Correspondence
Mass Fainting at Rock Concerts
N Engl J Med 1995; 332:1721June 22, 1995
- Article
To the Editor:
Mass fainting by members of rock-concert audiences has been a well-recognized phenomenon since the time of Elvis Presley and the Beatles, but it has been neglected in the medical literature. To investigate its mechanisms, we joined the first-aid workers during a concert by the New Kids on the Block. We interviewed 40 of about 400 people who fainted, immediately after they were brought to the Red Cross infirmary.
Those who fainted were all girls between 11 and 17 years of age. Forty percent reported having lost consciousness, suggesting that they had experienced syncope, whereas the others had remained alert throughout. Their faints could be classified as hyperventilation or panic attacks, especially since many of the girls were still breathing rapidly when we interviewed them backstage. In most, anxiety had been provoked when they felt squeezed, choked, and trapped in the middle of the crowd, whereas others had started to hyperventilate when they were overcome by emotion.
Those who lost consciousness usually reported a combination of syncope-provoking factors: sleeplessness during the previous night; fasting from early in the morning, when they had first lined up; a long period of standing in the arena; hyperventilation, which leads to cerebral vasoconstriction; and Valsalva-like pressure, induced either by screaming or reflexively by external compression of the thorax by the pushing masses. The Valsalva maneuver impairs venous return to the heart and consequently reduces cardiac output.1 Notably, most cases of syncope occurred in girls standing next to the stage, where squeezing is maximal, which emphasizes the effect of both orthostasis and the Valsalva maneuver.
The multifactorial pathophysiology of rock-concert syncope suggests guidelines for its prevention, which could be summarized as follows: sleep, eat, sit, keep cool, and stay out of the crowd. But what teenage fan will do that?
1 ReferencesThomas Lempert, M.D.
Universitätsklinikum Rudolf Virchow, 13353 Berlin, GermanyMartin Bauer, M.D.
Freie Universität Berlin, 14095 Berlin, Germany- Citing Articles (2)
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