To interrupt a calm sunny day, the radio chirps the familiar tones of your unit. A voice comes over the air; “Unit 1 respond, aircraft accident, unknown injuries.” You recognize the address as a small airfield at the north end of your response area. You’ve never been there before, but you update the GPS and head that way.
Are you prepared for this call?
Do you know how to get into that airport; is it controlled access?
Does your response change based on the airport size?
Are you prepared for any aircraft size?
Do you know how to be safe around general aircraft, small planes and helicopters?
Usually, the first thing that comes to mind when thinking about aircraft accidents is a large airliner; movie-style incidents with commercial airliners crashing down with patients, smoldering fire, utter chaos and hysteria everywhere.
Statistically, most aircraft incidents do not involve these large commercial aircraft, but rather, smaller private planes or helicopters. These incidents usually do not occur at busy large-scale airports, but rather, smaller airports, many of which may not have an aircraft control tower. These smaller airports often do not have a dedicated airport EMS service, and calls for EMS response fall to the local EMS system.
Are you ready to care for victims of an aircraft incident?
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Federal regulations for aircraft incident response
Many responders may say that all accidents are the same; it doesn’t matter if it’s a car or an airplane. While certain parts of this statement could hold true, there are some differences that need to be considered in aviation-related incidents.
In automobile accidents, federal organizations are not going to come in and investigate every single incident. Meanwhile, every aircraft accident is subject to federal reporting requirements, and the NTSB investigates aviation accidents and selected incidents, often working alongside the FAA. This is an important consideration for first responders as they should treat these incidents similar to how they historically treat crime scenes.
EMS providers should minimize unnecessary disturbance of the wreckage while prioritizing patient care, as the scene will likely become part of a federal aviation investigation.
Preplanning responses to these types of incidences can improve the effectiveness of both patient care and scene preservation.
Airports certificated under FAA Part 139 are required to maintain an Airport Emergency Plan. Even non-certificated airports often have local emergency procedures that EMS agencies should review with airport management.
All EMS agencies with an airport in their response area should review this plan. One of the mandates in these plans is to have provision for transportation and medical care for the maximum number of passengers in the biggest aircraft that could land there. Ask yourself, are you part of the plan, and are you ready?
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Aircraft crash standardized approach
The FAA has training modules available for first responders who may respond to small aircraft or helicopter incidents. Out of the five training modules, three are specifically designed and recommended for EMS personnel, with modules 4 and 5 being recommended for those who are tasked with rescue operations at these incidents.
If an aircraft crash does occur, any lack or presence of training will be evident immediately. The pre-planning portion is the definitive delineation between the two. As with most EMS responses, pre-planning is the foundation of the response.
Plan for:
Safety. As with every EMS scene, scene and crew safety is the No. 1 priority.
Aircraft may present hazards including hot engines, fuel leaks, electrical systems, composite materials, as well as spinning propellers or rotor systems. Do not approach until the aircraft has been shut down and it has been determined safe to enter by qualified personnel.
Ingress and egress: It is important for first responders at these scenes to be able to identify established ingress and egress avenues at these otherwise highly restricted areas. If it is required to get through a secured checkpoint, do you know where that checkpoint is and how to get through it? Is it manned or does it have an automated lock? Do you have the keycard?
It is important to look at your local protocols, and if they don’t include these provisions, inquire about the ingress and egress points for these operational areas.
Patient care. Patient care is the one element that stays the same in any EMS response. All EMS responders should be trained for MCI response and the initial assessment — evaluating number of patients, resources, triage and transport of patients — stays consistent with other multiple patient scenes.
It is important for the responders to also avoid getting tunnel vision and think about the location of the accident and the impact to those that were on the ground. Given the higher speeds of aircraft, it is possible that the crash scene extends over a much larger area than a traditional automobile accident may.
Communications: Inquire about the appropriate frequencies to respond on, how to contact the control tower if there is one.
Know the response plan, and execute it accordingly.
Obtaining training
As with everything in EMS, training is of utmost importance. If you have never trained to handle a specific response, with unique hazards, you are not going to be able to execute the rescue and care mission effectively when called to do so.
Aircraft safety and scene management is a unique skill that some in EMS will never face, but if there is air travel over your response area, it is always a possibility. This increases if you have small airport in your surrounding area.
Each EMS responder should be familiar with the basics of responding to aircraft incidents to have a foundation of knowledge to pull from should the time arise, even if this will likely never be a part of your annual training or the continuing education credits you are expected to obtain. This education may not be provided by the agency you work for and it will be on the individual responder to obtain this information.
There are many cases around the U.S. in which private EMS systems are contracted for airport EMS coverage, and those employees are rotated through the base station. While these assignments are usually run-of-the-mill prehospital care for people travelling who are having medical emergencies, it may also include the infrequent event of having to care for those involved in aircraft accidents.
The FAA training is free for any responder to access and provides a baseline of information that involves mission-specific hazards not traditionally taught in EMS didactic courses.
