It started even before many of the concert goers arrived to the Susquehanna Bank Center.
Video captured two young women fighting on a NJ Transit train on the way to the WXTU Anniversary Concert.
More than 25,000 country music fans converged on at the arena in Camden. One of them, Christie Bellis, found chaos when she got there.
"There were two guys down semi-unconscious on the ground. Then I found my friends and there was a guy bleeding on a chair from his eyebrow and his jaw was cracked. I started to help treat him," Bellis said.
Witnesses say fights broke out everywhere, leaving pools of blood on the ground and on the tailgate of a pickup truck.
Emergency Medical Technicians treated 163 people for various injuries.
At least a dozen were rushed to area hospitals.
"Broken bones, we had bruises, scrapes, a couple of them did have a little more severe injuries," Dr. Rick Hong of the Cooper University Medical Center said.
Police arrested 191 people.
But, witnesses say the police didn't do much to break up the fights.
Last year, a Camden officer was stabbed in the chest while breaking up a fight at this concert.
Recently the city announced it will hire up to 110 part-time officers to beef up the force during concerts at the Susquehanna Bank Center.
The management company that runs the concerts, Live Nation, also hires private security and medical staff.
They released a statement, saying, a small percentage at any venue can cause trouble, but, "we will continue to review and assess our procedures to ensure a safe and enjoyable experience for our fans."
The emergency room doctors at Cooper say fans can help themselves by drinking less.
"We want people to have a good time, but you have to take responsibility for your actions. Drink responsibly, be safe, bring friends along, make sure there's someone who can watch your back if something were to happen," Hong said.
The hospital says it will make special preparations before the other big concerts this summer.
