Patient Transports and Distribution in a Crowd Crush Disaster: The Case of Itaewon Halloween Festival, South Korea. Which is More Important: Early Access or Appropriate Treatment?

Introduction: On October 29, 2022, crowds gathered for a spontaneous Halloween event at the Itaewon area of Seoul, South Korea, resulting in a crowd crush disaster. In this study, the authors investigated the process of patient transportation and dispersal from call to hospital treatment and examined the medical characteristics of crowd disasters. Methods: Researchers analyzed the data of firefighter-paramedic transports of patients due to crowd crush during the Itaewon tragedy in 2022 based on the official input data of transports. Data from 310 patient transports were collected, excluding ambulance requests from hospitals or morgues that were not from the accident scene. The time taken for each stage of transport and transport distance were analyzed. Patients’ initial triage outcomes, initial medical characteristics, and clinical triage outcomes were also analyzed. Results: High fatalities relative to the number of injuries were found. A sudden increase in transport demand led to a temporary shortage of ambulances. The time for ambulance dispatch and access to patients was the longest. Even when paramedics arrived at the scene, the start time from arrival at the scene to patient care by paramedics was characterized by an increase due to the nature of crowd incidents, where dense crowds make it difficult to access patients. While there may not be many cases of visible trauma on the scene, stampedes are fundamentally a traumatic medical condition, and there may be many traumatic injuries that are not revealed until final diagnosis and autopsy. Conclusion: Issues of access to patients and high mortality are unique to crowd crush disasters, and further research should continue.