Bleacher Collapse: A Unique Mass-casualty Orthopedic Event

On 16 May 2021 a mass-casualty incident (MCI) was declared in Jerusalem after a bleacher (tribune) collapsed in a synagogue in a nearby town. To our knowledge all patients that were injured were transferred to one of the three major hospitals in Jerusalem: Hadassah Ein Kerem, Hadassah Mount Scopus or Shaare Zedek Medical Center (SZMC). The aim of this study was to describe the injuries and management of this unique MCI to help better understand and prepare ourselves and other institutions for similar events in future with the same mechanism of injury.

Data was collected from the above listed hospitals’ electronic data base. Cases with documented admittance between 19:00-21:30 on 16.5.2021 and deemed to be injured in the mass casualty event were included in the study. Data that was collected includes demographics, diagnosis of orthopaedic injuries, treatment, duration of hospitalization, and follow up.

In this mass casualty event, 265 patients were treated, all male with a mean age of 17.4 (range 9-47). Two patients died in the accident scene and one patient died a week after admission, he suffered from a major head injury. Thirteen patients were admitted to the intensive care unit. Regarding the Orthopaedic injuries, ninety-six fractures were documented, the distribution of injuries were; Fifty lower extremity fractures of them 11 femur, 17 ankle, 17 foot and 5 tibia fractures. Fourteen upper extremity fractures of them 6 humerus, 6 hand, 1 forearm and 1 clavicle fracture. Fourteen spine fractures, 14 pelvic fractures and 4 face and skull. Forty-three orthopaedics surgeries were performed on patients in the cohort. Eighteen surgeries were conducted during 24 hours from patients` admission. Nineteen after 24 hours, and 6 surgeries were returns to operation theatre for various of reasons. Documented main complaint at admission to emergency room of patients which were discharged without a diagnosis of a fracture or other major injury was a contusion of the lower extremity in 56 cases and contusion of upper extremity in 12. Back contusion in 15 cases and 8 pelvic contusions. The avrege time of hospitalized patients was 6.4 days (range 1-53). Only 49 patients sought follow-up care at their initial-treating hospital after discharge.

Bleachers are widely used throughout the word for various events. Our experience shows that hospitals should be prepared for this type of unique mass-casualty accident that leads to many musculoskeletal injuries.