WINNEMUCCA - Humboldt General Hospital Emergency Medical Services has had a contract to provide emergency medical services for the Burning Man counterculture event.
Between the last Monday in August and the first Monday in September each year, "burners" gather to build the third largest city in Nevada on the Black Rock Desert Playa, along with scores of art installations (some absolutely enormous and incredibly complicated) and then remove all traces they were ever there.
Why would a small-town ambulance service enter into such a contract? HGH EMS does make a significant profit on their emergency medical service provider contract with Burning Man.
HGH EMS Coordinator Pat Songer said, "We have a 15 to 20 percent profit margin that allows us to purchase equipment that is a benefit to our EMS organization as well as to Winnemucca and Humboldt County as a whole."
Songer pointed out, "We purchased six special ambulances we call delta ambulances for use at Burning Man - but also for use in any disaster situation,"
He added they would be ideal for FEMA (Federal Emergency Management Agency) deployment. One situation in which the special ambulances were used was the multiple-vehicle accident that happened in June outside of Winnemucca.
An entire mobile hospital is another example of specialty equipment that was purchased with the profit from the Burning Man contract.
Songer said FEMA has been interested in the mobile medical services HGH EMS sets up on the Black Rock once a year. He added that the federal disaster agency has been even more interested in the whole Burning Man, Black Rock City model.
He explained that the ability of the organization to set up an entire city, with an organized grid of streets, law enforcement, a dispatch center, radio station, cell towers, medical facilities and personnel, firemen, a post office, department of motor vehicles, and even recycling collection would be useful in an area experiencing a disaster situation in which normal emergency services and local government are not functioning.
Using the Black Rock City model of starting with absolutely nothing in a remote area, to organize and build a city infrastructure in only a few days, it might be possible to organize and set up essential services anywhere in a disaster situation.
Emergency Medical Technician (EMT) Tori Stephen is the Burning Man Logistics Section Chief and Paramedic Monique Rose is her deputy. Both have headed up preparation for the emergency medical services at Burning Man's Black Rock City for three years now. They've been working particularly hard since January on preparations for this third year's work on the Black Rock Desert.
Stephen said the most challenging part of the job is hiring 250 additional personnel in the form of EMTs and paramedics, nurses, and non-clinical personnel responsible for checking in patients, data entry and housekeeping. Those people come from all over the United States.
Stephen said, "We get requests from many people who want to work with us at Burning Man."
Not all of the 250 additional personnel are at the event for the full 10 days that HGH EMS is contracted to provide medical services. Most (about 90 percent) come for three to four days, so although a core of people stay throughout the 10 days, there are many different people working at the beginning, middle and close of the event.
Also, there are fewer workers needed during set-up, more workers needed during the highest-population days of the event, and fewer again toward the end.
Songer brings in four experienced "duty chiefs" to help him supervise all of the shifts of personnel. EMS Operations Chief in charge of ambulance services at Burning Man is Ken Whittaker. Five more supervisors run the mobile hospital, and Lacy Constable is the mobile hospital Operatios Chief and has four duty chiefs under her who supervise different shifts.
In all, only 15 regular staff members from HGH EMS work at Burning Man, some for the whole 10 days, some for a portion - the rest of the people needed are contracted to work just for the event.
The mobile hospital that's set up on the Black Rock Desert forms the core of "Rampart Urgent Care," the name HGH EMS has given to their Burning Man medical services organization. The whole hospital fits into an enclosed trailer to travel out to the Black Rock (or anywhere else it's needed).
Stephen said they've honed set-up of the mobile hospital to a fine art form. "We're getting faster each year."
She said they now have a good core of experienced personnel, and set-up can be completed in just two or three hours. Stocking each of the areas within the hospital takes another couple of hours.
That might not seem very fast, but considering that the approximately 4,000 square-foot mobile hospital consists of seven very large separate tent assemblies, it's a pretty amazing feat. A tent that measures 16-feet by 32-feet is used for a triage area, to which two longer tents - 22-feet by 42-feet are attached. Two tents, 22-feet by 24-feet, and two smaller tents 11-feet by 22-feet complete the whole assembly. Within the structure there is room for a separate X-ray area and separate suture area.
Not only have they streamlined procedures for setting up the mobile hospital, Rose said, "Each year we have better and better ideas for the whole operation."
Efficiency is also increasing because about 60 percent of the extra people hired for the event are returnees from pervious years. "We encourage that," said Rose.
According to Stephen, The HGH EMS "Rampart Urgent Care" set-up is reminiscent of the MASH (mobile army surgical hospital) featured in the 1972-1983 television show of the same name, except they don't do internal surgery (just outside stitches).
They see around 3,000 patients over the 10 days. Of those, she said, fewer than 25 have to be transported to Reno or elsewhere for additional medical services. For instance, a broken bone would be X-rayed, splinted, and the patient sent to Reno to have the bone set and cast. They can go by ambulance, if necessary, or just take personal vehicle if their injury is not an emergency.
Rose said the portable X-ray equipment and lab equipment capable of conducting a number of tests have helped them diagnose and give proper treatment to a number of cases they might otherwise have to send out.
Rose said cases they typically treat include dehydration, sunburn and other skin problems caused by the extreme dry conditions on the desert playa.
HGH Education Coordinator Louis Mendiola said other medical issues include soft tissue injuries, eye injuries from the blowing dust common on the Black Rock Desert playa, with some urinary tract infections, a handful of alcohol and drug-related medical issues, and complications from existing medical conditions such as diabetes, asthma, or heart trouble.
Mendiola also characterized a number of the cases they treat as trauma cases, since "burners" are often intrepid individuals seeking new and exciting experiences, such as riding in an art car of dubious safety, or climbing a towering art installation.
He said a common saying at Burning Man is "safety third," a departure from the usual "safety first" motto, pointing to a "throw caution to the wind" attitude that can lead to injuries.
At an event called Burning Man, one might think burns would be common, but Mendiola said that's not really the case. The burning that goes on at the Burning Man festival (many if not most art projects and installations are burned) requires a pyrotechnic license and there are firemen at the festival.
"We've had just one moderate to severe burn both years we've been there," said Mendiola.
There aren't many stomach issues, according to Stephen, who explained that everyone brings in their own food. The whole theory of the event is self-reliance; they have to bring everything they need to be dropped into a desert environment - shade, water, sunscreen, a way to shower or clean up and, other than some recycling sites at the event, everyone has to carry out any trash they create.
Stephen commented, "They do have porta potties, but that's about the only service offered."
Since people come to Burning Man from all over the world, language barriers can create a challenge to providing medical services, according to Stephen. But, she said "We have enough variety in the people who work for us that there is usually someone who can speak whatever language well enough to help."
All the additional personnel hired to work for HGH EMS during Burning Man come from the United States, although Stephen said they receive many inquiries from medical personnel in other countries who'd love to work the event.
Stephen said the visa issue for foreign workers is just too big a hassle for them to consider hiring from outside the U.S. The process of checking qualifications and medical licenses is already complicated enough. Some who've inquired are willing even to just volunteer their services, but that's not an option due to liability and other concerns.
They've taken six ambulances the past two years. The ambulances are particularly suited for Burning Man and emergency management-type deployment. They were used at the multi-car accident in June on I-80. This year they will take an additional ambulance.
Although the population of Black Rock City was originally capped in 2011 at 50,000 - a new four-year permit issued this year allows 68,000 participants - making it the third largest city in the state during the event.
Rose said there are times when all six ambulances are out on calls at once, so it's extremely likely the extra unit will be needed. Although the "city's" occupants are spread over only nine square miles, there is a five-mile-an-hour speed limit for any vehicles since most people are walking or riding bicycles, which affects response time.
Set up for "Rampart Urgent Care" began on the playa Saturday, Aug. 17. The clinic will have a "soft opening" on Aug. 21 (providing services to the set-up and early-arrival crews) and their main opening on Aug. 24.
Burning Man is open to those who've pre-purchased tickets, which can range from $190, for successful low-income applications, to $650.
HGH is the second "company" to have the contract to provide medical services at Burning Man, which has been held every year but one since the 1990s.
Rose explained, "Some patients 'come to us' and we go to the others. It's all done by radios. If someone is sick or injured, they or friends look around for a ranger who makes the call." Black Rock City runs a full dispatch center for emergency calls. Ambulance and clinic services run 24 hours.
After the crews come home from Burning Man, there is the type of clean out, clean up, and restocking one might expect from a multiple-day camp-out.
"We have to figure out exactly what we used and what we need to replace, and there are action reports to file," said Rose.
Not long after the demobilization is finished, it all starts over again with planning for next year. Stephen said that for about 10 months of the year, she and Rose are working, at least a portion of the time, on Burning Man preparations.
Stephen and Rose said they and the other HGH EMS personnel who work at Burning Man gain something that's even more valuable to the community than the the purchase of equipment and supplies that the Burning Man contract makes possible.
Rose said they get field experience like nothing else.
"We're a well-oiled team," she said. "In a disaster, we could throw up that mobile hospital and be ready to give medical care to our own community or anywhere in the country."
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