Monday, November 3, 2014

Aircraft Crashes & Disaster Planning

Aircraft Crashes & Disaster Planning
                                                                                                                  Dr. Abhishek Karn

Since 1949 - the year the first aircraft landed in Nepal - there have been more than 70 different crashes involving planes and helicopters, in which more than 700 people have been killed….. (

The Nepali skies saw 65 air mishaps in the last two decades…..

Aircraft accident
Defined as an occurrence that is associated with the operation of an aircraft and takes place between the time any person boards the aircraft with intention of flight and such time as all such persons have disembarked and the engine/s or any propellers or rotors come to rest, being an occurrence in which:
·         a person is fatally or seriously injured
·         the aircraft sustains damage or structural failure
·         the aircraft is missing or completely inaccessible.
Serious Injury means any injury that is sustained by a person in an accident and that:
·         requires hospitalisation for >48 hours, commencing from within 7 days from the date of injury; or
·         results in the # of any bone, (except simple #s of fingers, toes); or
·         involves lacerations, severe haemorrhage, nerve/muscle/tendon damage; or
·         involves injury to an internal organ; or
·         involves 2nd / 3rd degree burns, or any burns affecting >5% of the body surface; or
·         involves verified exposure to infectious substances/injurious radiation.

Team of the Doctors (Forensic Experts), Aviation agency investigators, Local law enforcements agents,  Funeral directors and Fire brigade and Civil defence personnel ---to discuss & prepare plans for the handling of the accident.
Should prepare a list of supplies and the place from which these can be obtained at short notice-like
·         body pouches
·         name tag plastic bags
·         Flashlights
·         Photographic equipments and
·         Formats for recording of findings of the investigation.
·         Photograph the body, with & without clothes & take x-rays (when indicated)
·         Describe clothing and personal effective data
·         Obtain Finger Print / ask police to do it
·         Make dental record (Dental Surgeon/Odontologist)
·         Note Identifying features weight, color of eyes, skin and hair, tattoos, scan, old bony deformity, absence of organs, surgery, or diseases
·         Describe and photograph , external injuries and burn and record them on body diagram.
·         Make internal examination, record and photograph.
·         Look for Natural disease Condition and describe in detail
·         Retain tissues for histological studies and toxicological analysis of hair samples for identification.
·         Collect Samples for DNA fingerprinting.

One aspect that falls under the responsibility of law enforcement and/or public safety and health officials after a mass disaster is the individualized identification of human remains found at the scene, so they can be returned to their families.
Characteristics or traits used to assist in the identification of the human remains include, but are not limited to:
     skeletal features
     dental comparisons
     distinguishing marks (tattoos and scars)
     medical devices and implants
     personal effects
     DNA profiles.
Forensic Expert and Anthropologists can also assist by providing information on general age, sex, size, color of hair and eyes, and race of the victim.

Collectively, all these procedures’ findings must support one another prior to a positive identification being determined.

Follow up Investigation
·         Reconstruct the mishaps
·         Additional investigation to identify cause of death and accident
·         Study of Finger Prints, DNA, dental and medical records to identify the body/part.
·         Relative interviewed--to obtain information about the body features, clothes and other personal effects
·         Toxicology--pilot and crew
·         Help establish approximate time of death
·         High impact disasters, such as airplane crashes, typically result in severe fragmentation and degradation of human remains.

·         Preserve life and rescue the injured promptly
·         Establish an inner and outer perimeter to limit access to the accident site
·         Act as if the accident site is a crime scene
·         Protect and preserve ground scars and marks.
·         Limit access to essential personnel only
·         How many people are on board? Injuries?
·         Sketches, descriptive notes, and photographs and/or video should be made, if possible, of the original positions and condition of the body/ body-parts of victims.
·         Coordinate with the team prior to removal of any fatalities
·         Document the surrounding area of the victim
·         Include positions, (Seatbelt / restraint positions, Position prior to removal: seat location, etc)

The hidden dangers within an aircraft wreckage that can seriously injure or kill first responders?
·         Biohazards
o   Blood
o   Bodily Fluids
o   Human Remains
·         Chemicals / Fluids
o   Fuel / Oil
o   Hydraulic Fluids
o   Unknown Aircraft Cargo
o   Battery Acid
·         Pressurized Objects
o   Oxygen Bottles
o   Rocket-propelled parachute systems

Ø  Attempt to save lives of those involved in the accident

Ø  Be aware of hidden dangers at the accident site

Ø  Locate victims/body parts and gather as much information as early as possible.

WHO Definition: A situation, which implies unforeseen serious and immediate threat to public health.

“Catastrophe causing injury or illness simultaneously to at least thirty people who will require hospital emergency treatment”-(Colin Grant).

“Disaster needs declaration when immediate patient load in the emergency medical services system is greater than normal, operator can care for” (Jenkins An). 

..modified according to local criterias of a particular country/city.

A disaster involves following Ingredients:
·         Unforeseen, Serious and Immediate Threat to Public Health (Suddenness in terms of time)
·         An Emergency, Calamity, Catastrophe, Misadventure, Tragedy, Epidemic etc.;
·         Where number of casualties far exceeds medical facilities in normal situation that disrupts the normal routine of life (Magnitude in terms of severity of damage or deaths)

Two distinct categories according to their causes.



Volcanic eruptions.
Land slides.
Metrological Phenomenon.
Wind Storms (Cyclones, Typhoon, Hurricane).
Hail Storms and Snow Storms.
Sea Surges, Flash Floods.
BIOLOGICAL PHENOMENA: Epidemics of Diseases.


Conventional Warfare.
Nuclear, Biological & Chemical Warfare.

Vehicular Accidents, (AirPlane, Train, Ship, Bus etc.).
Collapse of Building.
Chemical Including Poisoning.

Aim of disaster management: Prevention and minimization of death, disability, sufferings and losses.

The principle steps involved are:
Prevent” the occurrence of the disaster whenever possible.
Minimize The Number Of Casualties” if the disaster cannot be prevented.
Prevent Further Casualties”.
Rescue The Victims”.
“Provide First Aid To The Injured”.
Evacuate The Injured To Medical Installation”.
“Provide The Definite Medical Care”.

Role of Medical Man at the Scene
·         Mass disaster management is basically a team work consisting of police, army, home guards, civil authorities and medical experts (Forensic pathologist, forensic odontologists), finger print experts ballistic expert etc.
·         Work in co-ordination.
·         First & foremost job save life, give first aid.
·         Forensic pathologist is responsible for proper investigation of such episodes comprising of:
o   Identification of the site of occurrence and prepare a sketch diagram showing geographical location.
o   Reaching the spot along with team and necessary equipment
o   Immediate isolation, demarcation and protection of the site.
o   Photography of the site from various angles.
o   Identification of bodies as far as possible.

Identification from remains in disaster case is achieved by-
·         Appearance , Complexion, Photograph, Superimposition photography , Restoration of facial features – When skull is available, Deformities, Birth marks, Occupational marks, Scars, Tattoo marks, Race, Sex, Stature, Age, Finger prints, Foot prints, Miscellaneous Data—(presence of disease, biliary calculi, renal calculi, uterine fibroid, appendecectomy scar, exceptional growth of hair, old fractures etc. ), Blood grouping, DNA
·         Stature—
If a complete skeleton is available, stature =length of the skeleton plus 2.5 cm for thickness of soft parts.
If the body is mutilated, its stature is determined by:
approximately =length from tip of the middle finger to the tip of the opposite middle finger when arms are fully extended.
From 20th or 25th year onward, stature is twice the length from the vertex or heel to the top of the symphysis pubis.
The height can be ascertained from one arm by multiplying its length by 2 and adding 34 cm.
The length of forearm measured from tip of olecranon process to the tip of middle finger =5/19 of stature.
The length from the sternal notch to pubic symphysis =1/3 of stature.
The vertical distance from the top of the head to the tip of chin =1/7 of stature.

Points to consider,
·         Sorting of dead from injured. Arranging transport facilities both for dead and alive for treatment purposes to hospital or mortuaries.
·         Proper scientific numbering and tagging of the dead bodies for future identification purpose by the relatives.
·         Autopsy examination of all the casualties is must to confirm the cause of death.
·         Facility of ‘Cold Storage Cabinets’ or arrangement of Ice Cubes (blocks) for keeping the dead bodies till waiting for relatives or final disposition of dead bodies should be available.

(Secondary Disaster/Disaster After Disaster/Disaster Over Disaster)--due to law & order problems during T/t or at any stage of disaster management (like public outrage, conflicts between hospital staff and attendants of patient’s or so called self made local leaders, creating strike like situation)

Most people believe that a disaster is something that happens to someone else not to themselves or their families (Delusion Of Personal Invulnerability).
As a result they are likely to ignore or minimize warning and refrain from taking preventive measures.

Need for change of strategy from ‘post-disaster reactive approach’ to ‘pre-disaster pro-active approach

No master plan can be evolved to fit every emergency situation but a general schedule of emergency activity could prove extremely helpful in times of disaster, if executed in a coordinated and disciplined fashion.

Creating public awareness about safety from disasters by organizing workshops, symposium, seminars etc.

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