The anatomy of stadium disasters: causes, consequences and safeguarding the future from a medical perspective.

INTRODUCTION: Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past. This is a descriptive analysis of stadium disasters occurring between 1901 and 2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters. DESIGN AND METHODS: Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901 - and July 30th, 2022. A disaster is defined by Centre for Research on the Epidemiology of Disasters (CRED) in its glossary as 'technological accidents of an industrial nature, or involving industrial buildings'. All categories and definitions are predetermined by the EM-DATS as per their glossary. RESULTS: The 24th May 1964 Estadio Nacional disaster in Lima, Peru, was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths). Fourteen of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia. CONCLUSION: A total of 40 stadium disasters were included, leading to 2025 deaths and 6640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans.

Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula.

OBJECTIVES: To evaluate the exposure to crisis leadership theory already present in Council on Education for Public Health (CEPH) accredited Master of Public Health (MPH) programs in the United States and provide a compelling case for its future inclusion. STUDY DESIGN: This was a narrative review. METHODS: We compiled a comprehensive list of 179 CEPH schools that offered an MPH program. During January through March 2021, we examined 179 websites for the core courses and elective courses offered in the MPH degree program to determine if any courses covered the topics of leadership, crisis leadership, or crisis management in either the course title or description. RESULTS: Leadership courses were available in only 55.31% of CEPH-accredited schools. Only a single program (0.56%) offers a crisis leadership course. CONCLUSIONS: The current global COVID-19 pandemic and reality of climate-induced disasters have brought crises to the forefront for health systems. Successful leadership for the future requires public health leaders to have training in crisis leadership. The evaluation and revision of public health curricula must focus on leadership competency development to prepare graduates to lead complex multiple crisis events and system shocks simultaneously.

Use of Dimensional Analysis in the X-, Y-, and Z-Axis to Predict Occurrence of Injury in Human Stampede.

BACKGROUND: Human stampedes (HS) may result in mass casualty incidents (MCI) that arise due to complex interactions between individuals, collective crowd, and space, which have yet to be described from a physics perspective. HS events were analyzed using basic physics principles to better understand the dynamic kinetic variables that give rise to HS. METHODS: A literature review was performed of medical and nonmedical sourced databases, Library of Congress databases, and online sources for the term human stampedes resulting in 25,123 references. Filters were applied to exclude nonhuman events. Retrieved references were reviewed for a predefined list of physics terms. Data collection involved recording frequency of each phrase and physics principle to give the final proportions of each predefined principle used a single-entry method for each of the 105 event reports analyzed. Data analysis was performed using the R statistics packages "tidyverse", "psych", "lubridate", and "Hmisc" with descriptive statistics used to describe the frequency of each observed variable. RESULTS: Of the 105 reports of HS resulting in injury or death reviewed, the following frequency of terms were found: density change in a limited capacity, 45%; XY-axis motion failure, 100%; loss of proxemics, 100%; deceleration with average velocity of zero, 90%; Z-axis displacement pathology (falls), 92%; associated structure with nozzle effect, 93%; and matched fluid dynamic of high pressure stagnation of mass gathering, 100%. CONCLUSIONS: Description or reference to principles of physics was seen in differing frequency in 105 reports. These include XY-axis motion failure of deceleration that leads to loss of human to human proxemics, and high stagnation pressure resulting in the Z-axis displacement effect (falls) causing injury and death. Real-time video-analysis monitoring of high capacity events or those with known nozzle effects for loss of proxemics and Z-axis displacement pathology offers the opportunity to prevent mortality from human stampedes.

An attempt to measure the spread of emergency medicine internationally.

OBJECTIVE: To determine the feasibility of using the internet to track the spread of emergency medicine internationally. OVERVIEW: This was an attempt to perform a descriptive cross-sectional study employing a web-based survey. SUBJECTS: Potential respondents were identified from multiple sources. OBSERVATIONS: The primary outcome was the response to 16 questions about EM care and the setting in which it was delivered for acute cardiac, paediatric, obstetrical illnesses and trauma. The questions were divided into six general areas and elicited for urban, semi-urban and rural settings. A series of four e-mails soliciting completion of the survey were sent to potential respondents. ANALYSIS: Simple descriptive statistics. RESULTS: We identified 358 potential respondents with valid e-mail addresses over a period of three years. Overall, 145 (41%) responded and 117 (33% 95% CI 28-38%) of them were complete and interpretable. There was one response from 54 and two responses from 29 countries, representing an overall response rate by country surveyed of 65% (95% CI 57-73%), but of all existing countries of only 43% (95% CI 36-50%). Based on sparse data, it appears that in urban areas, 47% (obstetrics) to 65% (paediatric) of acutely sick or injured patients are taken to an ED-equivalent. For rural areas, this range was 19% (obstetrical) to 40% (trauma). CT scans are available in 78% of urban ED-equivalents but 12% of rural ones. Haematocrits are available in 72% of rural settings. In 60% of responding nations, some type of EM training was available, and in 42% physicians went abroad to study EM. CONCLUSIONS: A survey of international EM is challenging to achieve because of difficulty in both identifying and in contacting potential respondents. Based on sparse data, population density (urban, rural) appears to be related to both the location to which acutely ill patients are taken for their care and to the level of technology available. The specialty of EM is now recognised internationally and education in EM is common.

International development of emergency medical systems: educational techniques for the future.

An ongoing collaborative partnership between the University of Massachusetts Medical Center, Boston University Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia has been established since 1993. The primary goal of this partnership is to reform and improve the delivery of emergency medical care through a process of education and training that is reproducible, practical, and self-sustaining for the advancement of health care into the future. A six-step educational process was developed, using Armenia as the initial model site for this format. Through the development of a regional training center and two emergency medicine training curricula, the partnership has trained over 1800 health care workers and first responders. Preliminary results from pre- and post-course examinations show a significant overall improvement in scores. An ongoing trauma database collection also shows significant improvement in the number of advanced life support measures being implemented since the inception of this educational training programme. This educational strategy has subsequently been replicated in nine similar partnerships in other countries of the New Independent States, formed after the dissolution of the former Soviet Union in 1990. We believe this six-step educational format is effective for the development and improvement of emergency medical systems in developing countries worldwide.