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‘Can somebody help?’ The Live Music Exchange guide to dealing with illness or injury at live music events – Emma Webster

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This week’s blog post is by Live Music Exchange’s own Emma Webster.  In it, she considers what to do if an audience member is taken ill or is injured at a live music event and whose responsibility it is at events to look after and treat audience members in need.  The post offers an initial Live Music Exchange guide to dealing with illness or injury at live music events, based on contributions from St John Ambulance and others.

‘Can somebody help? I need help here!’ Words that you don’t particularly want to hear during a live music event, or any event for that matter.  However, these were precisely the words I heard shouted by a fellow audience member, seated a few rows behind me at a performance of the musical ‘Cats’ in December 2013.  I was sitting high up in a balcony for a Sunday matinee performance and the shouting began just before the first rendition of the show’s best-known song, ‘Memory’.  The result of the shouting was a ripple of panic as some audience members tried to move away from the shouting woman while others tried to move towards her, perhaps for a spot of rubber-necking or perhaps to ascertain whether help was required.  A couple of people shot off to search for a member of the front of house team, while a man claiming to be a doctor crawled his way over the raked seats to get to the woman.  Another audience member next to me shouted, ‘Oh my god, I think she’s dead!’ which was not helpful in any way.

What had happened (I think) is that an older lady had fainted about halfway along the row and the woman next to her had shouted for help.  After a few minutes, the doctor managed to get over to the woman and make a basic assessment. The audience, myself included, gradually settled back down and continued to watch the show, admittedly with a slight sense of surreal guilt while the (lessened) drama continued behind us.  Unfortunately, we missed the whole of ‘Memory’ but, luckily for the fainting woman, the song appears at the very end of the first act, and so she was able to be removed and taken the long way down to the Paramedics who had been summoned.  (Luckily for us, the song is reprised later in Act Two). The range of reactions to the ‘Cats’ incident got me wondering what audience members can or should do if audience members are taken unwell, and so this blog post considers advice from a variety of sources in order to compile the Live Music Exchange guide to what to do in these circumstances..

One important but complex consideration about incidents concerning audience members which occur during live shows is whose responsibility it is to ‘fix’ the problem – the artist, the audience, the venue, the promoter?  Does it come down to proximity – who is closest to the audience member at the time of the incident – or legal responsibilities?  The woman at ‘Cats’ was lucky that a) there was a doctor in the house, and b) that doctor was in the balcony and was able to get across to her quickly – more quickly, in fact, than any of the venue staff.  (It is worth pointing out that in the United Kingdom there is no legal duty for a doctor to offer assistance in an emergency, however, although the General Medical Council considers that such a duty exists).[1]

While it is generally not regarded as the artist’s responsibility to call for help, it has been known for them to become involved directly if an audience member is taken unwell. Although in the domain of theatre, James McAvoy allegedly jumped off the stage during a sword fight in a performance of Macbeth to check on a collapsed audience member before calling for help.  As another, and perhaps more common example, at an Arctic Monkeys gig at Glasgow’s SECC in 2009, people in the crowd near the front kept falling over and the show had to be stopped five times in order that the security could wait for them to get back up again. At one point, the head of security asked front man Alex Turner to explain moshing (or pit) ‘etiquette’ to the crowd, which he did: ‘We keep getting stopped, in case you’re curious, because a lot of people are getting crushed. So look out for each other and help each other up if they fall over’ (Turner 2009).

According to the UK’s Health and Safety Executive (HSE), the event organiser or ‘occupier’ – the person in control of the event – is the person charged with the safety of the participants. The occupier is therefore responsible for the ‘common duty of care’ to all their lawful visitors, where the ‘duty to take such care … is reasonable to see that the visitor will be reasonably safe using the premises for the purposes for which he/she is invited or permitted by the occupier to be there’ (Occupiers Liability Act 1957 section 2 (2), cited in HSE 1999, p. 185).  Legally speaking, then, the promoter (or their equivalent) is responsible for the safety of the audience but it is less clear as to whose responsibility if an audience member is taken ill or what they should do in these situations (although it should be pointed out that this piece is more about what the right response is in the moment rather than who carries the can at the end).

To this end, I asked Gordon Hodge, ex-Venue Manager at the Glasgow Royal Concert Hall, who provided the following useful reply:-

“My advice in this situation – as in any situation which makes audience members feel uncomfortable, unhappy or concerned – is to contact a member of FOH staff as soon as they can.  It doesn’t have to be a manager or supervisor – the member of staff they speak to in the first instance may not be able help, but they can certainly relay the message to someone who can … There are certain things that even the most pro-active staff members will not pick up on, because it is dark, often noisy, and quite simply, they are not viewing the performance as a member of the audience does.

“I understand that audience members are often hesitant to raise issues, either because they just don’t like to complain, or because they feel that by moving out of their seat, they are disturbing those around them, making the situation worse.  If the individual is right in the middle of a seating block or crowd, it will probably not be obvious to a member of staff unless someone alerts them to it, and in the situation of someone being taken unwell, every second counts.  Most venues will have First Aid-trained staff who can attend – even if they can’t alleviate the symptoms, they can make an assessment and advise the Duty Manager whether Paramedics are required.  In very serious situations, many venues now have publicly-accessible defibrillators which may help keep someone very ill alive until such time as Paramedics arrive.  Staff will be trained to use these, and even if they aren’t, there are easy-to-follow instructions on the equipment, and there is no danger to the user.”

It should be pointed out that in any situation, try to remain calm so as not to cause any further stress or panic to your fellow audience members – shouting out ‘I think she’s dead’, for example, may cause undue panic and add to an already stressful situation.

In addition to Gordon’s wise words, the following first aid advice is from Philippa Dillon of St John Ambulance.  As she states, knowing this first aid, first and foremost, means people can be the difference between a life lost and a life saved in a situation like this: “If people know how to administer first aid, this should be their priority. Then, our advice regarding who you should contact during an emergency is to always go to the nearest steward and ideally once the steward has confirmed medical assistance is on the way, the steward should stay with the casualty until the medical help arrives. This is simply because they are normally identifiable, either by uniform or high visibility jacket, so makes it easier for the first aiders/ambulance crew to identify where the casualty is located in the crowd”. Philippa also offers an overview of what to do in a number of medical emergency situations, to be found at the end of this article.

Finally, much has been written about the so-called ‘bystander effect’ which suggests that individuals are ‘less likely to offer assistance in an emergency when other witnesses are around’, not because they are primarily apathetic or fear reprisal, but because the presence of a group ‘actively inhibits an individual from acting in an emergency situation’ (Hudson and Brookman 2003, p. 168).  Based on work by Latané and Rodin in 1968 (cited in ibid.) into the bystander effect, it is suggested that the probability of help from other audience members will probably be inversely related to the number of bystanders, therefore it is possible that the larger the event, the less likely people will get involved.

With regards to the fainting woman at ‘Cats’, what was apparent was that once the initial mini panic had subsided and it was clear that someone had gone to fetch help, the majority of the audience members sat back down.  It is possible that part of the disturbance had stemmed from what is called the orienting response, a reaction to novel or significant stimuli such as loud noises, an evolutionary adaptation to needing to identify any changes to the environment which may be dangerous. Once the audience members had identified that the disturbance did not present any danger to themselves and that they could not affect the outcome in any way, there was nothing for it but to sit back down and watch the rest of the show. In this instance help was sought and found and the situation was resolved.

Emma Webster

With thanks to Gordon Hodge, Philippa Dillon, Jo Buchan, and Jan Webster for their help in preparing this article.

First Aid Advice

It should be pointed out that the following is information only and should not be used for the diagnosis or treatment of medical conditions. Live Music Exchange has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

Heart attack

If you think someone is having a heart attack you should act immediately:

  • Ask them to sit in the half sitting position, with his head and shoulders supported and knees bent
  • Try and find cushions to place underneath their knees
  • Call 999/122 for emergency help and advise that you suspect a heart attack
  • If possible, give them an aspirin tablet (300mg) to chew. While waiting for help to arrive, monitor their breathing and pulse. Constantly reassure them

Fainting

  • Advise the person to lie down and help them to raise their legs.
  • Kneel beside them and support their ankles on your shoulders – be aware of their dignity when doing this. Raised legs will improve blood flow to the brain so watch their face for signs of recovery.
  • Ask any bystanders to make space around you and the casualty.
  • As the person recovers, reassure them and help them to sit up slowly. If they begin to feel faint again, advise them to lie down and raise their legs once more until they fully recover.

Bleeding

  • Try to remove or cut any clothing that is preventing you from seeing the wound.
  • Place direct pressure over the injured area with your fingers using a sterile dressing or clean non-fluffy pad. If there isn’t a dressing to hand, ask the injured person to apply direct pressure themselves.
  • To help reduce further blood loss, raise and support the injured area above the casualty’s heart.
  • Help them to lay down on something comfortable such as blanket or rug and raise and support their legs just in case they go into shock.
  • Call for emergency 112/999 for emergency help.

Head injury

  • Head injuries can be potentially serious and should be treated with care.
  • If someone has experienced a head injury, and they are fully conscious, help them to sit down in a comfortable position.
  • Give them a cold compress to hold against the injured part of their head and monitor their condition.
  • If the injured person has been unconscious for any period of time, or becomes drowsy, confused, complains of a worsening headache, vomiting or double vision, call 112/999 for emergency help.

Fractures

  • Advise the injured person to keep still, while supporting the joints above and below the injury with your hands until is immobilised with a sling or bandages.
  • For arm injuries, you can secure the injured arm with a sling. For leg injuries, secure the uninjured leg to the injured one with bandages. You can also place padding around the injury for extra support.
  • Arrange for the injured person to be taken to hospital – some minor injuries can be transported by car, but if you have any doubts or when dealing with leg injuries call 999/112 for emergency help.

[1] In its event safety guide, the H&S Executive stipulates that the event organiser must design the site (or venue layout) to allow easy access for emergency services (1999, p. 17) and recommends liaising with the emergency services about planning for major incidents. The Health & Safety (First-Aid) Regulations 1981 do not place a legal duty on employers to make first-aid provision for non-employees such as the public or children in schools, although HSE strongly recommends that non-employees are included in an assessment of first-aid needs and that provision is made for them.  The Regulations do, however, place a legal requirement on employers to provide ‘adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work’. On its information page for audience and visitor security, the BBC stipulates that its managers must ensure they have appointed sufficient first aiders for their areas of activity.[1] If an emergency occurs, BBC staff are instructed to contact the local First Aider; if one cannot be found quickly or if an ambulance is required, staff are instructed to contact the National Central Control Room (NCCR) on 666. The HSE recommends that the minimum number of first aiders at small events where no special risks are considered likely is 2:1000 for the first 3000 attending, and that no event should have less than two first aiders (1999, p. 125).

Please note that this is a forum for discussion, dialogue, and debate, and posts and comments on this blog represent only the author, not Live Music Exchange as a whole, or any other hosting or associated institutions.

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