title: Epidemiological characteristics of human stampedes.
abstract: OBJECTIVE
  The potential for deadly human stampedes to occur at any mass gathering event highlights this unique form of crowd disaster as deserving of special attention from both scientific and planning perspectives. Improved understanding of human stampedes is indispensable in the mitigation of this type of mass casualty. With relatively few peer-reviewed reports on deadly human stampedes, information from news reports and the Internet is essential to increased collective understanding. Without incorporating nontraditional sources, no other way to reasonably acquire sufficient data is available. This study analyzed human stampede events from 1980 to 2007 to identify epidemiological characteristics associated with increased mortality.
  
  
  METHODS
  A LexisNexis search was followed by sequential searches of multiple Internet-based English-language news agencies. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Bivariate analyses of number of deaths or injuries were conducted using a nonparametric Wilcoxon rank test. Multivariate regression was performed to determine the factors associated with increased number of fatalities during stampede events.
  
  
  RESULTS
  A total of 215 human stampede events were reported from 1980 to 2007, resulting in 7069 deaths and at least 14,078 injuries from 213 events with available fatality information and 179 events with injury information. In bivariate analysis, stampedes occurring in the Middle East, in developing countries, outdoors, or associated with religious events had the highest median number of deaths. In multivariate analysis, events that occurred in developing countries and outdoors were associated with increased number of fatalities. Stampedes that occurred in the context of sports, religious, music, and political events, or that had a unidirectional mechanism, also increased the relative number of deaths.
  
  
  CONCLUSIONS
  Several epidemiological features of human stampedes associated with increased mortality are identified. Standardized collection of epidemiological data pertaining to human stampedes is strongly recommended, and further study of this recurrent, distinctive disaster is warranted.
authors.affiliation: Johns Hopkins Medical Institutions, Department of Emergency Medicine, Baltimore, MD 21209, USA.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Ka Ming
authors.initials: KM
authors.lastname: Ngai
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
authors.forename: Edbert B
authors.initials: EB
authors.lastname: Hsu
mesh_terms: D003441:Crowding; D016206:Databases, Bibliographic; D006801:Humans; D020407:Internet; D008399:Mass Behavior; D054527:Mass Casualty Incidents / Q000401:mortality / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009524:Newspapers as Topic; D012305:Riots / Q000523:psychology / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality