Few events in the world compare to Burning Man, the 50,000-person arts festival that takes place each summer in northern Nevada. During the week leading up to Labor Day, the remote Black Rock Desert is transformed into a spectacle of color, sound, art and performance. Perhaps more remarkable is that the Black Rock Desert is an oftentimes-hostile environment. Temperature extremes of 100+ degree days and near-freezing nights, dust storms that may rage up to 70 mph, and the caustic alkali dust that lines the ancient dry lake bed where the festival is held, are just some of the challenges visitors face. Between the natural environment of the desert and the festival’s revelry, accidents, injuries and illnesses are inevitable.

Coordinating Burning Man’s emergency medical response is the Black Rock City Emergency Services Department (BRCESD): a mostly-volunteer organization of “Burners” with a wide variety of backgrounds in emergency management and medicine. There are two main phases to ESD’s medical mission: the event itself and its setup and cleanup (known as Pre/Post). The Event Operations phase is characterized by bringing modern medical resources to an austere environment, while Pre/Post Operations more closely resemble a traditional wilderness approach.

ESD EVENT OPERATIONS

During the week-long event, ESD facilitates not only EMS and clinic-based medical support for Burning Man, but also Fire/Rescue and Mental Health services. Additionally, ESD builds the technical infrastructure to support radio and paging communications, and provides on-site dispatch services. Hundreds of healthcare providers from across the world volunteer their time and experience with Black Rock City Emergency Services. Burning Man contracts with Humboldt General Hospital (HGH) to provide advanced life support ambulances and clinical care, and the volunteers of ESD provide basic life support response. 

ESD brings modern emergency healthcare to a unique and austere environment, with three clinics forming the foundation of on-site medical care and a fleet of response units. And HGH’s 2,000 square-foot, 32-bed inflatable disaster medical tent is equipt with IV therapy, x-ray, blood labs, ECG, suture rooms and more. Due to the on-site facilities during the event, only the most critical cases are evacuated via ground or air ambulance to Reno. ESD Pre/Post-Event Medical Operations Year-round planning and several months of on-site work are required to prepare the desert for Burning Man. The event infrastructure’s physical set up period begins in July and the last crews don’t leave until early October after ensuring the event has abided by its Leave No Trace principle. The crews who build Burning Man’s infrastructure live and work in the same space for weeks on end. They share quarters, take meals together and spend their free time in each other’s company. The result is a unique culture and camaraderie that motivates the entire team in the face of less-than-ideal conditions brought about by working in the desert. During these times, there are no advanced medical resources: there is no on-site facility staffed with MDs and RNs and stocked with modern technology like there is during the event. It’s a 90-minute drive to the closest clinic and the closest hospital is two hours away in Reno. A small group of hand-picked ESD healthcare providers, familiar with the unique culture of Burning Man, deploy alongside the organization’s work crews to provide medical support. They live among them, treating injuries and illnesses, advocating for worksite safety and promoting public health.

Temperature extremes of 100+ degree days and near-freezing nights, dust storms that may rage up to 70 mph, and the caustic alkali dust that lines the ancient dry lake bed where the festival is held, are just some of the challenges visitors face.

 For situations beyond the scope of the on-site BRCESD medical crews, they have satellite phone access to a Nevada- licensed MD who can provide consults to ensure patients receive the most appropriate care, including calling in prescriptions based on comprehensive field assessment. For critical situations, Burning Man medical crews are trained to coordinate with local volunteer departments and, when necessary, facilitate air ambulance resources from Reno. By embracing traditional wilderness medicine practices— providing care with limited resources in an austere environment, as well as temporarily establishing modern medical systems in that same environment for a 50,000-person event—Black Rock City Emergency Services at the Burning Man arts festival has established itself as a powerful case study in dynamic approaches to austere medicine.