What started in 1986 as a bonfire and the spontaneous burning of a wooden man has evolved into a week-long camping event that attracts up to 50,000 people from around the globe each year. Dr. Marc S. Nelson has attended the Burning Man event for the past 10 years as one of three medical chiefs who serve the community of sculpture-building and sculpture-burning campers.
Burning Man takes place in Nevada's Black Rock Desert, about 120 miles north of Reno, Nev. The event's official Web site (www.burningman.com
In the raging heat of late August and early September attendees bring water, food, and shelter with them to create Black Rock City, an area that houses large-scale art projects, themed campsites, and villages. Clothing is optional. Illicit drugs are commonplace. Most anything goes here, Dr. Nelson said. But attendees are expected to embrace a sense of community.
“One of the things that make Burning Man work is that you need to do something to contribute to the community,” said Dr. Nelson, an emergency medicine physician who practices at Kaiser Oakland in California. “That's why the city works so well, because people contribute and do things. It can be as simple as setting up an espresso bar where you can get free coffee in the morning. The way I contribute is by being a doctor.”
Dr. Nelson helps to oversee a staff of 300-400 volunteers who provide medical services to attendees—known as Burners—throughout the week at one of three dedicated tents. Dr. Nelson's tent is located near center camp, where he is equipped to give intravenous fluids, suture simple lacerations, and do an EKG. “There are two peripheral tents at 3 o'clock and 9 o'clock, which serve as first-aid stations,” he said.
He and the other medical volunteers treat everything from dehydration to snakebites to sunburns. They also help to coordinate transportation for the 120-mile journey to Reno, if more advanced care is needed.
“Much of what we do is triage work,” Dr. Nelson said. “Different levels of experience come into play when you start making decisions about what to do with somebody who comes in with abdominal pain and trying to decide, could this be a case of appendicitis, in which case you need to get them to Reno, or is this just a bellyache from having eaten too much the night before? Or we may see a laceration and we need to decide, does this need sutures, or is this something we can put a band-aid on?”
The medical team holds daily briefings to talk about sites where they may need to increase surveillance, supply issues, drugs floating around that may be causing bad reactions, or any other medical concerns that may arise, he said.
Deaths have occurred at Burning Man, though none occurred in 2009. “But we have to deal with victims of trauma” from plane crashes to people falling off of high scaffolding with bad fractures, Dr. Nelson said. “There aren't that many drug overdoses. But we do see some that are serious enough” to require intubation and helicopter transportation.
The uninhibited environment of Burning Man also presents a unique set of questions from the patients Dr. Nelson sees. “[It's] the kind of place where somebody could come up to you and say, 'I'm on Lasix. Is it okay for me to take ecstasy with that?' That's not the kind of question you'd get asked anywhere else. It's an interesting question. The obvious answer is, 'You shouldn't be taking ecstasy,' but it is rarely that simple and it is forces us to think outside the box, [such as] how would the two drugs interact? What advice should we give them about hydration?”
One year a Burner on dialysis wanted to know if he could skip going back to dialysis that evening so he could watch the burning of the man, the climax of the week-long event. “I don't have the kind of things I would normally have in an emergency department to help me make that kind of decision,” Dr. Nelson said. “So you have to start relying more on your clinical judgment to make decisions.”
When he's not on medical duty (the chiefs work 24-hour shifts but most other medical personnel work 8- or 12-hour shifts), Dr. Nelson enjoys wandering the grounds and meeting fellow Burners. “One of the best experiences I ever had one year was when I went into a camp and opened the door of a big tent,” he recalled. “Inside there was a group of about 30 people who had come over from Ireland. They had saved up all their money for a year and they actually re-created an Irish pub there, with beer, guitar playing, and dancing. I spent almost the whole night there, talking with them, dancing, and singing.”