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Collapse of building during wedding reception in Jerusalem 2001 – KAMEDO-report 85

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.

Summary

Collapse of building during wedding reception in Jerusalem 2001 – KAMEDO-report 85 Summary On 24 May 2001 in Jerusalem 700 guests had gathered at a banqueting suite to celebrate a wedding. According to Jewish tradition, wedding receptions are open to large groups of relations and acquaintances, and therefore require spacious premises.

The Versailles banqueting hall where the wedding reception was being held was on the top storey, the third floor, of a large stone building. The dinner table was laid alongside the walls between supporting pillars, and the central section was left free for dancing. As the meal had just begun, most of the guests gathered on the dance floor, the music started up and the sea of people started to move in rhythm.

Suddenly a slight judder was felt – then the whole dance floor with more than 400 people fell. It fell in one single piece through the second and the first floors, before landing on the ground floor. All that remained on the third floor was a cloud of dust, a large, gaping hole and the guests that had not been caught up in the collapse.

At 22:42 one of the guests called the emergency services, and the first ambulance arrived on site at 22:44. The first two patients were transported from the site of the accident at 22:57. At 23.00 the scale of the disaster had become evident, and a green alert was issued, which meant that 80 ambulance crews were called up. Over a period of two hours more than 300 patients were transported to four different hospitals in central Jerusalem. The injured were sorted at the site of the disaster under the guidance of the ambulance official in charge. This person was constantly informed about current capacity from reception staff in the accident and emergency departments.

Most patients were treated according to the scoop and run principle. This means that the patient, having quickly had the spine and airways stabilised, was secured to a stretcher and driven the short distance to the hospital, without any intravenous needles or drips. Only seven patients needed immediate help with breathing.

After two hours the Israeli military made disaster equipment and digging vehicles available. However, the building was considered to be so unstable that digging had to take place mainly by hand.  

A total of 310 injured people were evacuated, of whom 134 were admitted to one of the four Jewish hospitals that were being used. The majority of those injured had fractures of the pelvis or the lower extremities. There were also many skull and spinal injuries. By 10:00 the following morning, the last of the 23 dead had been dug out.

The Israelis themselves refer to the “Versailles disaster” as the worst-ever civil disaster in the country’s modern history. Because of the situation in the Middle East, in Israel they are well equipped and used to acting quickly to adapt society and healthcare in the event of disasters in order to quickly take care of physically injured and psychologically traumatised individuals.

The municipality and psychiatrists in Jerusalem are used to organising speedy initiatives for people who have suffered traumatic experiences. They have also developed a pragmatic approach, which contributes towards the creation of simple courses of action in dealing with a situation.

However, the support offered to emergency services does not appear to be any more developed than it is in our country. Just as here, there is much to be done to reduce the emotional impact on people after stressful events.  

The observers’ conclusions 

General

  • The number of dead and seriously injured people was lower than might have been expected from an accident of this nature, bearing in mind the height of the fall. This can be explained by the braking effect caused by each floor.
  • In instances of large-scale injury in an urban environment, when transport distances are short, it is generally advisable to drive the injured to hospital as soon as possible, using the “scoop and run” principle. The creation of “gathering places for the injured” at the site of the accident is probably less appropriate.

Raising the alarm

  • Israel has automated group alarms to alert groups of personnel designated in advance. There is no corresponding system in Sweden. However, it would be interesting to try sending group SMS messages to private mobile phones to alert personnel designated in advance who are neither at work nor on call.
  • In order to be able to quickly mobilise a large number of ambulances in Jerusalem, the vehicles are stationed at the homes of the ambulance drivers. There is no corresponding system in Sweden, but this could be considered by those responsible. When there is an imminent threat of a major accident or disaster, ambulance staff who are on call could have the ambulances at home.

Disaster management

  • Israel’s disaster management on site, with a “Paramedic On-scene Commander” (the first paramedic on the scene takes control) and with subsequent reinforcement and a hand-over to specially-trained senior doctors, appears to work well. This reinforces the belief that we are on the right track in Sweden. Our management model is in principle the same as the Israeli model, with a lead paramedic on the scene.
  • In the case of this building collapse, the emergency services acted arbitrarily and without any co-ordination with paramedics. The situation thus arose that the emergency services blocked the access route to ambulances with two of their vehicles. This emphasises the need for co-ordinated management at the site of the incident with dividing lines and transport routes defined at an early stage.
  • Central/regional disaster management of the type organised in Sweden is not present in Jerusalem. However, the prioritisation of patient transport to the various hospitals works well thanks to immediate feedback from each accident and emergency reception to the lead paramedic at the site of the accident. For the Swedish system to work as well there is a requirement that every hospital has a good system for sending feedback to regional management, who then communicate this to the lead paramedic at the site of an incident. This requires practice and tools for communication that work well, even over large distances.  

At the hospital

  • There is a high degree of agreement among Israeli emergency doctors about the value of assigning an extremely experienced surgeon to prioritise at accident and emergency reception. Sweden should learn from this and practise it. Correct initial prioritisation saves time and leads to the correct use of critical resources.
  • Israeli accident and emergency reception has a one-way patient flow in the event of disasters. This was emphasised as a success factor on the basis of experiences from many instances of large-scale injury. By not taking patients back to accident and emergency reception after they have been diagnosed or treated, capacity is improved and the patient flow is manageable. This applies both within the hospital in question and to other hospitals.
  • Mobile teams of consultants with specialists from various fields, e.g. eyes, ears and psychiatry, are present in accident and emergency reception departments in Jerusalem when a disaster occurs. This relieves the load on the surgeon who has primary responsibility for examinations, and less time is wasted on referrals. This might sometimes mean a degree of over-staffing, but the model should be considered at our Swedish accident and emergency receptions where there are high volumes.
  • At the Jerusalem hospitals a special discharge department was set up for those suffering relatively minor physical and psychological effects. The departments were managed by internal medical staff who collaborated with other specialists, e.g. eye and ear specialists, orthopaedists and psychiatrists. The discharge department also enabled those with minor injuries to undergo a quick, appropriate assessment before they left the hospital. This model is interesting and should be tried out at Swedish hospitals.

Psychosocial initiatives

  • The municipality in Jerusalem has social workers who can be quickly mobilised in the event of a disaster. They have been assigned different areas of responsibility and trained for this purpose in advance. They are sent to the site of the incident and to important public institutions, e.g. receptions in hospital accident and emergency departments, in order to try to identify those in need of support. This approach should be the subject of an in-depth study by Swedish municipalities.
  • In the event of disasters in Israel a telephone line/hotline is set up through which those affected can be offered psychiatric help. The line is kept open for three days. This may be something worth imitating. This is a way of keeping the promises made that help will be offered.
  • There was no organised form of follow-up discussion for those involved among the police, emergency services and healthcare staff following the collapse of the building. There is an attitude among these people that “we can deal with it”. It is important that those responsible within the services deal with this attitude by underlining the importance of seeking relief after an incident in a well-considered way.

Information

  • The task of informing the relatives who flocked to the accident and emergency departments proved an overwhelming one. The relatives often caused serious disruption to the task of dealing with the injured. The system of locating social workers in the accident and emergency departments to deal with relatives proved insufficient. In similar situations earlier they had photographed all of the injured and displayed the photos on a general notice board. A method that might have breached integrity, but it was believed to have been effective. This example emphasises the need for an effective, well-rehearsed information strategy.
  • The disaster of the collapse highlighted the problem of the media’s actions. The press arrived at the site of the incident and at the accident and emergency departments with photographers and TV teams. They showed no regard for patients’ integrity in their visual reporting. It is important to adopt a preventive approach in working with the media. Providing information and practising together increases the understanding of the work of both the media and the emergency services. Breaching the integrity of those injured and their relatives benefits no one and must not become common practice.  

Read the full Summary

Contact

Susannah Sigurdsson
+46 (0)75 247 30 00