This was an Aerospace Medicine Board Review Lecture developed by Dr.Tripthi M. Mathew for presentation at the 86th Annual Scientific Meeting of the Aerospace Medical Association, May 10-14, 2015, Orlando, FL.
Goodmorning. My name is Dr. Tripthi M. Mathew from Alpha & Omega Healthcare Management Consulting. The focus of my presentation/lecture is on accidents that occurs at airports involving aircrafts and the management of airport disasters. Non-aircraft airport accidents is beyond the scope of this lecture. Abstract Introduction We often hear in the media about different aircraft disasters involving airports around the world. Airport disasters (The Airport series) have also been portrayed in movies since 1970’s. To date, the deadliest airport disaster in global aviation history was the Tenerife Airport Disaster of 1977, involving the runway collision of two airlines KLM flight 5805 and Panam flight 1736 killing 583 passengers. In the U.S, the most recent airport disaster was that of Delta Airlines, Flight 1086 skidding of the icy runway and crashing on the fence at the LaGuardia Airport, NY in 2015 causing non-life threatening injuries to 28 passengers, and 5 passengers hospitalized. This presentation provides an overview of airport disasters, medical response and management. Methods Literature review was conducted to research the reasons of airport disasters; data was collected from Flight Safety Foundation, National Transport and Safety Board (NTSB) on airport disasters and analyzed to find out, what is the most common type (s) of airport disasters involving aircrafts globally. Aerospace Medicine Board MOC Questions (self -assessment) pertaining to airport disasters, medical response and management was also reviewed, extracted and prepared from existing literature. Some of these questions will be reviewed during the presentation. Results The preliminary review of the self-assessment questions from the literature indicate that there were three chapters dedicated to the topic of airport disasters, medical response and management, with twenty five questions directly addressing this topic. Hence, it warrants sufficient attention for further review and preparation for the Aerospace Medicine Board. Analysis of the Flight Safety Foundation revealed the causes of the 10 worst disasters by flight phase (Taxi, Takeoff, Initial Climb, Enroute, Approach, Landing). Discussion Inspite of sophisticated planning with new technologies (simulation softwares, centers etc.) and emergency preparedness, airport disasters are inevitable. However, careful, systematic and periodic review of preparedness plan, resources and drills by medical professionals and other stakeholders might decrease fatalities.
This is a brief bio on the presenter/about me.
The lecture is organized as follows: Learning Objectives, Airport Disasters (go over the definition, classification and some statistics), then briefly touch upon some airport disaster movies, next regulations on airport safety and standards, then will review briefly management of airport disasters. I will also review some Aerospace Medicine Board MOC like questions, which are dispersed in between the presentations and is also provided electronically as handouts. I have placed some in italics with a star and some of them are discussed here in Q& A format and others (7 questions) are available electronically/in handout.
These are the learning objectives. 1) The participant will be provided with an overview of airport disasters, medical response and management. 2) The participant will be able to review some of the Aerospace Medicine Board MOC like questions pertaining to the topic of Airport Disasters, Medical Response and Management.
I was always excited about going to the airport as a child, flying in new airlines and I met interesting people at airports, beginning of new friendships. Nowadays travel has become stressful. When you think of airports, what comes to your mind? When I think of airports, the airport disaster movies come to my mind which I watched growing up and most of you might have watched. Each of them had interesting airport disaster scenarios The first movie of airport was in 1970. It portrayed a bomber on board an airplane, an airport almost closed by snow, and various personal problems of the people involved. In Airport 1975, A 747 in flight collides with a small plane, and is rendered pilotless. Somehow the control tower must get a pilot aboard so the jet can land. In Airport’77, Art thieves hijack a 747, hit fog and crash into the ocean, trapping them and the passengers under 100 feet of water. Airport’79 (The Concorde) is the last of the &apos;Airport&apos; genre which stars George Kennedy again in his aviation-disaster struck role as Joe Patroni who has to contend with nuclear missiles, the French Air Force and the threat of the plane splitting in two over the Alps! This is all because a lady on board, Maggie has some documents which put Harrison Industries in big trouble (showing that they make nuclear weapons) and their leader, played by Robert Wagner, wants the Concorde to crash with Maggie (Susan Blakely) in it!! Trailer of the movie series https://www.youtube.com/watch?v=Oyfi9hVaTj0
Now let us define what is a disaster. This definition is one of the self assessment questions, which is not in the select questions of the handout. As I mentioned earlier, I have highlighted some questions in Italics in the presentations, others as questions and answer format, and some in the electronic handout. A disaster is simply put as an incident which produces victims in numbers and rapidity which overwhelm the communities resources. More rigid definitions place numbers and classifications to disasters: &quot;Multiple Patient Incident&quot; is less than 10 patients and can be handled by on duty EMS services and can be transported to a hospital within 15 to 30 minutes. &quot;Multiple Casualty Incident&quot; involves up to 50 victims and seldom lasts more than a few hours. &quot;Mass Casualty Incidents&quot; are true disasters in that they involve hundreds to thousands of victims and last hours, days, or weeks. REFERENCES: Dwyer BJ. Emergency Medical Response to Civilian Disasters. Emergency Medicine Reports 1990 Aug 27, American Health Consultants, Atlanta GA. Disasters can be due to:1) natural cause e.g. dense fog, mud slides, floods, earthquakes, snowstorms 2) Wildlife hazards (e.g. bird strikes) 3) Human factors (unintentional accidents –collisions due to spatial disorientation 4) Intentional (sabotage, bomb threats, acts of terrorism) 5) Other (e.g. contagious infectious diseases like Ebola, SARS, etc)
The correct answer is d. The most likely cause of airport disasters is due to environmental factors causing spatial disorientation/loss of control. And we will see this in the analysis of the data of the ten worst accidents in global aviation history among the six phases (taxi, takeoff, initial climb, en route, approach and landing) of flight in the next slides. Reference Flight Safety Foundation. Aviation Safety Network. Internet. http://aviation-safety.net/statistics/worst/worst.php?phase=APR
This chart shows the ten worst taxi phase accidents with number of fatalities, location and date. The first accident was in 1935 and the last worst accidents in the taxi phase was in 1983. There was a total pf 467 fatalities in the taxi phase. The Tenerife Airport Disaster of 1977, was the deadliest accident in global aviation history which involved two airlines. One in the taxi phase (Panam), killing 335 occupants and the other airlines (KLM) while taking off killing 248 people. This accident is shown separately in both phases in the taxi and take off phase.
In the landing phase, there was a total of 1379 fatalities. The earliest one was in 1969 and the last one was in 2010.
The take off phase had 1443 deaths. The first worst accident of this phase was in 1962. And the last one was in 2008.
Among the ten worst Initial climb phase accidents, there was 1452 deaths. The first one was in 1962 and the second was in 1989. Please note in this chart there is a second airport disaster at Tenerife Airport which was in 1972 that killed 155 people. This was different from the accident in 1977, which was the deadliest in global aviation history where 583 people died.
The approach phase of flight had 2064 deaths. The first one was in 1972 and the last worst accident in this phase was in 1998.
The en route phase of flight had the most fatalities- 3,200. The first worst accident was in 1974 and the last one in 2014, when Malaysia airlines was shot down at Hrabove, Ukraine.
This table shows the causes of the ten worst global airport disasters by phase of flight. The next slide is a continuation of this table. The most frequent “cause” of fatal general aviation aircraft accidents as cited by the National Transportation Safety Board (NTSB) is “failed to obtain/maintain flying speed”. The second most frequent cause relates to Continuation of VFR flight into adverse weather and incurring spatial disorientation. Three &quot;causes&quot; most frequently cited bear on the problem of spatial disorientation or pilot vertigo. These are (1) continued VFR flight into adverse weather conditions, (2) spatial disorientation, and (3) attempting flight into adverse weather conditions. This triad is considered closely related to disorientation problems. REFERENCES: Kirkham WR, Collins WE, Crape PM, Simpson JM, Wallace TF. Spatial Disorientation in General Aviation Accidents. Aviat Space Environ Med 1978;49(9):1080-1086.
This table is a continuation of the previous slide.
So, there was a total of 10,005 deaths…….. Read the rest of the slide…or read some bullets depending on time. Now, I did not place a slide on North America or United States 10 worst accidents for time reasons. However, to summarize, in North America (which includes U.S, Canada and Mexico) there was a total of 1,983 deaths in all phases of flight from the period of 1978 to 2001. Seven of these accidents was in U.S, 2 in Canada and 1 in Mexico. Among the worst 25 geographical regions (having the highest number of fatal civil airliner accidents from 1945 until now. Military accidents, corporate jets, hijackings and other criminal occurrences are not included), from 1945 to now, the U.S ranked #1 in the worst 25 list, with 785 accidents, 10,611 fatalities, and 133 ground fatalities. Russia and Canada ranked 2nd and 3rd respectively on this list. There were only 5 terrorism related accidents, which were on the initial climb and en route phases of flight among the ten worst accidents globally.
Now time for quiz. Are you ready? First question, Name one Airport Disaster Movie…..The correct answer is A. Airport which started in 1970. As stated earlier, It potrayed a bomber on board an airplane, an airport almost closed by snow, and various personal problems of the people involved.
The correct answer is b), the Tenerife Airport Disaster of 1977. Source. Internet. http://en.wikipedia.org/wiki/Tenerife_airport_disaster https://www.youtube.com/watch?v=DxCLImowXB0 https://www.youtube.com/watch?v=glZIggnP47Y LaGuardia Airport Disaster Delta Airlines s http://www.nbcnewyork.com/news/local/Plane-Off-Runway-LaGuardia-Airport-New-York-Snow-295187641.html
The correct answer is c) Geese. “Geese are considered the greatest hazard to aircraft because of their abundance, large size, prevalence of large flocks (up to 25,000 birds), relatively slow flight and high altitude during migration. Nearly half a million Canada geese migrate south from Hudson or James Bay to the Mississippi Valley, and perhaps as many as 100,000 of these birds pass within 25 to 50 miles west of Milwaukee Municipal and Chicago O&apos;Hare Airports. Stray flocks may pass directly over the airports. Geese moving north in the spring fly up the Missouri River Valley in very large flocks, creating hazards to aircraft in the vicinity of airports at Kansas City, Omaha, Sioux City, and Sioux Falls”. REFERENCES: Federal Aviation Administration. General Aviation News. Washington DC: US Government Printing Office. Department of Transportation, 1977 Sept;16(5). According to FAA, Birds&apos; make-up 97% of the reported strikes, mammals about 3% and reptiles less than 1%. Most common mammal include white tailed deer. In a ten-year period of 1990-1999, 430 civil aircraft were involved with collisions with deer. And among reptiles crocodiles, turtles. Infact, in 2002, at Orlando International Airport, a crocodile wandered onto the runway. Wildlife airport disasters is an interesting topic and it is beyond the scope of this lecture to get into all the details.
In 2004, FAA issued a final rule that revised the Federal airport certification regulation [Title 14, Code of Federal Regulations (CFR), Part 139 (14 CFR Part 139] and established certification requirements for airports serving scheduled air carrier operations in aircraft designed for more than 9 passenger seats but less than 31 passenger seats. In addition, this final rule amended a section of an air carrier operation regulation (14 CFR Part 121) so it would conform with changes to airport certification requirements. The revised Federal airport certification requirements went into effect on June 9, 2004. All air carrier airports are required by the FAA to be certified safe. This certification requires having an adequate disaster plan which can be listed by general categories of action, thus making progressive planning more logical. The first group from which a physician must have support in order to establish an effective plan is the airport authority. References “No plan can be established without first obtaining the support of the airport authority. Once this is accomplished responsibilities can be delegated to the heads of the major divisions of airport activities such as the safety officer, the fire chief, the communications officer, head of security service, the medical consultant, and the surrounding community agencies”. Hays MB, Stefanki JX, Cheu DH. Planning an Airport Disaster Drill. Aviat Space Environ Med 1976 May;47(5):556-560. Certain infectious diseases are subject to the IHR, with regards to notification to WHO, on the duration of incubation periods, vaccinations, certificates, isolation and medical examinations (including stool examination) of suspected crew and passengers. These diseases are: cholera, plague, and yellow fever. For an airfield to be designated as a sanitary airport, the *The airport must have facilities for the transport, isolation, and care of infected persons or suspects. *The airport must have facilities within the airport for vaccination against smallpox and facilities within the airport or available to it for vaccination against cholera and yellow fever. *The airport must have a bacteriological laboratory or facilities for dispatching suspected material to such a laboratory. http://www.faa.gov/airports/safety-video-series/ http://www.faa.gov/airports/airport_safety/part139_cert/
Moving onto the next final phase of my presentation, management of airport disasters. Now, Certified airports are required to have a full scale drill of their emergency plan every 3 years, and an annual meeting to review the plan with all the involved parties. The Joint Commission on Accreditation of Health Organizations requires a written plan and a twice yearly drill for hospitals. Most plans use the ICS as a framework for control of a disaster. It was devised in the early 1970&apos;s. The Fire and Rescue personnel are the incident commanders with chiefs of finance, logistics, operations, and planning. REFERENCES: Mahoney BD. Disaster Medical Services. In: Tininalli J, Rothstein RJ, Krome RL, eds. Emergency Medicine: A Comprehensive Study Guide. American College of Emergency Physicians. New York City: McGraw-Hill, 1992. Part 139: Code of Federal Regulations, Volume 14. National Archives and Records Administration, Washington DC. The color coded triage system is internationally accepted and is usually part of a patient identification system. The &quot;Yellow&quot; or intermediate care level is for those injuries that are not life threatening but require definitive care. The &quot;Black&quot;, meaning expectant or dead level is for those victims who will be dead in spite of definitive care or whose age and injuries are such that they would have a small chance for survival (see a). Their care would divert resources that might better benefit others in a large disaster with many victims and limited resources. &quot;Green&quot; level victims have no life or limb threatening injuries and need minor care and psychologic support rather than hospitalization (see c). Red or severe injuries require rapid stabilization and transport to save the victim and limit disability (see d). REFERENCES: Dwyer BJ. Emergency Medical Response to Civilian Disasters. Emergency Medicine Reports 1990 Aug 27. American Health Consultants, Atlanta GA. One of the principles of disaster response as stated by Dr. Erik Auf der Heide, is that “Triage implies making the most efficient use of available resources”. To review the color coded triage system, there is a MOC question on it in your handouts (second from the last, the 6th question on page 5).
Be aware of “Auf Der Heides” Principles of Disaster response. There are about 25 principles outlined in his book, Disaster Response, Principles of Preparation and Coordination, 1989, CV Mosby, St.Louis. One of them that was listed in the self-assessment as a MOC question is that People will not usually panic and will not leave a disaster area with little encouragement. In the case of a large airliner crashing at a busy airport, experience has shown that well trained triage teams for medical response is most vitally important. Other items which are important include: Evacuation means, involving both ground transportation and air (helicopter) evacuation to support medical centers, Medical support from surrounding hospitals, Well-established and tested disaster communications systems, Adequate morgue facilities for the expected (or potential) several hundred casualties. While all of these items are vital components of an adequate disaster response plan, experience has shown that without an adequate triage system all of the other components are likely to fail due to overload. On-site triage is one of the most difficult problems in disaster medicine, and must be carefully pre-planned. &quot;Twenty Years Of Medical Support in aircraft disasters has led to the conclusion that large numbers of casualties may best be served by initial and possibly longer treatment at the scene.“ REFERENCES: Department of Defense. Emergency War Surgery. Washington DC: US Government Printing Office, 1975. Evans D. Simulated Aircraft Disaster Instructional Exercise at Baltimore-Washington International Airport. Aviat Space Environ Med 1976;17(4):445-448. Abelson LC, Star LD, Goldner AS. Twenty Years of Medical Support in Aircraft Disasters at Kennedy Airport. Aerospace Med 1973;44(5):560-566. Hays MB, Stefanki JX, Cheu DH. Planning an Airport Disaster Drill. Aviat Space Environ Med 1976; 47(5):556-560. References FAA’s Known best practices for airfield safety is a checklist for air traffic controllers, pilots, and airport personnel. http://www.faa.gov/airports/runway_safety/bestpractices.cfm ADMS (pronounced as ADAMS) is used to effectively train incident commanders, command post staff, and vehicle operators at all levels, either as a team training solution, training the complete chain of command simultaneously, or training individual parts of the chain separately. This company is actually located in Orlando, Florida and I have listed their website link below for those interested in more information. “Some of the largest airports and premier training organizations worldwide rely on ADMS to train and maintain the skills of the personnel responsible for aircraft rescue and aircraft firefighting. If you are accountable for any aspect of airport safety or airport security, either at civil or military airports, ADMS may be the training platform you need to ensure success in the event of a real-life aircraft emergency. In ADMS exercises, trainees take on specific roles: Emergency Coordination Center staff coordinates on-scene incident command Incident commander commands sector or vehicle commanders Vehicle commanders command the vehicle crews Vehicle operator drives and operates the vehicle Vehicle crew executes tasks ADMS trains all phases of on-scene incident command, including: Turn Out: Trainees receive alarm and drive to the scene Response: Trainees arrive at the scene and respond to the incident Recovery: Trainees scale down operations and return to the station Debrief: Trainees debrief the complete response operation Training with ADMS is very similar to live-training, the difference being that the scene is built in a virtual reality environment, and trainees deploy virtual resources. This difference allows ADMS to go beyond the capabilities of live training. In an ADMS environment, all types of incidents can be created, and resources can be made available to match all the resources you would have access to in the real world. Each participant has his or her own ADMS station that provides the visuals and sounds. The incidents can be played out on full immersion theaters, on projection screens, LCD/LED panels, or laptop computer screens. Multiple stations can be connected to create the team training suite. Optionally, driver modules can be connected to each station, enabling trainees to “drive” from their initial position to the incident scene”. Source: http://www.trainingfordisastermanagement.com/about/training-with-adms/ According to Lee et al, A properly and practically designed Mass Casualty Incident plan, good compliance of responders, and a strong support system of responding agencies are the most important factors for successful emergency response to any MCI.
Here are some of the references/resources for further study. Free clip art source. http://www.pageresource.com/clipart/traffic/roadsigns/info/index.html
Here is my contact info. Bon Voyage! Thank you for your attention. If there are any questions, I will be happy to answer them, or you may contact me via e-mail at DrMathewTM@gmail.com. My contact info is provide on the contact slide.