Ngai bangladesh & india human stampedes
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Human Stampedes in Bangladesh and India, presentation at WCDEM 2013
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Ngai bangladesh & india human stampedes
- 1. Human Stampedes: Repeated Patterns in Bangladesh and India K. Gordon Ngai, MD, MPH1,2 , Wing Yan Lee, MBBS, MPH, Frederick M. Burkle, Jr, MD, MPH, DTM3 , Edbert B. Hsu, MD, MPH4 1 The Icahn School of Medicine at Mount Sinai, New York City, USA 2 Bellevue Hospital/NYU Langone Medical Center, New York City, USA 3 Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA 4 Office of Critical Event Preparedness and Response, Johns Hopkins University, Baltimore, MD, USA Department of Emergency Medicine
- 2. Disclosures and Disclaimers ▶ I do not have any financial conflicts of interest to disclose ▶ 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 Research Career Development Program 5K12HL109005-02 Department of Emergency Medicine
- 3. Objectives ▶ Background ▶ Review of Events in Bangladesh & India ▶ Study Method ▶ Results ▶ Future Directions ▶ Acknowledgement ▶ Q&A Department of Emergency Medicine
- 4. Background—Pathophysiology ▶ Patients usually die of traumatic asphyxia ▶ 6 to 7 people pushing in the same direction can generate forces up to 4500N (1000 pounds) ▶ Patients can die standing up ▶ Stampede may occur when >10 people per meter2 Department of Emergency Medicine Ngai et al, 2009
- 5. Background—Pathophysiology Department of Emergency Medicine Bledsoe, 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. Background—Pathophysiology Department of Emergency Medicine Bledsoe, 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. Background—History Department of Emergency Medicine http://en.wikipedia.org/wiki/Colosseum. Assessed 5/23/2013
- 8. Background—History ▶ The Coliseum had 80 exits ▶ Visitors could evacuate in 5 minutes ▶ Cannot achieve by modern stadium Department of Emergency Medicine Helbing and Mukerji EPJ Data Science 2012, 1:7. http://en.wikipedia.org/wiki/Colosseum. Assessed 5/23/2013
- 9. Background—Global Pattern Department of Emergency Medicine Hsieh et al., Disaster Med Public Health Preparedness. 2009;3:217–223et al, 2009
- 10. Notable Events in Developed Countries
- 11. England 1989
- 12. Background Department of Emergency Medicine http://www.rte.ie/news/special-reports/2012/0202/311849-football/. Assessed 5/23/2013
- 14. Germany 2010
- 16. Background Department of Emergency Medicine http://www.bloggen.be/dekronkel/archief.php?ID=982827 Assessed 5/23/2013
- 17. Notable Recent Events in Bangladesh (Non-stampedes)
- 18. Bangladesh Department of Emergency Medicine http://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-risk- across-bangladesh-india-and-pakistan . Assessed 5/23/2013
- 19. Bangladesh Department of Emergency Medicine http://www.washingtonpost.com/world/deadly-blaze-sweeps-bangladesh-garment- factory/2012/11/25/d3c3f5ee-372c-11e2-8a97-363b0f9a0ab3_gallery.html Assessed 5/23/2013
- 20. Bangladesh Department of Emergency Medicine http://www.scmp.com/news/asia/article/1091597/dhaka-slum-blaze-highlights-fire-risk- across-bangladesh-india-and-pakistan . Assessed 5/23/2013
- 21. Bangladesh Department of Emergency Medicine http://www.guardian.co.uk/world/2013/apr/24/bangladesh-building-collapse-shops-west . Assessed 5/23/2013
- 22. Notable Events in India
- 23. India Department of Emergency Medicine http://www.cbsnews.com/8301-202_162-57552208/panicked-stampede-kills-17-at-india- religious-festival/ . Assessed 5/23/2013
- 24. India Department of Emergency Medicine http://www.emirates247.com/news/kumbh-mela-stampede-death-toll-rises-to-36-2013- 02-11-1.494501 Assessed 5/23/2013
- 25. Objective Department of Emergency Medicine ▶ To identify the common characteristics of stampede events occurred in Bangladesh and India, the two countries with the highest incidences.
- 26. Method Department of Emergency Medicine ▶ LexisNexis® Academic search method with the search terms “stampede” & “Injur*”, and Headline (stampede), source: News (all, English, full text) ▶ Hand searching of News o British Broadcasting Corporation (BBC) News o The New York Times o Arab News o Cable News Network (CNN) o Reuters o Internet searches were conducted on PubMed, Wikipedia, crowddynamics.com, and mapreport.com
- 27. Method Department of Emergency Medicine ▶ 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
- 29. Results—Global, India, Bangladesh Department of Emergency Medicine ▶ Globally 350 events, a total of 10,243 deaths and, 22,445 injuries in 83 countries ▶ 77 events occurred in India with median deaths of 12/event and median injuries of 12/event ▶ 22 events occurred in Bangladesh with median deaths of 2.5/event and median injuries 25/event
- 31. Results—Stampede in India Department of Emergency Medicine
- 32. Results—Stampede in Bangladesh Department of Emergency Medicine Sports 4% Religion 25% Poli al 7% Garment Factory Related 64% Event Type
- 33. Department of Emergency Medicine Results—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. Future Directions Department of Emergency Medicine ▶ Country specific ▶ Learn from success (Hajj in Saudi Arabia) ▶ Multidisciplinary Helbing D, Mukerji P. Crowd disasters as systemic failures: analysis of the Love Parade disaster. EPJ Data Science. 2012;1(7):1-40.
- 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 5K12HL109005-02 Department of Emergency Medicine
- 36. Thank You Department of Emergency Medicine ?
- 37. If you like this, come to the following Department of Emergency Medicine Session Number - Session Name BO-52 - Disaster Epidemiology 1 Session Date 5/30/2013 Session Time 13:15- 14:45 Abstract ID - Abstract Title ID #285 - From Hurricane Irene to Hurricane Sandy—State of Disaster Preparedness in the New York University and Bellevue Hospital Center Population Presentation Time 14:21– 14:33 Meeting Room Charter 3
- 38. Also this Department of Emergency Medicine Session Number - Session Name BO-61 - Disaster Epidemiology 2 Session Date 5/30/2013 Session Time 15:30- 17:00 Abstract ID - Abstract Title ID #228 - Human Stampedes: A Comparative Two Search Method Analysis to Assess Underestimation of Available Data Presentation Time 16:48– 17:00 Meeting Room Charter 3
Editor's Notes
- 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.