The crowd surge in Itaewon on Saturday quickly swamped hospitals in the vicinity, with victims filling their emergency rooms and morgues.

Around Saturday midnight, fire department authorities said that there were more than 50 suspected cardiac arrest patients. Soon the number jumped to hundreds.

Saturday night is typically busiest for ERs, according to ER doctors, especially for hospitals near neighborhoods known for their nightlife. Nearby Soonchunhyang University Hospital saw the most patients on the night of the tragedy.

“These weren’t mildly injured patients. They were CPR patients. There aren’t many hospitals that can accommodate dozens of such patients at once,” said a Seoul fire department official who was carrying out rescue efforts on Saturday.

“In a situation like this, patients are scattered across different hospitals so that no single hospital carries a disproportionate load,” he said. “That is the usual protocol.”

“ERs are busier during weekends, so this likely happened when they were already dealing with a heavy workload,” Dr. Ha Sang-ook, the head of Hallym University Medical Center’s emergency department, told The Korea Herald.

Chest compressions involved in CPR are a time-consuming process, “administered for 20 to 30 minutes, before deciding if the patient is untreatable,” he said. “It’s definitely not a one-person job.”

He said that for each cardiac arrest patient, there has to be at least four medical workers. Three patients in need of CPR would need “the entire team.” “If multiple cardiac arrest patients arrive simultaneously, then one ER cannot handle it,” he said.

Based on the triage scale used at ERs nationwide, cardiac arrest patients are classified in the top tier. “Everything else comes after we get their heart back on track,” he said.

Ha added that it was “very rare” for an ER to see more than one patient requiring CPR at the same time. The ER of the hospital where he worked was the government-designated emergency medical center for the entire southern half of Gyeonggi Province, and it “almost never happens,” he said.

He explained that there’s a system that allows first responders to view capacity status of ERs in the area in real time and decide where to send the patients.

The Ministry of Health and Welfare’s director of emergency health care, Kim Eun-young, told The Korea Herald that the Itaewon patients were accommodated at different hospitals based on the capacity data, and that patient distribution was part of the system.

“Even if there is a hospital close by, in the event of a sudden surge in emergency patients, they can run out of beds or health care workers, in which case they would be treated at another hospital,” she said.

Then there was a delay in getting to the victims in the first place, according to an officer at the Yongsan fire department.

Speaking with The Korea Herald, he said that as people had fallen on top of one another, it took time evacuating them out of the crowd one by one. “We got there at 10:19 p.m. But it was much later that we could begin rescue operations because it was so chaotic.”

Dr. Heo Tag, who until recently served as the Korean Society of Emergency Medicine’s chair, told The Korea Herald that cardiac arrest following crush asphyxia occurs around one to two minutes after the victim loses consciousness. The limit for cardiac arrest resuscitation delay was just four minutes.

“But as you know it was probably hard for first responders to get to them in time,” he said.

Like Ha, he said that it took “several medical workers to try and save a cardiac arrest patient.”

And CPR was only the first step. Heo said that Itaewon victims were trapped for 1 1/2 to 2 hours, and compression to such an extreme degree can damage the organs and lead to internal bleeding.

“In a crush injury like this, usually it’s the liver or the spleen,” he said. Such organ damage would have required surgery or some kind of procedure to stop the bleeding.

One doctor who helped with CPR in Itaewon told broadcaster YTN on Sunday that he noticed many of the patients there had a swollen stomach.

“I could feel their stomach swell up as I did CPR on them. I’m not talking about just one patient. But I could see that in a lot of the people who were hurt, and people who were already dead,” he said, explaining that the abdominal swelling could have been a sign of internal bleeding.

According to numbers updated Monday, the crowd surge left 154 dead and 149 injured, 33 of whom were in critical condition.

By Kim Arin (arin@heraldcorp.com)