Protocol in the Pits

In addition to the city, the company I work for has a contract with a large music venue nearby, and employees often get the opportunity to do "standbys" at the various acts that come through town. I picked up one of those shifts recently, a large rock concert consisting of multiple bands over the course of the day. Concerts like this are always a little bit crazy, packed with people fueled with alcohol and drugs, spurred along by the music into what often becomes a violent frenzy. This time was no exception.

It is a large venue, but people pack the place so tight that it is often hard to move. We carried portable radios on our shoulders turned up to maximum volume, but it was still difficult to hear the various dispatches over the guitars and yelling. Sometimes you would know to listen to the radio only because your partner had heard it by chance, and we would see eachother, head titled to the radio and hands cupping the speaker: hoping to hear. Eventually we would catch the dispatch, hearing a crackled "section 800, man down" before we would start moving.

Every response carried with it a little bit more adrenaline than usual. We pushed our ways through the crowd, yelling "move! move! make a hole!" as loud as we could. People would turn towards us with a little bit of "who do you think you are" look on their face, and then recognize, moving out of the way as quickly as possible. Sometimes people would take it upon themselves to charge ahead of us, clearing the way bully-fashion in a spontaneous effort of layman heroism. Each time they would smile at us, satisfied, and thank us for doing our job. We thanked them, too.

We carried a lot of people out of the crowds. A lot of people too drunk to stand, vomiting or passed-out, unresponsive or only slightly so. They open their eyes lazily to reveal hugely dilated pupils, often denying having a single drink all day. "Nah man," one patient slurred. "I've been straight all day. I dont drink. Much. I only had twelve." It was impressive. Beers were going for seven fifty apiece.

There was lot of trauma, too. Mosh pits would form along the edges of the cheaper seats, large circles where hyped-up fans ran around aimlessly, pushing and slamming into eachother as hard as they could. We stood and watched for a while as people would run into to the pits for 15 minutes, returning with cuts on their faces and bruises on the arms: smiling like crazy. There are unwritten rules about mosh pits, I learned. If someone falls down, everyone helps pick him up. You dont hit in the face and you dont throw punches or kicks. It is not about fighting, I was told, it's an organized expression of anger and rebellion to go along with the music. Sometimes there were fights though, and we would watch till they ended, carrying out those injured on wheelchairs or stretchers with c-spine equipment.

We were watching one of the bigger bands play when we were dispatched to another "man down" in the middle of the theater. This was probably our 10th of these dispatches, but we charged at it with energy nonetheless, pushing through the packed crowd to find our patient. We found him, in the center of a clearing of onlooking people, slumped on the ground and not moving. Two other crews, having heard the dispatch, showed up as well. We ask if anyone saw what happened, and someone stepped forward to tell us that he was crowd surfing and dropped "right on his head." He hasn't moved since.

We send someone to get the stretcher and c-spine equipment, which was stashed nearby. Someone grabs manual c-spine. I get on my knees in the muddy grass and lean down towards the patient's face, and he opens his eyes when I yell to him over the music. He seems a little lethargic, but is able to answer my questions slowly as he fights back tears. He is maybe 20 years old. His back hurts. He doesn't remember what happened. We get what information we can, and when the stretcher arrives we board and collar him, strapping him tightly to the rigid equipment. Again we push through the crowd, this time towards a waiting ambulance. On the way the patient wont open his eyes. I brush his eyelids lightly and see no response at all. My partner puts his hand on the guys chest to check for breathing, giving me a worried look. He is breathing, but completely unresponsive. We move a little faster.

We pass the patient to the waiting ambulance and we give our reports. We don't know much. We tell the story relayed from the witnesses, the patient's name and age that we got from a friend, and admit that we couldn't do very much of an assessment in there. Too loud, too chaotic. The receiving crew thanks us, hopping into the back of the ambulance to do their work. We grab their stretcher in return and head back into the crowds to find more patients.

We took out twenty-two that day.

With all the excitement and bustle of the concert, traumas run and drunks shuttled, everything seemed to settle down for the last few main acts. It was as if everyone took a deep breath and admitted that this is what they came to see, and there would be no more foolishness. We didn't take anyone else out after that point. Instead we settled down, as close to the stage as possible, and watched the last of the show.

We had great seats.



**

At the end of the shift we returned to the main office, sweaty, exhausted, and covered in mud. We exchanged stories from the day. There were a lot of amusing drunks, and angry ones too. One of my friends got punched directly in the face by a patient while he was transporting to the hospital. He said he saw stars, and then jumped on the guy with the help of another crew to restrain him.

I met up with the crew that took our crowd-surfing injury. The paramedic frowned as I asked him about it. "The guy had no neuros below the waist," he said. "The doc in the trauma room said that there was a T-9 fracture and that it looked pretty bad." The patient was intubated in the ER and taken upstairs. "They weren't sure, but the docs were pretty pessimistic that the kid would get anything back as far as motor control."

I was shocked. What? A spinal fracture with life-altering neuro damage? The kid was just one of many, a repeat of a ton of calls that we did that day: routine in both mechanism of injury and treatment provided. We did a good job protecting the spine, but only because we did that for everyone, routinely.

Retrospect is an amazing thing, but it felt good to look back and know that we all rested firmly on protocol, and followed the guidelines where they mattered most. Our treatment was solid, backed by everyday caution and routine methods. We did the right thing for this patient despite the fact that we had no idea how important those things would turn out to be. A little bit scary, but I guess that is what protocol is for.

I looked through the schedule when we got back, and signed up for another concert later in the summer. What a shift.