Letters to the Editor 303 ative recovery. Ryan's paper is important not festival was a three day event attended by in Cork! On a more serious note, there was J Accid Emerg Med: first published as 10.1136/emj.13.4.303-a on 1 July 1996. Downloaded from just for the proposal of accelerated transfer of 70000 people. The medical facilities at a marked absence of sale of items that could patients out of the A&E department but also Feile'95 were distributed between five first be used as missiles. We would therefore for its clear demonstration that A&E depart- aid posts and one medical centre with support Hewitt et al in their call for ment staff are, with or without a fast tracking facilities for observation and treatment. This consideration ofwhat is sold at such festivals. system, the key agents in assuring that these centre received referrals from the first aid Finally, our experience suggests that pro- priorities are tackled . posts and a small number presented directly. vision of on-site medical cover with an obser- The primary problem for elderly patients The medical staff consisted of 12 doctors, vation area is highly desirable. The benefits with femoral fractures is, of course, not the nine contracted through a private firm and of such a service have been noted at similar location of, but rather the quality of, their wait three accident and emergency (A&E) large gatherings on both sides of the Irish for definitive care. The universal scarcity of physicians who were from the local health sea.2 3 There is obviously a need for this type beds is offundamental concern to us all at the authority. Two A&E nurses staffed the of care and it is highly protective of the local present time, but it is something over which medical centre between 12.00 am and mid- A&E departments and general practitioners. clinical staff in an A&E department often night. The cost of the provision of medical have little control and which we believe is too services was funded by the organisers of the I S REDDY S CUSACK often used as an excuse for poor immediate event. Department ofAccident and Emergency Medicine, care. In our departmental policy, for A total of 1627 individuals required Cork University Hospital, Wilton, Cork, Ireland instance, patients with suspected proximal medical attention and their diagnoses are 1 Hewitt S, Jarret L, Winter B. Emergency femoral fractures are given opiates in a shown in the figure. In contrast to the medicine at a rock festival. JAccid Emerg Med judicious manner (rather than the non- Monsters of Rock festival, 407 (25%) of 1 996;13:26-7. steroidal medication described in Ryan's attendances were for heat related conditions, 2 Bitten S, Whitley MS, Fox PF, Goodwin MI, article, which is associated with acute renal while 180 (1 1%) of those attending required Horrocks MJ. The Glastonbury Festival 1993: pattem of attendences and admissions impairment and other serious complications attention after substance abuse (alcohol, to an NHS Trust. J Accid Emerg Med in the elderly2). We also prefer the three-in- Ecstacy, LSD, etc). Eighteen patients were 1995;12:30-1. one ("triple nerve") block which anaes- ultimately referred to the A&E services in the 3 Ryan JM, Noone E, Plunket PK. Review of a mobile accident and emergency unit at a rock thetises the femoral, obturator, and lateral city and of these only eight (0-5% of total concert. Irish 1994:87:148-9. cutaneous nerves3 (and not just the femoral medical encounters) required hospital MedJ7 nerve as was the case in 17% of Ryan's inpatient services. The Cork fans were patients), which then permits comfortable probably a more cheerful bunch in that there splintage and transfer to a bed. Alternatively, were only eight assaults with only one we transfer such patients directly from needing head injury observation in the ambulance stretchers to beds which are ,hospital. Perhaps this can be explained by the "borrowed" if necessary from our short stay higher intoxication rate among the devotees observation ward (SSOW) but which could, in other hospitals, be borrowed from the Thrower's fractures ofthe humerus closed wards that clinicians bewail. FEILE '95 EDITOR,-While the recent paper on Occasionally, younger patients (who are thrower's fractures of the humerus from better able to tolerate lying on hard trolleys) Spontaneous Evans et al was most informative, we cannot need to wait a little longer for a SSOW bed abortion to allow more appropriate use of such beds agree with the explanation offered for the for the infirm and elderly. Finally, when the Diabetics 2 aetiology ofthe fractures.' The forces used by elderly patients are comfortable, we begin the req insulin the individual patients were different as quest for orthopaedic transfer. evidenced by the case histories and the two In short, then, Ryan et al are to be Seizures 2 differing fracture patterns. applauded for establishing a system to reduce Inquires We have treated a 19 year old fit athlete http://emj.bmj.com/ delays in transfer but, while frustrating bed re:dialysis, 3 who presented with a fracture identical to morning that described in case 2, who, after open shortages and delays in transfer abound, they reduction and secure internal fixation, should not have an exaggerated bearing Burns 10 on the provision of timely, effective, and returned with a fracture of the same compassionate care in the A&E department. Clinically configuration six weeks later. It had occurred suspected 11 through the most proximal screw hole of the U GEARY fractures longer of the reconstruction plates used for A JONES fixation. The mechanism of injury was L C LUKE Dermatological 18 on September 30, 2021 by guest. Protected copyright. 0. identical on both occasions (a gentle overarm Accident and Emergency Department, action of a of clothing) Royal Liverpool and Broadgreen University 0 throwing light piece Hospitals Trust L. Dental 21 and similar to the type of throwing action described in case 2. He had not suffered 1 Ryan J, Ghani M, Staniford P, Bryant G, Edwards S. "Fast tracking" patients with a i Ophthalmic prodromal symptoms of any type. proximal femoral fracture. J Accid Emerg Med ° problems 24 The mechanism of injury is related, we 1996;13:108-10. .2 believe, to the more proximal attachment of 2 Schoch PH, Ranno A, North DS. Acute renal Respiratory 59 the relative to the biceps, resulting in failure in an elderly woman following a problems - triceps intramuscular ketorolac administration. Ann an extreme form of avulsion injury affecting Pharmacother 1992;26: 1233-6. Ear,nose & 76 the whole distal humerus. This explains the 3 Winnie AP, Ramurthy S, Dirrani Z. The throat oblique anteroposterior fracture pattern inguinal paravascular technique of lumbar plexus anaesthesia: the "3 in 1" block. Anesth without a significant spiral component. The Analg 1973;52:989-96. Headache 170 proposed fracture development ofTullos and King may explain fractures where the Substance overarm throwing action is more strenuous misuse 180 and more complex.2 The pathogenesis of radial head fractures from high level falls Bites 238 complements their theory but is not relevant Soft tissue to Evans' second case or our patient.3 related 40 We would also emphasise to readers the Emergency medicine at a large rock risk of refracture in patients with seemingly festival Heat related 407 strong humeral bone fixed in the standard fashion using either standard 4.5 mm EDITOR)-We were very interested to read the dynamic compression or reconstruction experience of Hewitt, Jarrett and Winter at 0 100 200 300 400 plates. the Monsters of Rock Festival p92.1 We have 50 150 250 350 450 just completed examining our experience at Number oyf patients IAN CALLANAN ADNAN ZUBOVIC a similar rock music festival held in Cork seen (total 1627) Cappagh Orthopaedic Hospital, from 4th to 6th August 1995 (Feile '95). This Diagnoses of medical encounters at Feile '95. Finglas, Dublin 11, Ireland