Aerodrome Emergency Medical Response
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This article introduces some of the issues and methods involved in preparing for emergency medical responses to aircraft-related accidents and serious incidents at aerodromes. The operation of medical clinics inside aerodromes — which may provide urgent health care and assistance to passengers, aircraft crewmembers and airport workers in other situations — and the involvement of health and medical entities such as hospitals are not considered or only briefly mentioned.
Current practices and experiences of typical emergency medical services (EMS) and aerodrome Rescue and Fire Fighting Services (RFFS) (also known as aircraft rescue and fire fighting [ARFF] in the United States) are referenced only as generic case-study examples. Preparations and practices in other countries may vary.
In its regulatory requirements for development of airport emergency plans (AEPs) at aerodromes that meet defined criteria, the U.S. Federal Aviation Administration (FAA) lists “emergency medical services” as one of 37 stakeholder entities (called AEP planning team members) expected to participate in the plan development and implementation process.
A key concept of EMS-response preparations involves mutual aid agreements, which are documents that state how EMS responders from different jurisdictions (town, city, county, state, federal) and separate organisations (private companies, volunteer fire departments, military services, etc.) will commit their resources in predefined circumstances. The agreements may cover each partner’s inventory of equipment, the number and qualifications of on-duty and on-call personnel, access to RFFS training for structural firefighters, compatible radio-communication capability, and following orders of the on-site RFFS incident commander at the aerodrome, among other arrangements.
A typical emergency medical response at a U.S. aerodrome to an aircraft-related accident or serious incident involves immediate dispatch of ambulances with emergency medical technicians (EMTs)/paramedics in close communication with ARFF and police. Aerodrome management then rapidly activates and staffs its emergency operations centre (EOC).
The ambulance crews on duty typically depart from permanent airside fire stations, fire stations close to the aerodrome and, if necessary, from other fire stations, hospitals and private ambulance companies under the established protocols for mutual aid.
At the site of the event, ambulance crews follow orders from an RFFS/ARFF incident commander responsible for overall safety and effectiveness of the first-responder activities. The incident commander also may order response by helicopter EMS crews from airports, hospitals, other bases of operation or in-flight diversion.
RFFS firefighters’ primary mission is saving lives immediately after an aircraft crash by protecting egress paths for evacuees and extricating occupants who are trapped, injured or otherwise unable to exit with crew assistance. Many also are cross-trained and certified, as noted, to various qualification levels as EMTs or paramedics (terminology varies).
The second-priority mission of RFFS/ARFF is fire control and suppression, and in some circumstances, they may participate in activities such as finding evacuees, triage (assessment) of casualties and temporarily providing first-responder emergency medical care pending transport from the site by ambulance or EMS helicopter to an appropriate medical facility.
EMS Response Planning
In general, AEPs address the mutual interests in emergency-management preparedness of local, state and federal government agencies. This includes preventing, as much as possible, duplication of effort, confusion and communication breakdowns. Extensive participation in creating and updating the AEP for major aerodromes reflects the complexity of these issues. “The AEP addresses essential emergency-related and deliberate actions planned to ensure the safety of and emergency services for the airport populace and the community in which the airport is located. The AEP document should be functionally oriented, comprehensive in the assignment of responsibilities, and coordinated at all levels,” according to an FAA advisory circular. Within the FAA’s AEP standards and guidance, EMS perform two basic functions analogous to those of their RFFS/ARFF counterparts under the AEP incident command system—aircraft accident:
- “Provide emergency medical services [including a medical command post] to the airport during emergency conditions to include triage, stabilization, first aid, medical care and the transportation of injured; and,
- “Coordinate planning, response and recovery efforts with hospitals, fire and police departments, American Red Cross, airport operator, etc.”
The AEP guidance also specifies that off-aerodrome health and medical care organisations such as hospitals — as represented at the EOC — provide, to the extent practicable, “medical services including transportation and medical assistance for the maximum number of persons that can be carried on the largest air carrier aircraft that the airport reasonably can be expected to serve.”
FAA also recommends voluntary use of its EMS guidelines by aerodromes that are not required to meet the AEP standard.
Hazards to EMS Responders
At an accident site, RFFS/ARFF incident commanders and designated supervisory officers in the chain of command typically take charge of safely positioning EMS vehicles and directing the movements of EMS responders. Directions consider factors such as terrain and surface hazards, aircraft and vehicle ground traffic, fire-smoke-fumes conditions, hazardous materials (hazmat), fuel leakage, wind velocity, accident aircraft/wreckage position and a single designated entry/exit point for the marked site.
The FAA offers training tailored to non-aerodrome–based EMS professionals in the form of a free online course titled First Responder Safety at a Small Aircraft or Helicopter Accident. It provides information that local EMS first responders (and other non-ARFF first responders such as police officers) should know about potential on-site hazards following small aircraft and helicopter accidents.
The course focuses on the hazards of aircraft-seat airbags; hazmat; ballistic parachute systems; fuel; inhalation and tactile hazards such as airframe composite structures (e.g., carbon fiber materials) and biohazards; oxygen systems (especially in EMS airplanes and helicopters); stored-energy components (batteries); operating engines/propellers; and how to work inside the accident aircraft near hazards such as a sharp/jagged structure.
Accidents & Incidents
The following events are included to demonstrate how RFFS and EMS units responded aerodrome events and to provide details of on-site problems.
- B735, Denver USA, 2008 — On 20 December 2008, a Boeing 737-500 being operated by Continental Airlines on a scheduled passenger flight from Denver to Houston departed the left side of Runway 34R during a normal visibility night takeoff roll in gusty crosswind conditions and then travelled across moderately rough but essentially level terrain before coming to stop still upright but with the fuselage broken into two pieces. A post-crash fire followed. Six of the 115 occupants were seriously injured, and 41 sustained minor injuries.
The investigation concluded that the probable cause of the event was: “The Captain's cessation of right rudder input, which was needed to maintain directional control of the airplane, about 4 seconds before the excursion, when the airplane encountered a strong and gusty crosswind that exceeded the Captain's training and experience.” It was considered that the following factors had contributed to the occurrence:
• An air traffic control system that did not require or facilitate the dissemination of key, available wind information to the air traffic controllers and pilots; and,
• Inadequate crosswind training in the airline industry due to deficient simulator wind gust modelling.
The NTSB’s final accident report said that the cabin crew and deadheading pilots completed their evacuation of all other aircraft occupants before fire entered the cabin and before ARFF vehicles arrived about five minutes after the crash. The report said, “Once outside the airplane, crewmembers and passengers with less serious or no injuries assisted others up a hill to ARFF station #4. When they reached ARFF station #4, the airplane occupants were triaged and received medical treatment as needed from ARFF emergency medical technicians and on-airport paramedics. The more seriously injured individuals were transported to local hospitals by ambulance, while others were transported to the terminal area by bus.”
- AT43, Lubbock TX USA, 2009 — On 27 January 2009, an ATR 42-300 being operated by Empire Airlines on a scheduled cargo flight from Fort Worth Alliance to Lubbock was making a night ILS approach in IMC to runway 17R at Lubbock when it stalled and crashed short of the runway. The aircraft caught fire and was effectively already destroyed by the impact. Both crewmembers were injured, one seriously.
The NTSB’s final accident report said, “According to standard protocol for an Alert 3 accident, Lubbock Fire Department units also responded and were dispatched at 0441:10. The response included the battalion chief and engine from Station 2 (which is about 3.2 miles from LBB and staffed with personnel who are all ARFF-certified firefighters with airport access badges); an engine from Station 5 (about 7 miles from LBB); and an engine, truck and HAZMAT team from Station 4 (about 7 miles from LBB). … The captain sustained serious injuries, and the first officer sustained minor injuries.
“As directed [by the protocol for arriving mutual aid fire trucks and mutual aid ambulances], one engine from Station 2 responded to Gate 48, which is an electronically controlled gate operated by a drive chain. The engine team was unable to enter the airport property at Gate 48 because the gate had ice in its operating mechanism and would not open. The Station 2 engine then drove to the ARFF station to proceed from that point.
“All other responding Lubbock Fire Department units were informed that the wreckage was closest to the FedEx hangar and were rerouted to respond to that site. A FedEx employee who opened the gate near the FedEx hangar for the Station 2 team, Station 5 engine, and emergency medical service (EMS) personnel informed them that the pilots were at the hangar; the EMS units proceeded to the hangar. … The first Lubbock Fire Department unit arrived on site at 0457:27. At that time, the ARFF units had contained the fire, with the exception of a few deep-seated cargo fires inside the airplane.
“The Lubbock Station 2 battalion chief assumed incident command and informed the ARFF captain that the flight crew was at the FedEx hangar. The ARFF captain stopped the search for survivors, and ARFF personnel resumed their fire suppression activities. The Station 2 battalion chief and ARFF personnel indicated that the ATCT [air traffic control tower] controller later called and stated that a pilot was walking around on the ramp looking for assistance, and a second search for survivors was initiated. ARFF personnel determined that both pilots were being transported to a local hospital, and the emphasis on fire suppression resumed.”
“The captain stated that, after exiting the airplane, he called Empire Airlines’ dispatch and reported the accident. Both the captain and the first officer then left the site and ran to the FedEx hangar before the first responders arrived. A FedEx employee subsequently notified the Lubbock Fire Department and EMS personnel when they arrived at LBB that the flight crew was at the FedEx hangar; however, by that time, the ARFF responders were already on site and looking for survivors.”
“The NTSB concludes that an iced and inoperable mutual aid gate could extend the response time of mutual aid, which could delay the delivery of medical attention to accident survivors and result in further fire damage to property. Therefore, the NTSB recommends that the FAA amend [Advisory Circular] AC 150/5200-30C to include guidance on monitoring and ensuring the operability of emergency response and mutual aid gates during winter operations.”
- “Airport Emergency Plan,” Advisory Circular (AC) 150/5200-31C, June 19, 2009.
- Hazards at Aviation Accident Sites - Guidance for Police and Emergency Personnel, ATSB, 7th edition, June 2017.
- “Survival Factors: NTSB’s analysis of how occupants fared after Asiana Airlines Flight 214 collided with a seawall points to research opportunities.” by Wayne Rosenkrans, Flight Safety Foundation, AeroSafety World, Nov. 4, 2014.
- “Mutual Aid: When the Q400 struck a house and exploded, the volunteer fire chief pulled ARFF specialists into a massive response.” by Thomas Chmielowiec Sr., Flight Safety Foundation, AeroSafety World, March 2010, 27–31.