Houston officials worried about crowd control before Travis Scott took the stage

It would be a few more hours before large numbers of patients reached the doctors’ tent. The other performances of the festival, which took place on two stages throughout the day, went as usual. “We thought it was pretty cool,” said Alex McLemore, 26, who described the scene in a VIP lounge area in the early afternoon.

According to the 56-page planning report, the organizers had planned to deploy security personnel throughout the arena, including along nearby roads, gates, fences and VIP areas. They also erected imposing fences: two-and-a-half meter high mesh fences, bike racks, snow fences, and concrete bollards to keep the crowd under control. Those fences and barricades were stronger and more sturdy than they were in 2019, officials said.

The security forces were given a list of visible signs to determine if the guests were about to require medical attention, including unsteady gait, confusion, vomiting, and loss of consciousness. “Many incidents will be minor and some will be complex,” the report said.

The first influx of people seeking medical help began around 3:30 p.m., Mr Anjum said. But nothing unusual for a concert with young fans, where overdoses are not uncommon.

A 22-page medical plan drawn up by ParaDocs provided for a main medical tent with two emergency doctors, six nurses, two paramedics, and nine emergency medics, and people to track and triage patients. In the main tent there were 30 cots, 12 tables and two wheelchairs; other smaller medical tents were set up around the event.

But the number of people in need of medical care – which grew to more than 300 and possibly many more – seemed to overwhelm those resources even before Scott began performing.

At around 8.15 p.m., the medical staff said it was not possible to document patients because there were so many people in need. “Many patients were last seen conscious more than 20 minutes before medical treatment,” said Mr. Anjum. They started triage.

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