Human Stampedes: RepeatedPatterns in Bangladesh and IndiaK. Gordon Ngai, MD, MPH1,2, Wing Yan Lee, MBBS, MPH, Frederick M....
Disclosures and Disclaimers▶ I do not have any financial conflicts of interest todisclose▶ My views do not reflect those o...
Objectives▶ Background▶ Review of Events in Bangladesh & India▶ Study Method▶ Results▶ Future Directions▶ Acknowledgement▶...
Background—Pathophysiology▶ Patients usually die of traumatic asphyxia▶ 6 to 7 people pushing in the same direction cangen...
Background—PathophysiologyDepartment of EmergencyMedicineBledsoe, Bryan E.; Berkeley, Ross. P.; Markus, Troy (2010). "Know...
Background—PathophysiologyDepartment of EmergencyMedicineBledsoe, Bryan E.; Berkeley, Ross. P.; Markus, Troy (2010). "Know...
Background—HistoryDepartment of EmergencyMedicinehttp://en.wikipedia.org/wiki/Colosseum. Assessed 5/23/2013
Background—History▶ The Coliseum had 80 exits▶ Visitors could evacuate in 5 minutes▶ Cannot achieve by modern stadiumDepar...
Background—Global PatternDepartment of EmergencyMedicineHsieh et al., Disaster Med Public Health Preparedness. 2009;3:217–...
Notable Events in Developed Countries
England 1989
BackgroundDepartment of EmergencyMedicinehttp://www.rte.ie/news/special-reports/2012/0202/311849-football/. Assessed 5/23/...
BackgroundDepartment of EmergencyMedicinehttp://projectavalon.net/forum4/showthread.php?49710-Hillsborough-Disaster-Police...
Germany 2010
BackgroundDepartment of EmergencyMedicinehttp://www.theage.com.au/world/stampede-at-love-parade-kills-19-20100725-10q1z.ht...
BackgroundDepartment of EmergencyMedicinehttp://www.bloggen.be/dekronkel/archief.php?ID=982827 Assessed 5/23/2013
Notable Recent Events in Bangladesh(Non-stampedes)
BangladeshDepartment of EmergencyMedicinehttp://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-ri...
BangladeshDepartment of EmergencyMedicinehttp://www.washingtonpost.com/world/deadly-blaze-sweeps-bangladesh-garment-factor...
BangladeshDepartment of EmergencyMedicinehttp://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-ri...
BangladeshDepartment of EmergencyMedicinehttp://www.guardian.co.uk/world/2013/apr/24/bangladesh-building-collapse-shops-we...
Notable Events in India
IndiaDepartment of EmergencyMedicinehttp://www.cbsnews.com/8301-202_162-57552208/panicked-stampede-kills-17-at-india-relig...
IndiaDepartment of EmergencyMedicinehttp://www.emirates247.com/news/kumbh-mela-stampede-death-toll-rises-to-36-2013-02-11-...
ObjectiveDepartment of EmergencyMedicine▶ To identify the common characteristics ofstampede events occurred in Bangladesh ...
MethodDepartment of EmergencyMedicine▶ LexisNexis® Academic search method with the searchterms “stampede” & “Injur*”, and ...
MethodDepartment of EmergencyMedicine▶ Location (City, State, Country)▶ Region▶ Type of event (Sports, Religion, Music, Po...
ResultsDepartment of EmergencyMedicine
Results—Global, India, BangladeshDepartment of EmergencyMedicine▶ Globally 350 events, a total of 10,243 deathsand, 22,445...
Results—TrendsDepartment of EmergencyMedicine
Results—Stampede in IndiaDepartment of EmergencyMedicine
Results—Stampede in BangladeshDepartment of EmergencyMedicineSports4%Religion25%Poli al7%GarmentFactoryRelated64%Event Type
Department of EmergencyMedicineResults—Multivariate Model for India▶ Negative binomial model on No. of Deaths– Type of eve...
Future DirectionsDepartment of EmergencyMedicine▶ Country specific▶ Learn from success (Hajj in Saudi Arabia)▶ Multidiscip...
Acknowledgements▶ Research Team Dr. Skip Burkle (Harvard) Dr. Edbert Hsu (Johns Hopkins) Dr. Wing Lee (my wife)▶ This w...
Thank YouDepartment of EmergencyMedicine?
If you like this, come to the followingDepartment of EmergencyMedicineSession Number - Session Name BO-52 - Disaster Epide...
Also thisDepartment of EmergencyMedicineSession Number - Session Name BO-61 - Disaster Epidemiology 2Session Date 5/30/201...
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Ngai bangladesh & india human stampedes

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Human Stampedes in Bangladesh and India, presentation at WCDEM 2013

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  • The sudden impact on the genitals causes an increase in intrathoracic pressure. In order for traumatic asphyxia to occur, a Valsalva maneuver is required when the traumatic force is applied.Exhalation against the closed glottis along with the traumatic event causes air that cannot escape from the thoracic cavity. Instead, the air causes increased venous back-pressure, which is transferred back to through the right atrium, to the superior vena cava and to the head and neck veins and capillaries.
  • Clinical signs include conjunctival petechiae, facial petechiae, cutaneous blue–purple discoloration and congestion of the face and neck, and seizures, confusion, and unconsciousness
  • Clinical signs include conjunctival petechiae, facial petechiae, cutaneous blue–purple discoloration and congestion of the face and neck, and seizures, confusion, and unconsciousness
  • The Colosseum is situated just east of the Roman Forum. Construction began under the emperor Vespasian in 70 AD, and was completed in 80 AD under his successor and heir Titus. Further modifications were made during the reign of Domitian (81–96). These three emperors are known as the Flavian dynasty, and the amphitheatre was named in Latin for its association with their family name (Flavius). The Colosseum could hold, it is estimated, between 50,000 and 80,000 spectators. it had more than 60 numbered entrances, and visitors exited through the same gate through which they had entered. In fact, exits were located side by side, around the entire circumference of the Coliseum. As a consequence, the Coliseum could be evacuated within just about 5 minutes, an efficiency that is not even reached by modern stadia due to their smaller number of exits.
  • Spectators were given tickets in the form of numbered pottery shards, which directed them to the appropriate section and row. They accessed their seats via vomitoria (singular vomitorium), passageways that opened into a tier of seats from below or behind. These quickly dispersed people into their seats and, upon conclusion of the event or in an emergency evacuation, could permit their exit within only a few minutes. The name vomitoria derived from the Latin word for a rapid discharge, from which English derives the word vomit.
  • In our 2008 study, we described the epidemiology globally. We maintain a database with periodic updates
  • While we are in England, this represent the typical pattern of events in developed countries are sports related event.
  • While we are in England, this represent the typical pattern of events in developed countries are sports related event.
  • Most published event in English medical journal is the Hillsborough disaster in 1989. The 1989 Hillsborough disaster was an incident that occurred during the FA Cup semi-final match between Liverpool and Nottingham Forest football clubs on 15 April 1989 at the Hillsborough Stadium in Sheffield, England. The crush resulted in the deaths of 96 people and injuries to 766 others. The incident has since been blamed primarily on the police. The incident remains the worst stadium-related disaster in British history and one of the world's worst football disasters
  • 96 deaths, 400 injured in Hillsborough Stadium
  • Similar things still occur regularly, this is July 2010 at Germany Love Parade
  • Similar picture
  • 16meter wide tunnel entrance
  • Dhaka Fire in September 2012
  • Washington Post Dhaka Fire 2012
  • One can reason the threat of working in these factories
  • April 2013 building collapse with 1100 death
  • India Ganges River in November 2012
  • The Maha Kumbha Mela is held at Allahabad (Prayag) (27 January to 10 March 2013). An estimated 30 million people visited the Maha Kumbh Mela on 10 February 2013 and an estimated 100 million are expected to visit the place during the festival spread over 55 days. On 10 February 2013 a stampede at the railway station killed 36 and injured at least 39.[49] In the vast crowds some elderly people, predominantly women, are abandoned by their families. Here are the details of most auspicious days (bathing dates) in year 2013 during Maha Kumbh Festival (mela).[50] 14 January 2013 (Monday) – Makar Sankranti 27 January 2013 (Sunday) – Paush Purnima 6 February 2013 (Wednesday) – Ekadashi Snan 10 February 2013 (Sunday) – Mauni Amavasya Snan (Main Bathing Day) 15 February 2013 (Friday) – Vasant Panchami Snan 17 February 2013 (Sunday) – Rath Saptami Snan 21 February 2013 (Thursday) – Bhisma Ekadashi Snan 25 February 2013 (Monday) – Maghi Purnima Snan 10 March 2013 (Sunday) – Mahashivratri
  • During the 17 th World Congress on Disaster and Emergency Medicine in Beijing in 2011,
  • In our 2008 study, we described the epidemiology globally. We maintain a database with periodic updates
  • Helbing D, Mukerji P. Crowd disasters as systemic failures: analysis of the Love Parade disaster. EPJ Data Science. 2012;1(7):1-40.
  • Transcript of "Ngai bangladesh & india human stampedes"

    1. 1. Human Stampedes: RepeatedPatterns in Bangladesh and IndiaK. Gordon Ngai, MD, MPH1,2, Wing Yan Lee, MBBS, MPH, Frederick M.Burkle, Jr, MD, MPH, DTM3, Edbert B. Hsu, MD, MPH41The Icahn School of Medicine at Mount Sinai, New York City, USA2Bellevue Hospital/NYU Langone Medical Center, New York City, USA3Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA4Office of Critical Event Preparedness and Response, Johns Hopkins University, Baltimore, MD, USADepartment of Emergency Medicine
    2. 2. Disclosures and Disclaimers▶ I do not have any financial conflicts of interest todisclose▶ My views do not reflect those of my department,employers, affiliations, or government entities▶ This work is partially supported by:The National Heart Lung and Blood Institute,Mount Sinai Emergency Medicine ResearchCareer Development Program5K12HL109005-02Department of EmergencyMedicine
    3. 3. Objectives▶ Background▶ Review of Events in Bangladesh & India▶ Study Method▶ Results▶ Future Directions▶ Acknowledgement▶ Q&ADepartment of EmergencyMedicine
    4. 4. Background—Pathophysiology▶ Patients usually die of traumatic asphyxia▶ 6 to 7 people pushing in the same direction cangenerate forces up to 4500N (1000 pounds)▶ Patients can die standing up▶ Stampede may occur when >10 people permeter2Department of EmergencyMedicineNgai et al, 2009
    5. 5. Background—PathophysiologyDepartment of EmergencyMedicineBledsoe, Bryan E.; Berkeley, Ross. P.; Markus, Troy (2010). "Know the Signs and Symptoms of Traumatic Asphyxia". JEMS .http://www.jems.com/article/patient-care/know-signs-and-symptoms-trauma Reprint with permission ©Bledsoe
    6. 6. Background—PathophysiologyDepartment of EmergencyMedicineBledsoe, Bryan E.; Berkeley, Ross. P.; Markus, Troy (2010). "Know the Signs and Symptoms of Traumatic Asphyxia". JEMS .http://www.jems.com/article/patient-care/know-signs-and-symptoms-trauma Reprint with permission ©Bledsoe
    7. 7. Background—HistoryDepartment of EmergencyMedicinehttp://en.wikipedia.org/wiki/Colosseum. Assessed 5/23/2013
    8. 8. Background—History▶ The Coliseum had 80 exits▶ Visitors could evacuate in 5 minutes▶ Cannot achieve by modern stadiumDepartment of EmergencyMedicineHelbing and Mukerji EPJ Data Science 2012, 1:7.http://en.wikipedia.org/wiki/Colosseum. Assessed 5/23/2013
    9. 9. Background—Global PatternDepartment of EmergencyMedicineHsieh et al., Disaster Med Public Health Preparedness. 2009;3:217–223et al, 2009
    10. 10. Notable Events in Developed Countries
    11. 11. England 1989
    12. 12. BackgroundDepartment of EmergencyMedicinehttp://www.rte.ie/news/special-reports/2012/0202/311849-football/. Assessed 5/23/2013
    13. 13. BackgroundDepartment of EmergencyMedicinehttp://projectavalon.net/forum4/showthread.php?49710-Hillsborough-Disaster-Police-Lied-CAssessed 5/23/2013
    14. 14. Germany 2010
    15. 15. BackgroundDepartment of EmergencyMedicinehttp://www.theage.com.au/world/stampede-at-love-parade-kills-19-20100725-10q1z.htmlAssessed 5/23/2013
    16. 16. BackgroundDepartment of EmergencyMedicinehttp://www.bloggen.be/dekronkel/archief.php?ID=982827 Assessed 5/23/2013
    17. 17. Notable Recent Events in Bangladesh(Non-stampedes)
    18. 18. BangladeshDepartment of EmergencyMedicinehttp://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-risk-across-bangladesh-india-and-pakistan . Assessed 5/23/2013
    19. 19. BangladeshDepartment of EmergencyMedicinehttp://www.washingtonpost.com/world/deadly-blaze-sweeps-bangladesh-garment-factory/2012/11/25/d3c3f5ee-372c-11e2-8a97-363b0f9a0ab3_gallery.html Assessed5/23/2013
    20. 20. BangladeshDepartment of EmergencyMedicinehttp://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-risk-across-bangladesh-india-and-pakistan . Assessed 5/23/2013
    21. 21. BangladeshDepartment of EmergencyMedicinehttp://www.guardian.co.uk/world/2013/apr/24/bangladesh-building-collapse-shops-west .Assessed 5/23/2013
    22. 22. Notable Events in India
    23. 23. IndiaDepartment of EmergencyMedicinehttp://www.cbsnews.com/8301-202_162-57552208/panicked-stampede-kills-17-at-india-religious-festival/ . Assessed 5/23/2013
    24. 24. IndiaDepartment of EmergencyMedicinehttp://www.emirates247.com/news/kumbh-mela-stampede-death-toll-rises-to-36-2013-02-11-1.494501 Assessed 5/23/2013
    25. 25. ObjectiveDepartment of EmergencyMedicine▶ To identify the common characteristics ofstampede events occurred in Bangladesh andIndia, the two countries with the highestincidences.
    26. 26. MethodDepartment of EmergencyMedicine▶ LexisNexis® Academic search method with the searchterms “stampede” & “Injur*”, and Headline(stampede), source: News (all, English, full text)▶ Hand searching of Newso British Broadcasting Corporation (BBC) Newso The New York Timeso Arab Newso Cable News Network (CNN)o Reuterso Internet searches were conducted on PubMed, Wikipedia,crowddynamics.com, and mapreport.com
    27. 27. MethodDepartment of EmergencyMedicine▶ Location (City, State, Country)▶ Region▶ Type of event (Sports, Religion, Music, Political,Others)▶ Day vs. Night▶ Indoor vs. Outdoor▶ Mechanism (Unidirectional vs. Turbulence)▶ Trigger (descriptive)▶ Number of Participants, Injuries and Death
    28. 28. ResultsDepartment of EmergencyMedicine
    29. 29. Results—Global, India, BangladeshDepartment of EmergencyMedicine▶ Globally 350 events, a total of 10,243 deathsand, 22,445 injuries in 83 countries▶ 77 events occurred in India with mediandeaths of 12/event and median injuries of12/event▶ 22 events occurred in Bangladesh with mediandeaths of 2.5/event and median injuries25/event
    30. 30. Results—TrendsDepartment of EmergencyMedicine
    31. 31. Results—Stampede in IndiaDepartment of EmergencyMedicine
    32. 32. Results—Stampede in BangladeshDepartment of EmergencyMedicineSports4%Religion25%Poli al7%GarmentFactoryRelated64%Event Type
    33. 33. Department of EmergencyMedicineResults—Multivariate Model for India▶ Negative binomial model on No. of Deaths– Type of event (Sports, Religion, Music, Political, Others)– Day vs. Night– Indoor vs. Outdoor– Mechanism (Unidirectional vs. Turbulence)• BOLD is statistically significantly predictive of number of deaths (P<0.05)
    34. 34. Future DirectionsDepartment of EmergencyMedicine▶ Country specific▶ Learn from success (Hajj in Saudi Arabia)▶ MultidisciplinaryHelbing D, Mukerji P. Crowd disasters as systemic failures: analysis of the Love Parade disaster. EPJ Data Science. 2012;1(7):1-40.
    35. 35. Acknowledgements▶ Research Team Dr. Skip Burkle (Harvard) Dr. Edbert Hsu (Johns Hopkins) Dr. Wing Lee (my wife)▶ This work is partially supported by: NIH NHLBI 5K12HL109005-02Department of EmergencyMedicine
    36. 36. Thank YouDepartment of EmergencyMedicine?
    37. 37. If you like this, come to the followingDepartment of EmergencyMedicineSession Number - Session Name BO-52 - Disaster Epidemiology 1Session Date 5/30/2013Session Time 13:15- 14:45Abstract ID - Abstract Title ID #285 - From Hurricane Irene toHurricane Sandy—State of DisasterPreparedness in the New YorkUniversity and Bellevue HospitalCenter PopulationPresentation Time 14:21– 14:33Meeting Room Charter 3
    38. 38. Also thisDepartment of EmergencyMedicineSession Number - Session Name BO-61 - Disaster Epidemiology 2Session Date 5/30/2013Session Time 15:30- 17:00Abstract ID - Abstract Title ID #228 - Human Stampedes: AComparative Two Search MethodAnalysis to Assess Underestimationof Available DataPresentation Time 16:48– 17:00Meeting Room Charter 3

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