EMS at Woodstock

Forty years ago, hordes of people set off on a pilgrimage toward what was billed as “three days of peace and music” in upstate New York. In addition to lending its name to a generation, the 1969 Woodstock Festival had the potential to generate a medical disaster of epic proportions.

Although the planning proved woefully inadequate, the festival came off with a minimum of death and injury. This success is a tribute to the adept improvisation of medical providers and the vibrant volunteer spirit that took over medical care during that trying weekend. EMS has come a long way since 1969, but planning and improvisation are still key to successfully managing actual and potential disasters.

The Plan
From the beginning, confusion crept into the planning for Woodstock. The promoters had originally imagined the concert taking place in Woodstock, N.Y., a village in the Catskill Mountains. They moved the venue twice before settling on a patch of remote farmland 60 miles away in Bethel. While trying to convince local authorities to host the event, the promoters fudged the expected number of spectators, suggesting 50,000 attendees as a ballpark figure. Unfortunately, that number was used to draw up the initial plan for medical care.

Concert promoters hired 43-year-old William Abruzzi, MD, a local general practitioner, to oversee the EMS aspects of the event. Abruzzi had experience in “crowd medicine” from having worked large civil rights demonstrations. He knew the terrain and was non-judgmental when it came to drug use, which was expected to be widespread at the festival.

Abruzzi hired 18 physicians, 36 nurses and 27 medical assistants to work the festival in eight-hour shifts over three days. They would work in several trailers and a 30-bed hospital tent. That meant that at least two doctors and four nurses would be on duty around the clock.1

Some suggested that Abruzzi use additional volunteers to cover the event, but he felt that a dedicated, paid staff would be easier to manage. At the time, there were few volunteer EMTs available. The EMT training program was just getting underway following passage of the 1966 National Highway Safety Act, the law that ushered in modern EMS.

Abruzzi put hospitals in nearby towns on alert to receive the overflow of more serious cases from the festival. With several walkie-talkie transceivers for communication, a stockpile of medications, bandages and Merthiolate, he felt that his staff was ready for a crowd of 50,000.

It soon became clear that the number of spectators would be larger than expected. Much larger. Abruzzi took an aerial survey the day before the festival was to begin and judged the crowd slouching toward Bethel to be “frightening in its aspects.”1 Some estimated it could top half a million people–a gathering of unprecedented size.

Abruzzi knew that the larger crowd would seriously complicate the medical situation. It wasn’t just the greater number of injuries and illnesses. Clogged roads and an overcrowded venue would compromise his ability to transport patients. He had arranged for Sullivan County Ambulance, a commercial service, to provide two ambulances around the clock for three days (for a total of $600). The day before Woodstock began, he asked the company to station an additional ambulance at the festival. But by that time, many of the routes in and out of the site were already impassible, because most festival attendees had abandoned their cars along the roads. This meant ambulance transport would be slow, if not impossible.

“We have the makings of a medical disaster here,” said one participating physician.2 Observers soon realized that emergency medical facilities could become completely overwhelmed. Fences around the site had already been trampled. Violence and riot were distinct possibilities. Lacking adequate supplies, people and transport, even Abruzzi feared the possibility of “the greatest medical tragedy of our times.”1
Improvisation Proves Crucial
Staff, triage, facilities and transport were all factors that required rapid improvisation.

Staff: It was clear that the medical staff Abruzzi had hired wouldn’t be able to handle the injuries and illnesses that would inevitably arise from such a large crowd.
A call went out for help. A few doctors flew up from New York City. Some local physicians found their way to the site on back roads. Nurses and volunteers from nearby ambulance squads were flown in by helicopter. Many medically trained spectators, including nurses, physicians and psychiatrists, who had come for the music, soon realized what was transpiring and found their way to one of the first-aid stations to help.

Triage: Local hospital officials and school administrators in nearby Monticello soon converted an elementary school into a triage center, establishing a critical hub in the improvised EMS system. Some patients were treated at an infirmary in the Monticello school, but others were moved on to local hospitals or to larger hospitals farther away.

Facilities: In addition to Abruzzi’s original trailers and tent, a large circus tent in use at the festival as an employees’ mess tent was converted into a field hospital. One hundred cots were installed, and plastic sheets were laid on the ground to accommodate patients. The tent was conveniently located in close proximity to the helicopter landing zone. Eleven smaller tents were set up around the grounds as first aid stations.

Transport: Promoters had contracted for a fleet of helicopters to bring in performers and equipment. Many of these choppers, which were converted to flying ambulances, transported patients to the triage center or directly to hospitals and brought back medical supplies.

Two large U.S. Army Huey (UH-1D) helicopters on summer maneuvers at West Point Military Academy were also dispatched to Woodstock with U.S. Air Force medics on board. A pickup truck with a mattress in the bed supplemented Sullivan County Ambulance’s vehicles.

“Many of the treatments had to be improvised, such as the treatment of a case of digitalis toxicity with orange juice since we had no potassium,” remembers Glen Joshpe, who was a medical intern when he volunteered to help at the festival.3 Plastic bags were routinely applied to bandaged feet to protect wounds from contamination.

The most common complaint at Woodstock was foot lacerations. Hundreds of barefooted attendees stepped on broken glass and jagged rocks. The concert took place on a working farm, so the danger of tetanus was high. Emergency medical providers spent a good deal of time cleaning and disinfecting feet and suturing if needed. Word was sent out to scour the county for tetanus toxoid, and doctors and nurses made sure that anyone with a cut received a shot.

“˜Bad Trips’
A similar spirit of improvisation guided the handling of the hundreds of cases of bad reactions to the recreational drugs that characterized the festival. LSD, mescaline and psilocybin were popular and widely available, as were other drugs and alcoholic beverages.

Later, a newspaper estimated that the medical staff at the festival was handling “25 freakouts each hour from LSD-type drugs” on the first night of the festival.4 Patients with bad reactions to psychedelics presented with hallucination, paranoia, anxiety and delusions–effects that could continue for several hours.

Because these symptoms mimicked psychosis, on-scene physicians could have used Thorazine (chlorpromazine), a potent tranquilizer and anti-psychotic, for many of these patients. But instead of the standard medical treatment, festival doctors adopted a method of handling these patients that Joshpe said was, “revolutionary and carried significantly less risk than heavily sedating a patient “¦ who was already severely intoxicated.”3

Woodstock promoters had hired 85 members of a commune known as the “Hog Farm” based on their experience running “trip tents” at other festivals. The Hog Farmers had developed a methodical approach to LSD freakouts. They advised against the use of Thorazine and instead recommended “talking down” patients experiencing a bad trip.

This method included talking quietly with patients, assuring them that they weren’t going crazy and that the effects of the drug would soon wear off. They tried to get “trippers” to connect to reality, orient themselves and relax.

When a few hours had passed and patients had calmed down, they were recruited to help others with similar problems cope with the drug experience. This responsibility steadied the original patient and provided the manpower needed for the lengthy process of talking others down.

The technique worked, and the medical providers began to refer LSD trippers directly to the Hog Farmers. They adopted the technique themselves. “We would sit there and talk to the kids and hold their hands,” Frances Marks, RN, remembered.
“We got our philosophy into the doctors’ heads, and they started treating people like we were treating people,” remembered Hog Farmer Tom Law.2

At the same time, the Hog Farmers were savvy enough to quickly refer more serious drug cases–particularly overdoses of heroin or amphetamines–to medical personnel. Injectable Valium (diazepam) was the standard treatment at the festival for LSD or amphetamine users who couldn’t be talked down.

It wasn’t always easy to assess patients for drugs. Many presented with physical complaints. “In my brief [previous] experience as a doctor, I had not seen so many drug reactions that mimicked physical illness,” remembered one volunteer physician.5 Stomach pains and other symptoms often turned out to be the result of recreational drug use. Many of the providers at the festival were tolerant of drug use, and their non-judgmental attitude helped alleviate the situation. Patients under the influence of drugs didn’t hesitate to seek help at the medical tent. Removing them from the crowd not only helped them to reorient themselves, but  also prevented a contagion of panic, a significant danger in a crowd of that size.

The Outcome
Two young people died at the Woodstock Festival. A New Jersey teenager was crushed by a tractor while sleeping on the ground; and a Marine from Long Island was rushed to a hospital, suffering from what was described as a heroin overdose, and died the next morning. The definitive cause of this second death was never disclosed.

Those losses were tragic, but the deaths at the festival were remarkably few. The final Woodstock crowd estimate was more than 400,000. The city of Buffalo, with a population of 462,000, registered 40 deaths that same weekend.

Medical providers, including hundreds of volunteers, treated at least 3,000 patients during the festival. In a report after the festival, Abruzzi listed 938 foot lacerations, along with 135 punctures and 346 other foot injuries. There were 23 epileptic seizures and 176 cases of asthma requiring therapy. Approximately 250 patients were airlifted out of the site.

Despite of the fact that drinking water was sometimes scarce and daytime temperatures reached into the 90s, only 57 patients were treated for heat exhaustion. Although there were widespread and persistent rumors of one or more births at Woodstock, there’s no evidence of a single birth on the festival grounds. Abruzzi reported one baby born in a car on the way to the festival and another born in a local hospital.

The handling of drug cases proved particularly effective. Abruzzi reported 797 cases of “bad trips” that required care. But of those cases, only 72 were seen by a doctor, and only 28 were treated with medications. The vast majority responded to supportive therapy alone.

Lessons Learned
Plan for contingencies: Abruzzi planned adequately for a smaller crowd, but he didn’t formulate contingency plans–despite evidence that the festival could attract a much larger mass of spectators than expected.

These days, planning for mass gatherings tends to be more comprehensive, but the potential for participants to overwhelm planned medical facilities still exists. EMS providers at the 1994 concert marking the 25th anniversary of Woodstock were hard pressed to deal with the large crowd, although their planning had spanned an entire year.

A crowd twice as large as planned can multiply medical demands severalfold, rather than just double them. That’s because the transportation of the patients will be hampered if traffic jams develop, the danger of violence or panic will increase, and the size of the crowd will limit access to patients.

Prepare to improvise:
EMS training emphasizes the need to improvise when necessary. A tree branch can be a splint, a piece of plywood can serve as a backboard, a shirt can become a bandage.

But Woodstock demonstrated how improvisation can work on a broader scale. Today, there are likely to be even more trained EMS providers in any large crowd. Ways of alerting them and organizing them into effective teams should be considered during the planning stage.

The problems presented by illegal drug use also require a flexible EMS response. Recreational drugs rise and fall in popularity; it’s possible that psychedelics will one day again become the drugs of choice. Patient assessment and triage remain the provider’s key responsibilities. The experience at the Woodstock Festival indicates that organized, supportive therapy can effectively manage such a situation, even for hundreds of patients.

Reflecting afterward, Abruzzi attributed the lack of a medical disaster at Woodstock largely to good fortune. However, nimble improvisation and the goodwill of volunteers contributed immensely to the positive outcome.
“Good vibes” dominated the festival, and Abruzzi reported that, “not a knife wound was sewed, not a punch wound was treated.” JEMS
 1. Abruzzi W. “A White Lake Happening.” New York State Department of Health. p.2. 2 Sept. 1969.
 2. Makower J: Woodstock: The Oral History. Doubleday. New York. p. 254. 1989.
 3. Joshpe G: Joshpe’s Journey. Stonecrest Publishers. Stamford, N.Y. p. 87. 2001.
 4. “The Second Day: Bulletins on Death, Birth, Illness and Aid.” Times Herald-Record. p. 7. 16 Aug. 1969.
 5. Ulmann, P. “Doctor at Woodstock”. The Medical Post. 24 Apr. 2001.

This article originally appeared in May 2010 JEMS as Peace, Love, and EMS: Reflecting on mass care at the 1969 Woodstock Festival.

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