Skip to main content

An Analysis of Mass Casualty Incidents in the Setting of Mass Gatherings and Special Events

  • Sheila A. Turris (a1) (a2), Adam Lund (a3) and Ronald R. Bowles (a4)

Mass gatherings (MGs) and special events typically involve large numbers of people in unfamiliar settings, potentially creating unpredictable situations. To assess the information available to guide emergency services and onsite medical teams in planning and preparing for potential mass casualty incidents (MCIs), we analyzed the literature for the past 30 years.


A search of the literature for MCIs at MGs from 1982 to 2012 was conducted and analyzed.


Of the 290 MCIs included in this study, the most frequently reported mechanism of injury involved the movement of people under crowded conditions (162; 55.9%), followed by special hazards (eg, airplane crashes, pyrotechnic displays, car crashes, boat collisions: 57; 19.6%), structural failures (eg, building code violations, balcony collapses: 38; 13.1%), deliberate events (26; 9%), and toxic exposures (7; 2.4%). Incidents occurred in Asia (71; 24%), Europe (69; 24%), Africa (48; 17%), North America (48; 27%), South America (27; 9%), the Middle East (25; 9%), and Australasia (2; 1%). A minimum of 12 877 deaths and 27 184 injuries resulted.


Based on our findings, we recommend that a centralized database be created. With this database, researchers can further develop evidence to guide prevention efforts and mitigate the effects of MCIs during MGs. (Disaster Med Public Health Preparedness. 2014;0:1-7)

Corresponding author
Correspondence and reprint requests to Sheila A. Turris, PhD, Central Health Center, Floor 6, 132 W Esplanade, North Vancouver, British Columbia V7M 1A2, Canada (e-mail:
Hide All
1. Lund, A, Gutman, SJ, Turris, SA. Mass gathering medicine: a practical means of enhancing disaster preparedness in Canada. CJEM. 2011;13(4):231-236.
2. Jangi, S. Under the medical tent at the Boston Marathon. N Engl J Med. 2013;368(21):1953-1955.
3. Soomaroo, L, Murray, V. Disasters at mass gatherings: lessons from history. PLOS Curr. 2012;4:1-12.
4. Hsieh, YH, Ngai, KM, Burkle, FM Jr, Hsu, EB. Epidemiological characteristics of human stampedes. Disaster Med Public Health Prep. 2009;3(4):217-223.
5. Polinder, S, Haagsma, JA, Lyons, RA, etal. Measuring the population burden of fatal and nonfatal injury. Epidemiol Rev. 2012;34:17-31.
6. Stratton, SJ. Use of structured observational methods in disaster research: “recurrent medical response problems in five recent disasters in the Netherlands”. Prehosp Dis Med. 2010;25(2):137-138.
7. Koshashvili, Y, Loebenberg, MI, Lin, G, etal. Medical consequences of suicide bombing mass casualty incidents: the impact of explosion setting on injury patterns. Injury. 2009;40:698-702.
8. Ngai, KM, Burkle, FM, Hsu, A, Hsu, EB. Human stampedes: a systematic review of historical and peer-reviewed sources. Disaster Med Pub Health Prep. 2009;3(4):191-195.
9. Ripley, A. The Unthinkable: Who Survives When Disaster Strikes—and Why. New York, New York: Crown Publishers; 2008, chap 6, pp 141-162.
10. Armstrong, G. Hooligans: Know the Score. Oxford, England: Berg Publishers; 2003.
11. Dunning, E. Toward a sociological understanding of football hooliganism as a world phenomenon. Eur J Criminal Policy Res. 2000;8:141-162.
12. Frosdick, S, March, P. Football Hooliganism. Gloucester, United Kingdom: Willan Publishing; 2005.
13. Giulianotti, R. Participant observation and research into football hooliganism: reflections on the problems of entrée and everyday risks. Sociol Sport J. 1995;12(11):1-20.
14. Giulianotti, R. Football and the politics of carnival: an ethnographic study of Scottish fans in Sweden. Int Rev Sociol Sport. 2013;48(5):191-220.
15. Marsh, P, Fox, K, Carnibella, G, McCann, J, Marsh, J. Football Violence and Hooliganism in Europe. Oxford, England: Social Issues Research Center, The Amsterdam Group; 1996. Accessed May 14, 2013.
16. Peiterson, B. Supporter culture in Denmark: the legacy of the ‘world's best supporters’. Soccer Soc. 2009;10(3-4):374-385.
17. Stott, C, Adang, O. Understanding and Managing Risk: Policing Football Matches. Slagelse, Denmark: Bavnekbanke Press; 1995, pp 7-14.
18. Stott, C, Livingstone, A, Hoggit, J. Policing football crowds in England and Wales: a model of ‘good practice’. Policing Soc. 2008;18(3):258-281.
19. Stott, C, Adang, O, Livingstone, A, Schreiber, M. Tackling football hooliganism: a quantitative study of public order, policing and crowd psychology. Psychol Public Pol Law. 2008;14(2):115-141.
20. Stott, C, Reicher, S. How conflict escalates: the inter-group dynamics of collective football crowd ‘violence’. Sociology. 2013;47(5):875-886.
21. Head, J. Turkey bans men from football match. BBC News. September 23, 2011:1-3. Accessed May 14, 2013.
22. Lee, D. Are African football stadiums too dangerous? BBC News. November 4, 2010:1-3. Accessed May 14, 2013.
23. Begum, AA. Unnatural deaths during Zakat distribution. Bangladesh Med Res Conc Bull. 1993;19(3):99-102.
24. Mahoney, EJ, Harrington, DT, Biffl, WL, Metzger, J, Oka, T, Cioffi, WG. Lessons learned from a nightclub fire: institutional disaster preparedness. J Trauma. 2005;58(3):487-491.
25. Spanish church fireworks display explodes. CBCNews. August 14, 2012. Accessed May 14, 2013.
26. Fireworks explode in crowd in China. Telegraph. October 14, 2012. Accessed February 27, 2013.
27. Several injured during Liberty Park fireworks show. abc4 Utah; July 25, 2010. Accessed on: Feb 27, 2013.
28. Fireworks explosion kills 21. Available at: Accessed February 27, 2013. .
29. Suphan Buri fireworks display affects 500. The Nation; January 26, 2012. Accessed February 27, 2013.
30. Court to pronounce verdict on Lamehorse Club fire case. ITAR-Tass; March 10, 2008. Accessed February 17, 2013.
31. 13 Held for Shenshen club fire that killed 43. China Daily; September 9, 2008. Accessed February 17, 2013. .
32. Nightclub fire kills 16 in Equador.; April 10, 2008. Accessed February 18, 2013.
33. Carley, S, Mackway-Jones, K, Donnan, S. Major incidents in Britain over the past 28 years: the case for the centralised reporting of major incidents. J Epidemiol Community Health. 1998;52:392-398.
34. Lennquist, S. Protocol for reports from major accidents and disasters in the International Journal of Disaster Medicine . Eur J Trauma Emerg Surg. 2008;5:486-492.
35. Marres, GMH, Eijk, J, Bemelman, M, Leenen, LPH. Evaluation of admissions to the major incident hospital based on a standardized protocol. Eur J Trauma Emerg Surg. 2011;37:19-29.
36. Coppola, DP. (ed.) International Disaster Medicine. Oxford, England: Butterworth-Heinemann Limited; 2004.
37. Barillo, DJ, Wolf, S. Planning for burn disasters: lessons learned from one hundred years of history. J Burn Care Res. 2006;27(8):622-634.
38. Welling, L, Van Harten, SM, Patka, P, etal. Medical management after indoor fires: a review. Burns. 2005;31:673-678.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed