Paramedics and emergency medical technicians in the Kenosha Fire Department deal with a lot, but they have never had to deal with something like this.
“It’s like half the population of New York got up and walked to one place,” one man said.
Emergency medical crews from the Kenosha Fire Department went through an unusual training session Tuesday at Gateway Technical College, hearing a presentation from Dr. Khalid Ateyyah, an emergency medicine specialist from Saudi Arabia currently working on a fellowship with the Medical College of Wisconsin.
At home, Ateyyah is an emergency medicine specialist who has been part of the medical team that comes together to handle medical emergencies during the Hajj, the annual pilgrimage to Mecca.
The Hajj is one of the five sacred pillars of Islam, a duty that all Muslims are expected to do at least once during the lifetime. The five-day ritual brings together millions of Muslims each year, each person going through a prescribed series of rituals at several sacred sites during the pilgrimage.
Making sure the Hajj is successful is a major focus for the Saudi government.
“From the king to the simplest people in Saudi Arabia, it is an honor to serve the pilgrims,” Ateyyah said.
It is also a serious logistical challenge.
Since the 1990s, millions of people have come together each year during the five-day Hajj each year, moving together on foot in vast crowds in a relatively small area. In 2012, Ateyyah said, the official estimate of the crowd was 3.65 million people, but he said he believes it was closer to 4 million people.
With such vast numbers of people moving together trying to complete the same ritual tasks, trampling injuries are a serious threat.
“You are in big danger, you might die,” Ateyyah said, pointing out one photo of crowds gathered around a pillar for one part of the Hajj. “In 2006 we had a huge and very bad stampede. One thousand people were injured, 300 died.”
Before that incident the Saudi government had already worked to make the site safer with structures that attempted to control traffic flow. Since then, Ateyyah said the government has spent billions on new structures and safety procedures that direct the crowds and provide safety buffer areas.
During the Hajj, Ateyyah said, 22,500 health care workers come together to try to handle the medical needs of the pilgrims. The need for medical help is so great that every medical student in residency is required to go through a one-month Hajj rotation.
The medical needs the crews encounter may include any of the emergency medical needs that any typical large city may need during a five-day period, from dental emergencies to child birth.
In one year when he was working, Ateyyah said, during the five-day period doctors saw 362,740 patients and handled 41,851 emergencies. They did 463 cardiac catheterizations and 35 open heart surgeries. The medical needs also includes the special problems associated with the pilgrimage, including heat stroke to crush injuries.
At the same time, Ateyyah said, medical crews need to deal with sensitive religious and cultural issues. Muslims from around the world come to Hajj, and crews are dealing with seven primary languages in addition to Arabic.
For the paramedics in the training session, the way crews respond to medical emergencies on the ground was eye-opening.
One photo of an ambulance tightly surrounded by a sea of people drew gasps from the paramedics in the audience. The crush of people make using typical emergency response impossible, Ateyyah said.
Crews are now using specialized stretchers they can push through crowds. Once patients can be loaded on ambulances, the site is designed with an elevator the ambulance can drive onto, taking it directly to a helipad on a tower, where medevac helicopters can pick up and transport patients.
Dr. Chuck Cady, medical director for the Kenosha Fire Department, organized Ateyyah’s lecture as part of the department’s ongoing training program.
“The fact that someone from Saudi Arabia is here to learn about our EMS system is something we can all be proud of, but that doesn’t mean we always do things the best way or the only way,” Cady said. “We always want to be thinking of ways we can do things better.”