It is noon on a Sunday. The weather is perfect — 75 degrees with a steady 5 mph breeze. No rain is forecast and the ground is dry. In all, a perfect day for an airplane crash drill.
Local scout troops are volunteering their time and have been moulaged to play the roles of victims. All the EMS resources have gathered at the host agency’s building, enjoying doughnuts and coffee, catching up on gossip from the other agencies and swapping war stories.
Does this sound familiar? Have you ever participated in a drill like this? What did you learn?
To quote Monty Python, “Now for something completely different.”
It is Jan. 29, 1990, 9:15 at night. Three days of constant rain has turned the ground to mud. The temperature is 45 degrees, and the rain has been replaced by fog.
Against this backdrop, Avianca Flight 052, a Boeing 707 jetliner on approach to Kennedy International Airport in New York City, radios the control tower to report a fuel problem. Because of language difficulties, the nature of the problem is not realized by the tower. The plane runs out of fuel and crashes into a hillside at a speed of 135 knots in Cove Neck, NY, a small, well-to-do suburb of New York City, best known as the site of Sagamore Hill, President Theodore Roosevelt’s summer White House.
Because the plane was out of fuel, there is no fire and the engines are no longer running. The crash site is a wooded area at the end of a private, one-lane, tree-lined road approximately 11¼4 miles long. The area is protected by a small village police force, with two officers on duty — one on patrol and one answering telephone calls — and a volunteer fire department that also provides EMS.
Does this sound like any drill you have attended? Cove Neck does not have an airport and the chance of a plane crash occurring there was extremely remote.
A fire department does not have to be providing coverage to an airport to experience an aviation emergency; any EMS provider could be called to a plane crash. Some basic knowledge is required to successfully handle a crash and a few terms must be defined — just as fire and EMS personnel have their own lingo, airports and the aviation industry have theirs. Additionally, there are rules of conduct to be followed when responding to plane crashes.
Some unique responder actions have been noticed at plane crashes. The first is referred to as the “touch-the-plane” syndrome. This occurs when responders try to get close enough to touch the plane. You have probably experienced this syndrome to a small extent yourself. If you go on mutual aid to a neighboring community for a multiple-casualty incident, ask yourself, would you rather go to the scene or stand by at the other agency’s station and handle 911 calls? If you are like most action-oriented people in our line of work, you would rather be at the scene. If you are receiving mutual aid, this will become a problem. At incidents in which there are few crash survivors, responders trying to reach the scene can create confusion. The confusion will manifest itself when responders are unwilling to acknowledge that they may not be needed and it could be difficult to persuade them to remain in a staging area.
A problem that occurred at the Avianca crash was self-dispatch. The command post called for an adequate number of ambulances to respond to the staging area based on the number of survivors. Other EMS agencies dispatched themselves to the scene, contributing to a reported doubling of responding ambulances, and a rescuer-to-patient ratio of seven-to-one.
Types Of Crashes
There are three different types of plane crashes: high impact, low impact and runway incursion. Many different variations of these three types of crashes can occur. Once you understand the different types, you will appreciate the different strategies that have to be employed to successfully manage the incident.
- High impact. This type of crash is usually a solo-plane incident but can be a mid-air collision. The plane is already in the air when a problem develops, causing the pilot to lose control and the plane heads to the ground at a rapid rate. The plane strikes the ground at a rapid, uncontrolled rate of speed and on impact breaks into very small pieces. Recent crashes of the commuter planes are examples of this type of accident.
The single-plane crash with the largest loss of life occurred in Japan on Aug. 12, 1985, when a Japan Airlines Boeing 747 crashed into Mount Ogura, killing all 520 people aboard.
A problem for EMS providers who are used to rapid pre-hospital care of patients is that a plane crash will have few, if any, survivors. Victims will be dismembered or otherwise severely mutilated. The mutilation can be grotesque, and body parts may not be readily recognized as human remains. After the Dec. 21, 1988, bomb explosion of a Pan Am 747 over Lockerbie, Scotland, responders recovered small body parts, such as a nose, separated from the rest of the body. That crash killed 270 people, including 11 on the ground.
The majority of EMS tasks at this type of incident will be performed by the original responders, normally triage personnel. As more responders arrive in the staging area some will have trouble acknowledging that there are few or no survivors. They will want to check the area themselves, which should be prevented. Many of the responders will need critical incident stress care after a crash — to needlessly expose more responders to the sights and smells of the crash site is inviting a second disaster.
Some responders can be put to use staffing a treatment area for emergency personnel. Depending on the conditions at the crash site, there may be a large number of injured rescuers. For example, 53 rescuers were injured after responding to the crash of USAir Flight 405 on March 22, 1992, at LaGuardia Airport in New York City. The Fokker F-28 crashed and burned, sliding into a bay after attempting to take off during a severe snow storm. Twenty-six passengers were killed and 24 survived. As rescuers become psychologically overwhelmed by conditions at a crash site, they will start to perform tasks by rote, not realizing they are injured until the end of the operation. It is possible that there will be a rise in the number of rescuers seeking pre-hospital care at the end of the operation.
- Low impact. These crashes are not as destructive to the aircraft and there is a greater survivability of the passengers than in high-impact incidents. Most of these crashes will stretch an EMS system to the limit, more than a high-impact crash.
During a low-impact crash, the plane is usually in proximity to the ground and traveling at a lower speed at impact. The majority of these crashes occur during take-off or landing; for example, when a plane skids on the runway, has a landing gear collapse or stalls during take-off. A plane may also be forced to make an emergency landing on a field or highway.
- Runway incursion. These are incidents that occur on runways, when aircraft are not airborne. Examples of runway incursions are collisions between planes or between planes and motor vehicles, or involving planes that strike buildings.
Generally, this type of plane crash will produce a large number of minor, or “walking,” injuries, and few critical injuries or deaths. If emergency escape slides are used, anticipate that about 10 percent of the people not injured in the initial crash will be hurt using the slides. They may suffer friction burns, severe abrasions, extremity fractures and head and neck injuries.
Although most of these incidents will be relatively minor, some can be devastating. One of those occurred on March 27, 1977, in Tenerife, Canary Islands, when two fully loaded 747s collided on the ground, killing 582 people.
Be Ready For Anything
There are many variations to those three crash types. For example, if your airport is near a body of water, a plane may wind up in the water and create a tremendous water rescue problem. Think about how your department handles an overturned boat. Can you rescue four or five people easily? Now think of trying to rescue 150 to 200 people simultaneously.
We normally consider turbulence an inconvenience; however, a plane that hits severe turbulence can drop hundreds of feet unexpectedly, causing numerous passenger injuries but no structural damage to the plane. The injuries can include severe head and neck trauma. Passengers not wearing seat belts can strike their heads on the ceiling or overhead compartments. Or those compartments may open, spilling their contents on the passengers. In such a case you will meet the plane at the gate and have to immobilize people still aboard the aircraft. The aisles are too narrow for stretchers, so the patients will have to be hand carried off the plane.
Mounting evidence from the National Traffic Safety Board (NTSB) and the Federal Aviation Administration (FAA) indicates most plane crash victims are killed or injured by fire after the crash. Your pre-plan for a crash should be generic and must include an incident management system. The use of an incident management system will contribute to your success in handling this type of emergency. Without such a system, an organized, systematic approach to a confusing and overwhelming incident will be impossible to obtain.
David J. Fenton is a lieutenant with the EMS Bureau of the FDNY. His district includes Kennedy International Airport and LaGuardia Airport. Fenton is also medical safety officer for the Port Washington, NY, Volunteer Fire Department. He has responded to six airplane crashes in his 16-year career.
