difficulty is this is one sensitive subject – emergency rooms. Because of patient care and privacy issues, access was limited, but we did spend Labor Day near one of the emergency units, along with watching The Man burn. We got some neon necklaces and a gist of the operation. It was a positive experience. In a nutshell, it was a pretty mellow affair. CrowdRx’s business model is to shift promoters’ and venues’ reliance on ambulance service to an onsite, physician-led medical service that provides doctors, paramedics and/or EMTs, depending on the event.

Event promoters assume medical services are too costly; CrowdRx argues it can be equivalent in cost. Whereas ambulances require transport costs, onsite care compensates that by deploying “event-specific levels of staff” at the event itself, plus reduces the strain on the local emergency rooms. The company even argues it saves lives with this approach. Last year, CrowdRx was well-established in New York City and Philadelphia, handling medical coverage needs of Yankee Stadium, the Philadelphia Phillies, Bonnaroo and Madison Square Garden, among others. Since then, the company has made an effort to expand across the country, including the Burning Man contract.

It began working with Live Nation at The Gorge in George, Wash. – a venue that had been in the press because politicians wanted to tack on a ticket fee to offset the increased transports to Quincy Valley Medical Center during events like the Sasquatch! Music Festival.

At Burning Man, CrowdRx had dedicated pilots to transport patients to Reno if needed, but it also had a healthcare system complete with emergency physicians, nurses, paramedics, X-Ray facilities, ultrasound, a medical laboratory, a pharmacy, and its own fleet of ambulances roaming the playa. The medical treatment and associated costs were paid for by Burning Man and included with the cost of the ticket. CrowdRx also touted that it was able to obtain for the first time in the event’s history a Nevada license for the facility and medical laboratory, “passing criteria to be officially recognized as an Independent Center for Emergency Care.”

The emergency care center was dubbed “Rampart” in honor of the TV show “Emergency!” but we didn’t see anybody yelling into Motorola radios. It was a pretty chill place, with visitors who were appreciative, talkative and whose needs were as routine as a stitch on a pinky finger to as severe as putting a femur in traction after a skydiving accident.

In the latter case, the patient would ultimately be returning to Canada to complete his treatment; CrowdRx Chairman Dr. Andrew Bazos told him to make sure that any doctor he spoke to understood that the bone was reset by a doctor. The CrowdRx team transferred X-ray images to the patient’s smartphone so he could send them ahead to his treating physician.

That weekend, CrowdRx also handled the U.S. Tennis Open, Madison Square Garden, Electric Zoo and a Dave Matthews Band concert. It would soon move to covering the Pope’s visit to MSG and, concurrently, the unlovely events of TomorrowWorld.

Before leaving, Pollstar spoke with Dr. Bazos, Connor Fitzpatrick and Burning Man Medical Director Dr. Jeff Westin. Fitzpatrick, a former financial consultant who trained at Cornell University and co-founder of a company that builds apps for paramedics and who, if needed, can also fly a plane. The interview took place in a “dhomain,” a transportable, inflatable bubble that was introduced to festivals this summer. CrowdRx used it as breakroom for the staff. 

So how much has CrowdRx grown since last November?

Dr. Bazos: Where we’re sitting (the Nevada desert) is a good example. The size of our company has literally enabled us to meet the manpower demands of the Burning Man assignment. Carl Monzo, our co-founder, was approached by the directors of Burning Man to consider covering the event. The merger between our two companies has really given us the resources to handle events of this scale. We’ve created this one-stop medical shopping option, which takes the headaches away from promoters top to bottom. When I began working with Madison Square Garden in the 1980s, event operations staff were ordering medical supplies and equipment they didn’t know about. From a liability perspective, medical makes everybody nervous. Venue operators and promoters would much rather unload that responsibility to medical professionals.

Certainly people are scared of liability, but are they hesitant to this service rather than another?

Dr. Bazos: I think they’re more and more understanding, especially around the critical news stories that have happened at many shows. You see what’s happening in L.A.., where promoters are becoming increasingly fearful that they will lose venues and shows to medical issues. Or it could be something as simple as overrunning a local emergency room, even in big cities like Chicago. When you think of it, promoters are essentially throwing parties at “their house” so they want to take good care of their guests. Promoters are held responsible for their attendees’ conduct, health, and safety, be it alcohol, drugs, or maybe falling down a stairway. Studies have shown that more rapid medical response leads to greatly improved outcomes.

How many people have contacted you since last year?

Bazos: Over a dozen promoters and venue operators reached out to us in the past few months. CrowdRx has been in the press a good bit and been asked to present at several industry meetings. We’ve been to industry conferences, and I’ve given some talks to venue management conferences where people will come up afterward and say, “Hey, I’ve had a problem with our current coverage. Can you help us out here?” Also some of the smaller clubs who have not had coverage are rethinking it, and putting EMTs and/or paramedics in place. We are fortunate to cover many of the major music festivals already including Bonnaroo, Coachella, and Lollapalooza; companies like Live Nation and AEG are adding festivals all of the time and we have leveraged our experience to compete for this new business.

What kind of problems are venue operators seeking help with?

Bazos: A lot of venues are reaching out to us, saying, “We’re having troubles with too many transports.” In these cases, we will often speak with local regulatory agencies and work with the venue to implement an improved medical plan. Understanding state and local regulations is key; it often means 50 different sets of rules that we need to understand. With a lot of these EDM shows and their high transport rates, promoters can lose a venue so we will emphasize onsite treatment. We don’t want to insert all our people; that’s not our style. We’ll go in working with local doctors and medics, like we did here at Burning Man, who are already licensed in the state, and give them a playbook. Sometimes that’s all we need to do.

Why would a promoter with his eye on the bottom line want to pay more for CrowdRx and, on the backend, how much do they save?

Bazos: Oftentimes our costs are not much different than a traditional ambulance service. We realize that when we practice medicine we are not doing it with a bottomless pit of money. Promoters are in business to turn a profit. Some are public companies, some are little clubs, but they’re not doing it for charity. We realize cost is important. What we’ve found is when we go into new areas and cities, the medical budgets have skyrocketed because no one knows what the care should cost. Again, how are promoters supposed to know what a fair price for an ambulance and a paramedic is in Houston or Atlanta? In New York, staff and ambulance pricing can vary by 100 percent. Oftentimes we come in to a new venue, look at the prior medical budgets and say, “Tell that ambulance company it is charging an embarrassing number based on national or regional rates.”

If you got a surgery bill from me, you don’t know what a fair price is. You have no idea. You may be a little shocked by it but in the end you’ll just pay it, or the insurance company pays it. CrowdRx can come in and say, “Theatre A in Chicago, you’re paying $X to host a 4,000-person event and I see your hourly rate for your ambulance company is full retail, and you do 200 events a year. That company should be dying to cover your venue and offer you a much better price – it’s a nice perk for its employees besides.” We can help those negotiations based on our database of national rates… We know the cost per-hour for an EMT in rural Tennessee, at Bonnaroo, in New York City and everywhere in between. We can do some financial analysis as well, and I can guarantee that we can put a doctor in at some of these places and actually cut down on personnel and cost.

Doctors are not as expensive as you would think. People think, “Oh my gosh, it’s going to be $1,000 an hour.” First of all, these are fun events, and there’s a contribution to the community, and if you give the doctors a couple tickets for their friends, you don’t have to pay that much for a doctor. What does a doctor do? It allows onsite decision-making, it eliminates transports, which we just saw (with the bone reset). By cutting transports, you can eliminate the need for an extra ambulance at your venue for 300 events a year. It’s through the roof what you save. And you’ve made your fans happier because they don’t have to leave, sit in a hospital room for two hours and get delayed care.

Anything else?

Westin: I just want to echo what Andy is saying. Especially in a very remote event, you have people having accidents, you have this golden hour but when you have a two-and-a-half hour drive from the nearest large-scale hospital it makes a difference. We can provide the care immediately and at least get things started. And for a lot of these things, they’re not that major; you can take care of them onsite. That’s something that Burning Man looks for because it’s part of their self-reliance ethos and to keep people involved in the event. Past models have led to more transports. > As you expand, how do you keep in charge of it? Bazos: The festival business is seasonal and that’s one of the downsides of this business. As you know, many of these events overlap, especially in the summer. The festival season is pretty well defined and we’re in the latter third of the season here. We have managers who are in charge; in the winter, we go through the entire festival list, and everyone picks which events they want to manage.

Can you double your business in the next year?

Bazos: Definitely. Our model is very scalable. It’s a playbook that we designed. Tell us how many people will be there, if it’s indoors or outdoors, the temperature, proximity to a hospital, event type, age, alcohol, drug risk factors, etc. We can review our database and predict how many and what type of staff should be onsite and how many ambulances are needed. Dr. Westin can tell you from the emergency medical literature that there is a wealth of statistics out there that you can predict you’re going to see. We can pretty much dial it in: country music will be a bit of a cantankerous group. At a Red Sox versus Yankees game there’s going to be some physical trauma. EDM will have young people partying for many hours in the hot sun. At Barbra Streisand you’re going to see ailments typical of an older population including chest pain.

What’s interesting, to me, is that I’ve seen patients here that are just nice people, and the humanity doesn’t show up in the media. You read the statistics and don’t see that these people can be calm and personable but they don’t appear that way when bundled into an emergency room statistic.

Bazos: I completely agree. I think this event in particular attracts some really lovely people from all over the world. This is my first Burning Man and it’s a really crazy, special event and I finally got to appreciate it. I think people who spend money to be entertained are generally outgoing and fun people and I think they’re generally nice. In the emergency room you see everybody, and people are having good days or bad days, and maybe if your team’s losing you’re a little cranky, or you can be generally disappointed.

Westin: I can practice ideal medicine here. I don’t have to deal with the constraints we have in a normal emergency department. We can prescribe the medications people need as opposed to what they are told they need by advertising. You can practice “watchful waiting” on a patient who doesn’t really need a CAT scan or an invasive procedure. I also enjoyed that the patients are very understanding and appreciative.

Bazos: One of the best things about our model is that it provides benefits to the patient, the venue or festival, and also the local community. Because we are bringing a higher level of care to the festival, sick patrons who didn’t intend on getting sick in the first place, can potentially remain at the festival longer and receive proper medical care faster. Our transport rates are lower because of the onsite physicians, which keeps local hospitals from being burdened by an influx of patients.

Not to harp but to watch this medical care first-hand then expect to read in the paper an injury report without getting reviews from the patients, who liked the treatment – doesn’t that affect you on an emotional level?

Westin: I think what is neglected to be mentioned is that, however many people we transport this year, is how many we didn’t transport. You’re looking at a city of 70,000. If you look at the average statistics for emergency room visits and the hospital and injuries I think you’ll find the statistics out of here are quite low compared to any other statistically similar-sized city in the country. If you extrapolate the numbers you’ll see about 130,000 people were here. If you took any 100,000-plus city hospital in the country you’d have 4-6 hour wait times just to get in. Here they’re seen within a matter of an hour or two, and it’s free.

Bazos: The other thing is, 30,000 of them aren’t sitting at a computer doing nothing. You have 70,000 people buzzing around this place climbing five or six stories high sometimes, or moving in 75 directions on this dark, flat surface, often on bikes. To answer your question about the media, I think, as medical professionals we generally, unlike any other industry it seems, kind of ignore it but there is some passion that comes up.

I know when I open the New York Post I won’t see, “Nothing happened last night at Madison Square Garden. Everybody got home safe.” You’re never going to see that article. I do everything I can to make a fractured bone line up and hold, and hope the body can heal it. But we can’t go to bed anxious that the media needs a story and is going to jump on it. I think the promoters lose sleep and I can tell you I feel bad for promoters because there are no studies or articles written about “John Doe came into the emergency room and passed away at home from a drug overdose” or “fell 20 feet from his roof.” It’s not a sexy story.

But if you can tag it to a celebrity, venue, or festival, it’s huge. We “get it” in medicine but we feel bad for promoters. We want them to pass all that responsibility off to us. They should say, “Look, we hired a company that does this all over the country. They have more experience than anybody else. We did not skimp on financing them. We gave them the proper space they wanted, proper equipment, we got proper permitting, we made relationships with the hospitals, we did everything we could. The patient was in the best place he could be to have this injury. There couldn’t be a better spot.” And the promoter shouldn’t be talking about medical issues. They’re forced into making these public statements and that’s frustrating to us. We prepare the best we can and because we have such a vast national database; we can prepare pretty damn well. We never know what medical conditions we will see on a particular night but you can be sure we will be prepared well.

Anything in conclusion?

Bazos: Many of us, Jeff and I, have regular “day” jobs. We’re caregivers and when we have to take a break to cover an event, we rely on somebody whose job it is to make our job easy. At Burning Man – the credentials, permitting, the pillows in our room; everything, has to be thought of. You can’t run to CVS here so we need CrowdRx leaders on the ground who, A, sees the big picture for the company and, B, the little picture for every event we do.

Connor reached out to us when he saw a CrowdRx sign at MSG. He’s helped forge relationships with medical supply companies, venues, transport agencies, and EarPeace – our official hearing protection. Those are all things you can do as you grow and capitalize on size and expanded resources. Jonathan who is directing this event as we speak, and our president, Carl Monzo, COO Danny Monzo and Vice President Mike Diienno have made a team that has been a pleasure to work with.