By Michael Merschel, American Heart Association News

As a veteran of more than 20 music festivals, Los Angeles law student Christian Langston has seen a little bit of everything.

Musically, he’s seen indie rock bands and electronic dance music extravaganzas. He’s witnessed unbelievable spectacles such as a giant flame-spouting metal octopus in Las Vegas – and that time EDM act Ookay brought out smooth-jazz saxman Kenny G for a solo.

He’s also been around a range of health crises. He’s had friends who needed medical help for cuts, scrapes or because they didn’t drink enough water and needed an IV. And he’s seen medical workers weave their way through crowds to help people dealing with dehydration or drug issues.

Doctors who work such events have seen it all, too. “Every event is unique in and of itself,” said Dr. Matt Friedman, emergency medical services fellowship program director at Maimonides Medical Center and an assistant professor of emergency medicine at SUNY Downstate Health Sciences University, both in Brooklyn.

He’s worked at venues ranging from New York City’s Yankee Stadium, where he’s lead house physician, to the Gorge Amphitheater in remote central Washington.

With heavy metal or country crowds, he’s seen “a fair amount of blunt trauma, either from the mosh pit or from fights.” For EDM crowds, the most common emergency has been drug toxicity. And when he’s worked the massive Burning Man festival, which draws tens of thousands of people to the Nevada desert, he’s dealt with eye problems from blowing dust, as well as injuries from accidents.

“People are frequently intoxicated, and people frequently are engaged in high-risk activities like climbing,” which is “not a great combination,” said Friedman, who also is national medical director of CrowdRx, which provides medical services at large events.

Whatever your own idea of an exciting festival, whether it’s Lady Gaga and Missy Elliott at Coachella in California in April or Luke Combs and Olivia Rodrigo at Bonnaroo in Tennessee this June, here are some of the health issues doctors say they commonly see – and advice on avoiding them.

Stay hydrated

“Not drinking enough water may be the most likely reason someone will end up in a medical tent,” said Dr. Katie FitzGibbon, an emergency medicine physician at UPMC in Harrisburg, Pennsylvania.

The combination of outdoor heat and excessive alcohol leaves a lot of people feeling miserable, said FitzGibbon, lead author of a 2017 study on medical care at EDM festivals. “If you could make sure you’re hydrating for a couple of days before you go, and not just chugging water the day that you’re there, that probably would be a good idea.”

Dr. Alison Leung, a clinical assistant professor of emergency medicine at the University of Florida in Gainesville, also said that the bulk of cases she’s seen at festivals are “heat-related or related to not eating enough or not drinking enough water.”

Langston has seen how this happens. One of his favorite festivals, the Electric Daisy Carnival, takes place at Las Vegas Motor Speedway, where he’s experienced triple-digit temperatures well into the night. “You could be completely sober, and people were still passing out from dehydration, because you’re not thinking about water – you’re thinking about, ‘I have to get across the speedway to the next stage because my favorite artist is playing.’”

Leung, who has worked or attended festivals from Moonrise in Baltimore to Coachella in Indio, also is the associate medical director for Sumter County EMS. She said many major music festivals “are very good at providing cooling areas and hydration stations for participants.” If you’re allowed to bring in a refillable water bottle or hydration pack, “I always highly recommend that,” she said, and if you drink alcohol, drink a bottle of water between every one or two alcoholic drinks.

Know the weather

Heat isn’t the only temperature concern, Leung said. At desert venues or at a place like the Gorge Amphitheater or Burning Man, where she was one of the medical directors for the field hospital last year, it can be scalding during the day but freezing at night, she said.

“Many people wear very little clothing at these festivals,” said Leung. “They don’t realize it gets cold,” and medical workers hand out foil-like emergency blankets to warm them up. A friend, she said, jokingly likens the people in such gear to “baked potatoes.”

While Leung recommends bringing a small fan to help you stay cool during the day – and don’t forget the sunscreen, of course – “bring a jacket” to avoid becoming a baked potato after sundown, she said. “Bring layers.”

Keep the shoes sensible

“Your choice of attire and footwear is really important,” Langston has learned. Attire can be a part of the fun at a festival, he said, but people can be more concerned about looking good than being practical. He’s had friends in “crazy” strap outfits who’ve fallen on a Friday, then suffered for the rest of the festival weekend.

So, wear sturdy shoes that can stand up to all the walking and dancing you’ll be doing, Leung said. “You want to make sure that you’re not going to be wearing something that you can easily trip in or sprain your ankle in, like a pair of high heels or platforms.”

And carry a change of socks, Langston advised, “because if you get blisters at one o’clock in the morning, and then you keep going, and you have three more days of that, it can become miserable.”

FitzGibbon can vouch for that. At one large EDM event, she saw a steady stream of people needing bandages for their feet because of ill-fitting shoes.

Bring essential medications

People sometimes forget important medications, said Friedman, who with Leung was a co-author of a 2021 National Association of Emergency Medicine Services Physicians position statement on mass gathering medical care.

“If you, for example, have a history of anaphylaxis, bring your EpiPen,” he said. “If you have a history of diabetes, make sure you have your insulin with you. If you have a history of asthma, make sure you have an extra asthma pump with you, just in case.”

Don’t overindulge

Ever since some of the grandparents of today’s festival fans were warned about the “brown acid” at Woodstock, recreational drugs have been part of the concert scene. Leung said that “whether or not we want to acknowledge that as a constant presence at festivals, it’s going to be available.”

Unfortunately, FitzGibbon said, many people at these festivals are younger, “and common sense is not always as readily present as we wish it would be.”

So, while “it obviously goes without saying, ‘Don’t use drugs that you find in the bathroom,’” FitzGibbon said, some people do. And sometimes, that type of behavior gets them in lethal trouble.

Euphoria-inducing drugs such as MDMA (also known as molly or ecstasy) predominate at EDM festivals. In high doses, MDMA can lead to a fatal increase in body temperature. It also can disrupt the heart rhythm and cause spikes in blood pressure.

Friedman describes the problem at festivals as “a lack of moderation” for attendees who try multiple stimulants at once. He’s also had patients who thought they were taking a stimulant that turned out to be a potent opioid, which depressed their breathing to the point that they needed to be put on a ventilator.

For people who plan to use drugs despite the risks, many festivals have stations where pills can be tested to make sure they’re what the user is expecting, Leung said.

She encouraged those who can to carry naloxone, the over-the-counter nasal spray that temporarily reverses the effects of opioids. If someone is unresponsive and not breathing normally, American Heart Association guidelines say to call 911 and start CPR while someone else retrieves an automated external defibrillator, if one is available. If opioids are thought to be involved, give naloxone, use the AED and continue CPR until EMS arrives.

“You just never know when you might be able to save a life,” Leung said.

Have a plan and stick together

When you arrive at a festival, scout out the medical tent and know where the exits are, FitzGibbon suggested.

It’s a great idea to go with friends who can keep an eye on one another, she said.

And stay in a group, Friedman said. Make sure you have extra batteries for your phone, and arrange for a place to meet in case of a problem.

Ask for help

Don’t be afraid to make use of the medical tent, Leung said. That includes for mental health.

“Festivals are very unique in that it’s unlike any other environment that you’ll ever be in, with the crowds and the music and the lights,” she said. Medical staffers see “a fair number” of people dealing with anxiety who “just need a place to relax for a few minutes to a few hours before they can collect themselves and go back out.”

Some festivals reserve spaces for that purpose, but whatever you need, Leung said, the medical staff wants to help.

Have fun

Festivals can be healthy in several ways. Researchers who recorded the physical activity of 22 attendees at the massive Glastonbury Festival in England found that they covered, on average, 7 miles a day over six days.

Festivals also can build healthy social connections, Friedman said. “You see the best of humanity at these events. The amount of people willing to help out strangers is really overwhelming.”

For Langston, music festivals “are ultimately about joy.” But pace yourself, he said.

“Multiday festivals are a marathon. They’re not a sprint.” If you go too hard on Friday, by Sunday you’ll be out of energy. “And I think that’s where sometimes people can get hurt.” You don’t realize the strain from all the dancing and walking “until you go to bed and wake up the next day and your legs are on fire.”

Langston, 27, has been hitting big EDM festivals since he was 19, but he expects to slow the pace in the future. There’s an event in his home state of Montana called Under the Big Sky. “That’s just country, bluegrass, folk music, and it’s over at 10 o’clock at night. You know, when I was younger, I couldn’t imagine going to bed at 10. And now I think it’s almost preferable.”

This story was published by American Heart Association News and made available by the Associated Press. American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.