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Leadership as a Component of Crowd Control in a Hospital Dealing with a Mass-Casualty Incident: Lessons Learned from the October 2000 Riots in Nazareth

Published online by Cambridge University Press:  28 June 2012

Moshe Pinkert ,
Yuval Bloch ,
Dagan Schwartz ,
Isaac Ashkenazi ,
Bishara Nakhleh ,
Barhoum Massad ,
Michal Peres  and
Yaron Bar-Dayan
Moshe Pinkert
Affiliation:
1. Israel Defense Forces Home Front Command Medical Department
Yuval Bloch
Affiliation:
Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Dagan Schwartz
Affiliation:
Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel Magen David Adom, Medical Division
Isaac Ashkenazi
Affiliation:
Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Bishara Nakhleh
Affiliation:
General Manager, Nazareth English Hospital, Nazareth, Israel
Barhoum Massad
Affiliation:
General Manager, Nazareth Italian Hospital, Nazareth, Israel
Michal Peres
Affiliation:
1. Israel Defense Forces Home Front Command Medical Department
Yaron Bar-Dayan*
Affiliation:
1. Israel Defense Forces Home Front Command Medical Department
*
Chief Medical Officer IDF Home Front Command, 16 Dolev St. Neve Savion Or-Yehuda, Israel E-mail: bardayan@netvision.net.il
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Abstract

Introduction:

Crowd control is essential to the handling of mass-casualty incidents (MCIs).This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals.

Methods:

Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered.The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed.

Results:

During 10 days of riots (01–10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the “immediate care” location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control.

Conclusions:

During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management control crowds. It may be advisable to train medical teams and hospital management to recognize potential leaders, and gain their cooperation in such an event. To optimize such cooperation, community leaders also should be acquainted with the roles of public health agencies and emergency services systems.

Keywords

crowd controlhospitalleadershipmass-casualty incidentpoliceriotsecurity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 6 , December 2007 , pp. 522 - 526
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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