Evaluation of trauma management in injured Iranian Hajj pilgrims in 2015 Mina stampede

Abstract

Introduction: The Muslim annual pilgrimage (Hajj) ceremony in 2015 was one of the most catastrophic and tragic events of the Hajj pilgrimage in history. Thousands of pilgrims have been tragically stampeded to death and injured in the land of Mina in Mecca, Saudi Arabia, on September 25 in 2015. The last official statistics declared that at least 2,431 pilgrims died and 427 pilgrims were missed in the blocked street. Furthermore, 464 corpses were Iranian Objectives: The purpose of this study was to evaluate the treatment of the injured pilgrims by the Iranian Hajj Medical Team in Mina and assess its strengths and weaknesses in order to develop a comprehensive approach in dealing with similar events. Methods: The records of the patients were obtained from the archives of the Islamic Republic of Iran Hajj Medical Center. Firstly, the demographic data, method of triage, cause of admission, treatment methods, and referral to Mecca hospitals were extracted, and then some interviews were performed with the members of the medical team who were present at the incident scene. Finally, a protocol was proposed for the management of patients in similar incidents. Results: Out of a total of 1,633 referred patients, 567 injured pilgrims were admitted and treated during the incident. Due to the incomplete medical records, a total of 403 complete medical sheets were included in this study. Moreover, 362 cases (89.8%) improved after cooling and proper fluid replacement. They were discharged with therapeutic measures. A total of 41 injured pilgrims (10.2%) were referred to urban hospitals, and 13 cases of the referrals were due to acute respiratory distress syndrome. Furthermore, 12 subjects were referred for dialysis, and 4 cases of the referrals were due to anxiety disorders. Moreover, three cases of diabetic ketoacidosis, one case of epidural hemorrhage, one case of intracranial hemorrhage, one case of spleen hematoma, one case of sigmoid volvulus, and one case of gastrointestinal bleeding were successfully treated. The most common diagnosis was observed to be dehydration, followed by heat exhaustion and contusion. Approximately, all the victims had some degrees of the aforementioned injuries. Initial therapeutic attempts included rehydration, cooling in the cold tunnel, and correction of electrolyte imbalances. Performing a complete blood count with differential, blood urea nitrogen, sodium, and potassium tests, and urinary catheterization were determined as per case (if needed); nevertheless, fluid therapy and cooling were carried out (as primary resuscitation) for all the injured patients. Conclusions: Therapeutic efficacy was evaluated as excellent due to zero mortality. As a result, it was decided to propose a treatment method for the Hajj Medical Team as a protocol for the management and treatment of injuries caused by mass gathering (e.g., contusion and heat exhaustion) in similar events. For the implementation of the best measures in similar situations, it is compulsory to organize medical teams with trained personnel.