Summary Background Knowledge about longitudinal changes in epidemiological data at mass gathering events is sparse. The goal of this study was to determine and compare the type, severity and frequency of illnesses at a large music festival over 7 consecutive years (2011–2017). Methods Prospectively collected data from the rescue operation protocols of an Austrian music festival were retrieved and analyzed. Patient presentation rates (PPR) and transport to hospital rates (TTHR) were calculated and compared between years. Linear regression was used to investigate the association between (a) total number of visitors and number of patient presentations, and (b) environmental factors and temperature related medical emergencies. A descriptive analysis of pertinent medical logistics management was performed. Results The median (minimum to maximum) PPR and TTHR were 12.01 (9.33 in 2016 to 20.86 in 2011) and 0.57 (0.40 in 2017 to 1.06 in 2013) per 1000 visitors, respectively. In linear regression models, no significant associations were found between the number of visitors and either the total number of patient presentations, NACA 1–2 or NACA 3–5 classified emergencies. Environmental temperature had a significant impact on heat related patient presentations (p < 0.001). Conclusion There were significant differences and a high variance in both PPR and TTHR over the years. Contrary to our expectations, the number of visitors did not predict the number of patient presentations. Ambient temperature was associated with the number of heat related emergencies but not with the number of cold related emergencies. Prevention strategies, such as the removal of insect nests, resulted in significantly fewer insect related emergencies.