EMS Operations at Water Aircraft Crashes


 
 

Louis Cook, AS, EMT-P | | Tuesday, January 20, 2009


When US Airways Flight 1594 splashed down in the Hudson River with 155 souls on board, a massive response on the part of the New York City emergency community was undertaken, part of which was the Fire Department City of New York (FDNY) EMS Haz Tac Battalion's officers, Haz Tac ALS and BLS units and rescue medics. Water landings of fixed-wing aircraft are inherently dangerous, usually leading to the aircraft breaking up and sinking quickly. This was not so with the Airbus A-320 jet that was US Airways Flight 1594.

Thankfully, the full technical capabilities of the officers and members weren't needed on this assignment. Yet, EMS providers will undoubtedly be challenged when confronted with such an emergency. EMS providers everywhere can apply what has been learned from the rescue of people onboard US Airways Flight 1594 and a similar crash from 1992 when responding to an emergency water landing.

Any EMS operation around any body of water, or one in which the responders are deployed on a vessel, should make the use of personal flotation devices mandatory. Agencies that provide EMS personnel with bunker gear should have training and a policy regarding marine and littoral responses and the use of bunker gear. EMS strike team leaders, communication resource coordinators and branch directors should have the ability to monitor and communicate on Marine Radio Channel 16 when operating in a marine or littoral incident. This will make communication between the U.S. Coast Guard, fire and police boats, and EMS units seamless.

Weather can be a contributing factor in the cause of the crash. It can also impact the responders. Operating on the Hudson River, in weather that's 20-degrees Fahrenheit with a wind chill hovering around the single digits, had an impact on the patients, responders and equipment. The water temperature during this incident was around 40 degrees, making timely rescue of passengers in the water critical to their survival. Personnel performance will be negatively affected, requiring mandatory rotation and rehabilitation. Drugs and IV fluids will freeze, batteries will die quicker, and computer and ECG/AED screens will be altered. Any foam or water over-spray being used to fight resulting fires or suppress fuel vapors will create slip and exposure hazards if working on land or off the deck of a vessel.

Jet aircraft fuels areblends of various hydrocarbons, including alkanes (paraffins) and cycloalkanes (naphthenes), aromatics, as well as small amounts of such compounds as benzene, hexane and polycyclic aromatic hydrocarbons, whichsmell like kerosenewhen combined in the finished product. They're contact dermal irritants and can lead to chemical pneumonitis if inhaled. Besides the obvious fire hazard resulting from aviation fuels leaking from the aircraft, responders need to be concerned with vapor inhalation, fuel contamination and possible ingestion. Victims, as well as surface rescue swimmers in cold-water suits using facemasks and snorkels, who are floating around aircraft where fuel has leaked can have vapor inhalation as well as product ingestion. This happens with the inevitable gulping of air and swallowing resulting from swimming in a personal floatation device. Public safety/rescue divers using recreational-type SCUBA regulators are at particular risk for inhalation of fuel vapors when the fuel and water mixes and gets inside the regulator. Only diving rigs with a full facemask and helmet"breathe dry,"which means outside water doesn't get into the apparatus.

In March 1992, USAir flight 405 crashed during takeoff and came to rest at the very end of the snow-covered runway in the Bowery Bay at Queen's LaGuardia Airport. During this incident, 27 people on-board died, yet at least 100 rescuers suffered serious injuries from the sharp and jagged fuselage. There are many entanglement and other hazards in an aircraft crash. Steel wires, jagged airframe members and aircraft skin can all cause serious lacerations. Some steel wires can be almost invisible underwater to the public safety diver performing rescue operations. Any steel cabling or any other similar roping that is under tension can suddenly break free and become a deadly whip, injuring those around them.

Hydraulic lines that are still pressurized make operating around the scene hazardous to all. Most current commercial aviation hydraulic fluids are a phosphate ester fluid that has solvent-like properties. Fluids from cut hydraulic lines that are under pressure can dissect deeply into tissues, dissolve fat, and cause local and systemic toxicity issues. Vapors of these hydraulic fluids have been known to precipitate brochospasms in asthmatics. Hydraulic fluid and jet fuel are not the only hazardous materials associated with an aircraft crash. Responders must also be concerned with the possibility of hazardous materials exposure from the cargo as well as possible ionizing radiation issues from the aircrafts avionic systems.

When operating on land, responders must also be aware of the hazards of carbon monoxide from running vehicle and generators. Casualty collection points, command posts and other fixed posts should have CO detection equipment lest the rescuers become victims of the rescue effort.

Had this incident been adjacent to an airport, as in the 1992 LaGuardia crash, the response would most likely been onto the runway tarmac and to the site of the crash. EMS units arriving at an airport should never enter a runway area without airport personnel escorting them, because the hazards of taxiing aircraft and service vehicles as well as the possibility of running off the road into drainage ditches are very real concerns. Lighting on the runways is virtually non-existent except for directional and marking lights. This means responders might need the use of reflective vests to increase their visibility.

The use of privately owned or merchant vessels for the rescue effort must be judged on a case-by-case basis and be approved by the incident commander. The area where this incident occurred is heavily trafficked by water taxis, and sightseeing and dinner cruise lines. These vessels were the first to arrive and began picking up victims immediately. Once moored, these vessels became ideal casualty collection points. All the amenities a medical strike team leader could ask for was at hand -- heat, light, shelter, bathroom facilities and clean water for consumption. The vessel I boarded had 22 victims tended to by an FDNY EMS response physician, and an EMS lieutenant with an ALS and BLS crews to perform triage and treatment as needed. Force protection was accomplished by a contingency of New York Police Department (NYPD) officers.

At this event, the American Red Cross quickly arrived and provided blankets, dry clothing, and hot beverages and snacks to the victims, which made the rescue more effective. Interestingly enough, the Red Cross on-scene commander was a retired FDNY EMS Chief and former commanding officer of the unit that preceded the current Haz Tac Battalion. That"face recognition"and working relationship proved to be invaluable in this event. EMS agencies should endeavor to reach out to their local Red Cross chapter when pre-planning such responses. The Red Cross can quickly bring mass care assets that far outweigh what EMS can muster at a mass-casualty incident (MCI).

Thankfully, we had no fatalities on the Hudson River in the Jan. 15 incident. Sadly, that isn't the norm. Many crashes are MCIs that require delicate inter-agency cooperation. The New York City Medical Examiner Special Operations Response

Team, led by a former EMS paramedic, operates as a small disaster mortuary response team. EMS commanders should become familiar with the resources of their local medical examiner before an incident occurs. The National Mass Fatalities Institute has an introductory course available online for first responders of all ranks and disciplines.

Today, the US Airways plane still sits in the Hudson River. It's tied to the bulkhead mere yards from the footprint of the World Trade Center, the black box still unrecovered from the silt and mud. FDNY Fire and EMS units with their NYPD counter parts are still standing by as the Federal Aviation Administration and National Transportation Safety Board investigate. Many have sung the praises of the New York response community, and to them we are grateful. But more importantly, we're grateful that 155 people are were able to see their families again and that all our members went home safe.




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