7 Injuries and Heat Emergencies Hospitals See Most During Visarjan Processions

The most serious cases arriving at casualty wards during visarjan are not the dramatic ones, they are people who were simply standing in the wrong part of a crowd. Crowd crush, clinically called compressive asphyxia, occurs when bodies are pressed together with enough force to restrict breathing. The chest cannot expand. A person can lose consciousness within seconds and show no external injury at all. The 2013 Madhya Pradesh bridge stampede during a Navratri procession, which killed 115 people, is the documented benchmark Indian disaster managers now use when modelling festival crowd density thresholds. During visarjan, the highest-risk zones are narrow lanes near ghats, bridge approaches, and points where multiple procession routes converge. Bystanders and family groups who are not part of the main procession but are watching from the sides face the greatest risk, they have no forward momentum to carry them out of a compression event.

Processions run for hours through afternoon heat on asphalt that can reach surface temperatures well above 50°C in cities like Hyderabad, Nagpur, and Pune during early September. The distinction between heat exhaustion and heatstroke is the one that determines whether someone walks out of a hospital or is admitted to an ICU. Heat exhaustion presents with heavy sweating, weakness, and nausea, the body is still thermoregulating. Heatstroke means the thermoregulation has failed: the person stops sweating, skin turns hot and dry, and core body temperature crosses 40°C. A 2019 review published in the Indian Journal of Critical Care Medicine found that delay in recognising the transition from exhaustion to stroke, often because bystanders assume the person is simply tired or dehydrated, is the primary factor in heatstroke fatalities at mass gatherings in India. Participants in full costume, particularly those wearing heavy dhol-carrier harnesses or deity processional gear, are at highest risk because insulated clothing blocks evaporative cooling entirely.

Dehydration is the expected risk. Hyponatremia, dangerously low sodium from drinking too much plain water without electrolyte replacement, is the one that surprises people. Both present with similar early symptoms: headache, fatigue, confusion. But the treatment is opposite. Pouring more plain water into someone with hyponatremia worsens the condition. Procession participants who drink large quantities of water from roadside distribution points over several hours without eating anything are the typical presentation. Children are disproportionately affected because their sodium regulation is less stable. ORS sachets, available at any chemist for under ₹10, address both conditions and are the single most cost-effective intervention a procession organiser can deploy.

Sparkler burns to the hands and forearm are the most common minor burn presentation. The serious cases are face and eye burns from fireworks misfired horizontally in crowd conditions, and burns from tipped dhunachi, the incense burners carried during processions. A tipped dhunachi spills burning coal and ash at knee and shin height, which is exactly where children's faces are. Partial-thickness burns to the face require specialist care within 6 hours to minimise scarring. The error most families make is applying toothpaste, ghee, or ice directly to a burn, all of which worsen tissue damage. Running cool (not cold) water over the burn for 20 minutes is the only first-aid step that reduces burn depth.

Barefoot participation on roads littered with broken clay idol fragments, discarded flower garlands, and wet stone ghats produces a predictable pattern: lacerations to the sole, puncture wounds, and ankle sprains from uneven wet surfaces. Tetanus exposure from a puncture wound on a public road is a real clinical risk, not a precautionary formality. Anyone who has not had a tetanus booster within five years and sustains a puncture wound during a procession should present to a casualty ward the same day. Ankle sprains on ghat steps are the most common orthopaedic presentation, the combination of wet stone, crowds, and the inability to look down while moving in a dense group makes a misstep almost inevitable.

Sustained exposure to dhoop, agarbatti smoke, and fireworks particulate in enclosed or low-wind urban lanes causes acute respiratory distress in people with pre-existing asthma or COPD, and occasionally in people with no prior diagnosis. The particulate matter from a single fireworks burst in a narrow lane can spike local PM2.5 readings to levels comparable to severe Delhi winter smog. Participants who feel chest tightness or begin wheezing during a procession should move to open air immediately rather than waiting for the procession to reach the ghat. Using a salbutamol inhaler without a prior prescription is not advised; moving away from the smoke source is.

Gulal and synthetic colour powders thrown during processions cause chemical conjunctivitis and, in cases of high-concentration synthetic dye, corneal abrasion. The instinct to rub the eye drives the particulate deeper into the conjunctival surface. The correct response is to flush the eye with clean water for at least 10 minutes without rubbing. Coloured contact lens wearers face a compounded risk: the lens traps the dye against the cornea. Any persistent blurring, photophobia, or pain after flushing warrants a same-day ophthalmology visit. Synthetic colours sold at low price points near procession routes are the highest-risk source, they are frequently unregulated and contain industrial dyes not cleared for skin or eye contact.

The pattern across all seven is the same: the injury arrives fast, the window for correct first aid is short, and the wrong response in that window, ice on a burn, water into hyponatremia, rubbing a dye-contaminated eye, converts a manageable situation into a hospital admission. Knowing what not to do in the first two minutes is worth more than any post-injury treatment.