Internal Medicine Emergencies During the Munich Oktoberfest, 2013–2022

Munich’s Oktoberfest (OF) is the world’s largest fair, attracting 6 to 7 million visitors every year (1). Owing to excessive alcohol consumption, the Oktoberfest represents an annual stress test for acute care in the emergency departments, challenging acute patient care across Greater Munich (2). While immoderate consumption of alcohol and large amounts of fatty food are well-known risk factors for various acute health conditions—particularly cardiovascular events (3)—studies on the impact of mass events have mainly focused on hospital admissions due to traumatic injuries (4).

Methods

Data were collected via the IVENA Interdisciplinary Care Registry, a web-based communication platform used for the coordination between emergency medical services (EMS) and hospitals across Bavaria. The system provides real-time information on hospital resources and capacities; further, it facilitates the registration, notification, and allocation of patients to the emergency departments (5). Among other categories, the IVENA register includes hospital admissions classified preclinically as internal medicine emergency (IME), covering cases involving acute symptoms indicative of potentially life-threatening internal diseases or events. Additionally, cases of acute coronary syndrome (ACS) were examined (these cases are excluded from the IME category). Preclinically documented ACS cases were identified based on admission labels used for emergency room registration, including ST-elevation myocardial infarction and chest pain (including non-ST-elevation myocardial infarction and angina pectoris).

The study focused on the Greater Munich area (Bavaria, Germany) and compared admission rates for IME and ACS before, during, and after the Oktoberfest. Moreover, median incidence rates from 2013 to 2019 and in 2022 were compared with a reference period during the COVID-19 pandemic (2020–2021), when the Oktoberfest did not take place. Later years could not be included because the admission labels were changed and therefore no valid comparability of the data could be assured. As the duration of the Oktoberfest varies, year-to-year comparisons refer to a standardized 16-day period. Statistical analyses were performed using SPSS version 26 (IBM Corporation), and frequency distributions were reported. Non-parametric tests were applied to compare the median number of hospital admissions, in line with the distribution structure of the data.

Results

Between 2013 and 2019, the median number of admissions classified as IME increased significantly during the Oktoberfest (median, IQR): before OF 109.5 (100.3–119.8); during OF 131.0 (120.3–141.0); after OF 115.8 (105.0–125.0), p < 0.001. This increase was not observed in the reference period with no OF (2020–2021), even after stratification by season (before, during, after OF). In 2022, when the OF took place again, an increase in IME cases was again observed during the OF (Figure). Furthermore, the overall comparison showed that the median number of IME admissions during the OF was higher in 2013–2019 and 2022 than in the reference period. The median number of ACS admissions in 2020–2021 and 2022 significantly exceeded those of 2013–2019. When stratifying by season (before, during, after OF), however, no significant difference in the occurrence of ACS was seen (Table).

Figure

Number of internal medicine emergencies

Table

Overview of IME and ACS admissions, stratified by year and season

Discussion

The results of this secondary analysis show an increased admission rate for IME cases during the Oktoberfest, while there was no substantial change in the incidence of ACS cases.

Although the higher number of IME admissions might be partially attributable to the larger number of visitors, we would argue that this is not the primary explanatory factor, as no corresponding increase in the incidence of ACS was observed. Furthermore, the stable incidence rate of ACS across the different periods (before versus during versus after OF) suggests that at least the short-term heavy consumption of food and alcoholic beverages may not significantly affect the risk of acute coronary syndrome. Importantly, it should be noted that ACS cases in this context refer to suspected diagnoses or initial EMS assessment, which needs to be verified through extended diagnostics. The observed increase in ACS admissions in the years 2020, 2021, and 2022 in comparison with 2013–2019 is not supported by epidemiological data, as, to the best of our knowledge, no data on annual incidence of ACS cases in Germany are available. However, it is likely that admission rates—particularly for chest pain—changed due to the COVID-19 pandemic. Nevertheless, the increase in chest pain admissions constitutes a rising burden on internal medicine emergency care, even if the preclinical diagnosis is not confirmed during the hospital stay.

Conclusion

Our findings show that mass events not only lead to increased rates of referral to surgical emergency departments, but also place a burden on internal medicine emergency care. Since the data are descriptive in nature, no causal association can be concluded. However, the results can serve to generate research hypotheses for further investigation.

Jenny Schlichtiger, Viktoria Bogner-Flatz, Dominik Hinzmann, Stefan Brunner

Department of Medicine I Cardiology, University Hospital Munich, LMU Munich, Schlichtiger, Brunner ([e-mail])

Musculoskeletal Center MUM, University Hospital Munich, LMU Munich – District Medical Officer, Emergency Medical Service Upper Bavaria West, Government of Upper Bavaria (Bogner-Flatz)

Department of Anesthesiology and Intensive Care Medicine, TUM School of Medicine and Health (MH), TUM Rechts der Isar Hospital, Munich (Hinzmann)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript submitted on 24 March 2025, revised version accepted on 26 June 2025

Cite this as:
Schlichtiger J, Bogner-Flatz V, Hinzmann D, Brunner S: Internal medicine emergencies during the Munich Oktoberfest, 2013–2022. Dtsch Arztebl Int 2025; 122: 560–1. DOI: 10.3238/arztebl.m2025.0121

References

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