We are all busy this time of year with Music Festivals and other New Year’s Eve / New Year’s Day community events throughout Melbourne, Sydney, Brisbane, Adelaide, Perth, Canberra and Hobart. As always to ensure positive patient outcomes and Event Healthcare, we need to be particularly vigilant with the use of illicit substances, in particular MDMA (ecstacy) and a cheaper, more toxic substance called PMA/PMMA being sold as MDMA. Focus group work with government and stakeholder agencies have developed the “sooner than later” principle. In other words if you are suspecting illicit substance effects and abnormal vital signs (see criteria below), please obtain higher level medical assistance as soon as possible. Do not hang on to these patients. Serotonin toxicity and high temperature effects must be recognised and dealt with quickly.
There is anecdotal information that higher concentrations of MDMA are currently on the market and the user may not and often does not know what strength they are taking. Similarly a mixture of methamphetamine can have a serotonin potentiating affect.
Quick google searches with regard to serotonin syndrome and MDMA or other methamphetamine will yield much information. Do not forget other drugs such as depressants or poly-pharmacy effects with/without alcohol.
Be pedantic with your observations & documentation. Some of many web based information links below:
And much more info – do your research. Be pedantic with recording temperatures. The following advice is issued by the NSW Department of Health and will apply to all Colbrow Medics.
Stay safe. Be vigilant. Have plenty cold fluids/ice/shade/fans etc available.
Vital Sign Criteria
- Temperature: 35.5°C-37.4°C
- RR between: 12 and 22
- BP between: 160 and 100
- HR between: 110 and 50
- Oxygen Saturation <95% on room air
- Disability (Neurological assessment): Any decrease in level of consciousness or new confusion
Vital Signs Criteria: Suggested ACTIONS
- Persistence of vital signs outside of these zones despite 15 minutes of inactivity, oral fluids, and active cooling should trigger medical officer review and further intervention (i.e. IVC and IV fluids). Serial medical review should occur every 15 minutes to assess for response to intervention and need for transport to hospital
- Vital signs outside of these zones at presentation in combination with either impairment of level of consciousness and/or fever should trigger immediate medical review by a medical officer
Event Healthcare: NSW Department of Health – Music Festival Guidelines
The thresholds in this document are more conservative than those applied to the general population to account for other factors such as:
- Pre-test probability of higher risk
- Time since ingestion
- Ingested dose
- Ambient temperature and activity
- Time for transfer
- Facilities for onsite treatment
Calling & Escalation Criteria
Where there is a conflict between these guidelines and the ‘between the flags’ calling criteria, the NSW Department of Health – Music Festival Guidelines shall be used.
- Fever is the most important observation in assessing for actual or developing toxicity in this population.
- Tympanic temperature should be remeasured whenever there is any clinical deterioration or concern about the patient’s status.
- Tympanic temperature should be checked routinely in any patient presenting with an acute medical complaint, including headache. This would not necessarily be applied to patients presenting for provision of band aids for blisters or sanitary products, in the absence of other clinical concerns as assessed by the triage or medical personnel.
Fever: Suggested ACTIONS
In relation to temperature, based on use of tympanic temperature:
- 1. Any febrile patient (tympanic >37.4) should have oral fluids, whatever cooling strategy is available and their temperature and vital signs repeated at 15 minute intervals
- 2. Any patient with temperature at or above 38 degrees should be reviewed by a medical officer