This is one of four Pre-hospital Guidelines NSW Health has prepared to guide clinical management and decision-making in the music festival context. The intended audience is healthcare professionals who provide clinical care onsite at music festivals. These will support the early identification of substance-induced toxicity, together with initiation of appropriate pre-hospital care and early transfer to tertiary health facilities.
Recreational drug toxicity can cause behavioural disturbance or aggression. Drugs commonly associated with agitation or psychosis are amphetamines, caffeine, cocaine, steroids, Phencyclidine (PCP), Lysergic acid diethylamide (LSD) and marijuana.
Agitation (and associated delirium) is often transient and usually caused by direct drug effects on the CNS, however other secondary complications must be observed for and managed e.g.. Hyperthermia, rhabdomyolysis and dehydration. See additional flowcharts attached.
A person presenting with severe behavioural disturbance and altered cognition is not competent to make their own decisions regarding their welfare. In an emergency, restraint or sedation may be necessary to address an immediate threat to the life, health or safety of the patient or others if less invasive attempts to calm a patient are not successful. People who are intoxicated or behaviourally disturbed should not be ejected from venues or discharged from on-site medical care unless they have been appropriately assessed by the most senior health professional available for medical/toxicological causes. Have a low threshold to arrange transfer of patrons with behavioural disturbance to hospital for further assessment.
If there is any concern regarding staff or public safety, police or security staff presence may be required to support medical staff. The aim of police or security staff involvement is to protect the safety of the patient and others, enable skilled personnel to assess and treat the patient in a timely manner, and assist with restraint for medical sedation or transfer to hospital if indicated.
If there is no need for further medical assessment or treatment and the patron is not required to speak with police, then the patron can be discharged into the care of a responsible adult.