15 October 2011

Responding to mass-casualty plane crashes

It heartens me to see the medical community's tremendous response to extraordinarily demanding disasters. The Reno airshow crash this September sent 35 patients, many of them grievously wounded from complex trauma, to a particular hospital's emergency department. Reno's main newspaper described the situation inside the ED in a riveting article.

The ED began preparing for patients as soon as they received word of the crash, and an automated telephone system requested that off-duty emergency medicine physicians come in immediately. Physicians from all types of specialties flocked to the hospital unasked so that they could be on-hand. What resulted was remarkably efficient and collaborative care.

I'm reminded also of the 1989 crash of United Flight 232 in Sioux City, IA. 296 people were aboard the DC-10, which due to improper maintenance lost its tail engine and all of its hydraulics. This meant no flight controls (throttle, rudder, elevators, ailerons), no landing gear, and no brakes. All that the pilots could control was the amount of fuel going to their two remaining engines. By opening and cutting off the fuel lines, the pilots were able to very crudely control their altitude and somewhat guide the plane, which was constantly turning right. Through a combination of sheer luck, skill, experience, and the assistance of a quick-thinking air traffic controller, the pilots guided the plane over Sioux Falls airport and crash-landed near the runway.

Approximately 200 survivors were rushed to Sioux City's hospital. Physicians, in turn, rushed in to help assist. There were so many physicians on hand that the hospital director arranged for each arriving patient to be met by a team of a doctor, a nurse, and a technician. This team would remain with the patient until they were either discharged from the hospital or admitted. Miraculously, 185 aboard the plane lived.

Sioux City had conducted a mass-casualty simulation a little over a year prior to prepare its emergency response services. The scenario: a passenger aircraft crash-landing at Sioux City airport.

Tragedies can sometimes bring out the best in people, and in these tragic crashes the medical community put its best foot forward.