SPECIAL REPORT Mortality at Music Festivals: An Update for 2016-2017 – Academic and Grey Literature for Case Finding

Sheila A. Turris, RN, PhD;1 Tracie Jones, RN, MA-DEM;2 Adam Lund, MD, FRCPC (Emergency)1

Abstract 1. Department of Emergency Medicine, In 2016, the authors published a paper on music festival fatalities between the years 1999 University of British Columbia, Vancouver, and 2014 (n=722). In this Special Report, they provide an update on fatalities reported at British Columbia, Canada music festivals globally for the period 2016-2017 (n=201). Using a search strategy designed 2. Surrey Memorial Hospital, Surrey, British to capture grey literature and media reports of music festival fatalities, reports of the overall Columbia, Canada frequency and cause-of-death breakdown for publicly reported, festival-related deaths are recorded. This update shows an increase in the frequency of festival-related fatality reports Correspondence: during the new period, together with an increase in the number of deaths attributable to Tracie Jones, RN, MA-DEM terror (n=60) and overdose/poisoning (n=41). Drawing conclusions about the cause of this Manager Site Operations increase is challenging given the growth in Internet use, online media reports, and number Surrey Memorial Hospital of music festivals occurring annually when compared with the previous reporting period. Surrey, British Columbia, Canada The authors re-emphasize the need for a uniform reporting standard and reliable epide- E-mail: [email protected] miological data for fatalities related to music festivals, mass gatherings, and special events. Turris SA, Jones T, Lund A. Mortality at music festivals: an update for 2016-2017 – academic and grey literature for case finding. Conflict of interest: The authors have no conflicts of interest to declare in relation to this study Introduction Keywords: fatalities; hazard; mass gathering; Background music festivals; risk In December of 2016, Prehospital and Disaster Medicine published a paper on music festival 1 Received: May 5, 2018 fatalities between 1999 and 2014. Since that time, the research team has continued to Revised: June 19, 2018 follow fatality reports in both media and the published literature. Given the exponential Accepted: June 25, 2018 growth in use of the Internet, the authors hypothesized that reports of festival-related deaths would also multiply. In this short report, they provide an update on fatalities at doi:10.1017/S1049023X18000833 music festivals for 2016-2017, inclusive. In this manuscript, the authors present an analysis of fatalities associated with music festivals, drawn from both the academic and grey literature. Challenges related to data collection and analysis underscore the magnitude of the problem and the need for uniform reporting standards.

Research Questions The research questions asked for this report included the following: 1. How many, and what types of fatalities were reported in the setting of music festivals between 2016 and 2017 (inclusive)? a. In the academic literature? b. In the popular media? 2. What are the sources and limitations of the evidence available for analysis?

Methods Case Finding A search strategy, reported in the original paper, was created in consultation with a refer- ence librarian and applied to the academic literature. The authors also conducted a search of English language articles published in the mainstream media during 2016-2017, using academic and non-academic search terms. Retrospective case-finding identified articles referencing death at eligible events during the time period of the study. Prospective Internet

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alerts were set up using Google Alerts (Google; Mountain View, terror (n=26), drowning (n=8), assaults (n=6), falls (n=5), California USA). Search depth was a minimum of 10 pages deep. hanging (n=2), and thermal injury (n=2). Non-traumatic deaths Academic and media reports were used to locate new cases (eg, included overdose/poisoning (n=96/722; 13%), environmental researchers [and reporters] sometimes cited previous, similar causes (n=8/722; 1%), natural causes (n=10/722; 1%), and deaths). Names of victims (when publicly available) were recorded unknown/not reported (n=14/722; 2%). The majority of non- to prevent double counting. Additional information gleaned from trauma-related deaths were related to overdose (96/128; 75%). reports allowed the search strategy and database to grow and The majority of deaths reported in the academic literature were become more specific over time. also reported in the grey literature (368/380; 97%). The academic literature documented trauma-related deaths (n=368) and over- Inclusion and Exclusion Criteria dose-related deaths (n=12). Mortality rates could not be reported, Reports were selected for review if: as the total attendance at events (denominator) was not known. 1. They were published in the English language; 2. The death or deaths occurred from January 1, 2016 through Two Additional Years: Fatalities at Music Festivals December 31, 2017; in 2016-2017 The grey literature for 2016-2017 documented a total of 201 3. The report(s) described a fatality related to attendance at a 3-91 music festival; and deaths, including both traumatic (105; 52%) and non- 4. The report included demographic information such as the traumatic (96; 48%) causes. Music festival fatalities were evenly name and location (city/town and country) of the music distributed between the two years, with roughly 100 fatalities per = festival, the month/year of the fatality, age of the deceased, year. Deaths resulted from acts of terror (n 60), trampling = and sex and/or name of the deceased. (n 13), motor-vehicle-related (including pedestrians being struck; n=10), thermal injury (n=6), shootings (n=5), falls (n=4), Reports were excluded from review if the fatality: structural collapses (n=3), miscellaneous trauma (n=2), and assaults (n=2). Non-traumatic deaths included overdoses/ 1. Was not clearly related to attendance at a music festival; poisonings (n=41), non-traumatic miscellaneous causes (n=36; 2. Occurred in the setting of a permanent night club or dance eg, cardiac arrest or seizure), unknown/not reported (n=18), and venue; or natural causes (n=1). The majority of non-trauma-related deaths 3. Was only reported in private blogs or social media sites. were related to overdose (44%). No academic literature was found documenting fatalities that Data Extraction and Analysis occurred while attending a music festival during 2016 or 2017. An Excel spreadsheet (Microsoft [Microsoft Corp.; Redmond, Washington USA] for Mac [Apple Inc.; Cupertino, California Discussion USA] 2011) was created for data extraction per the original Comparing the data from the original study with data from 2016- protocol. Data were reviewed and subsequently entered by two 2017, two things are noteworthy. There was an apparent shift in research team members (TJ, ST). Classification and categories for cause of death and there was an overall increase in the number of fatalities were identified inductively as the data were collected and media reports on music festival fatalities. analyzed. Fatality data were then summarized. In the previous paper, over a period of 15 years, there were a total of 26 deaths related to acts of terror. This stands in contrast to a total Categorizing Cases of 60 terror-related fatalities for 2016/2017 (a two-year period), Cases were categorized according to proximal cause of death. For which accounted for 56% of the trauma-related deaths. This finding example, if an individual imbibed a recreational drug, became is in keeping with the current national and international political paranoid, and then ran into oncoming traffic, the case was cate- situation and points to the need for continued and focused attention gorized as a death resulting from trauma. Due to a general lack of on emergency planning for venues and special events. detailed reporting on cause of death, overdose (ie, taking too much In the most general terms, the original results translate into an of a recreational drug or drugs) and poisoning (ie, death related to average of 45 deaths related to music festival attendance, reported contaminated recreational drugs) were classified in the same annually during the 15-year study period. Roughly six deaths each category. If a death occurred off-site, but was clearly associated year were related to overdose/poisoning. In contrast, data from with attending a music festival, the case was included (eg, attendee 2016-2017 illustrated an average of 100 deaths each year related to returning to personal vehicle after being ejected from a festival, hit music festival attendance and nearly 20 deaths each year related to by a car).2 overdose/poisoning. This finding must be interpreted with extreme caution as the Internet was not in widespread use during Ethics the early days of the previous study and so fatalities may have been Ethics approval was waived by the University of British Columbia under-reported by the media and/or not posted online. (Vancouver, British Columbia, Canada) Research Ethics Board, The lack of academic reports during this period may well be as data were collected from publicly available sources. explained by the lengthy process for traditional publishing with ethics, data collection, writing, and peer review. In contrast, grey Results from the Original Study literature publication can occur within hours to days. The grey literature documented a total of 722 deaths, including traumatic (594/722; 82%) and non-traumatic (128/722; 18%) Conclusion causes. Traumatic fatalities were caused by trampling (n=479), In this extension of the original study, new results confirm that the motor-vehicle-related (n=39), structural collapses (n=28), acts of annual number of fatality reports has increased when compared to

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the annual average for the previous 15 years. This may indicate one These findings also show an increase in the number of music- or more of the following: festival-related fatality reports attributable to terror and overdose/ poisoning. 1. An actual increase in fatalities; These and the previous results confirm the need for a uniform 2. An increase in the number of reports about fatalities; and/or approach to reporting on fatalities that occur during, or in asso- 3. An increase in the number of music festivals occurring annually. ciation with, music festivals, special events, and mass gatherings.

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