Airport emergency calls really catch your attention when they come over the radio. Crews will immediately start mentally refreshing mass casualty incident (MCI) policies and preparing for the worst. These calls aren’t uncommon in Wichita, Kan., but they’re typically a prophylactic response for issues like a cockpit warning light, smoke in the cabin or other in-flight emergencies.
However, in Wichita, Kan., on the morning of Oct. 30, 2014, the notification for an airport emergency was distinctly different–it was dispatched as a “real plane crash.” The word “real” sunk in very quickly for the public safety units hearing the dispatch and incident managers immediately elevated the response based on the early information received from the control tower and dispatch center. When situations like this occur, EMS planning and training pay big dividends for a community.
The ‘Real’ Plane Crash
At 9:49 a.m., Sedgwick County EMS (SCEMS) units were dispatched to an airport emergency at the Wichita Mid-Continent Airport. A twin engine Beechcraft King Air lost power to one of its engines just after takeoff, which caused the aircraft to bank hard off the path of the runway and impact the northeast corner of the Wichita Cessna FlightSafety International building. The aircraft and structure burst into flames, with the fire fed by the aircraft’s recently topped-off fuel tanks. Large plumes of smoke were visible from miles away.
The FlightSafety building housed over 60 employees, who began to evacuate the structure immediately. There were also four massive aircraft training simulators that were all in use at the time of the crash, but those participants weren’t able to evacuate the structure.
The response to the crash included numerous public safety agencies: Wichita Airport Public Safety, Wichita Fire Department, Wichita Police Department, Sedgwick County Sheriff Office and Sedgwick County Fire Department, along with multiple other agencies. The primary EMS response was by SCEMS. Mutual aid response was provided by Butler County EMS.
Single conveyance devices such as Med Sleds or large-wheeled stretcher carriers can ease the movement of patients. Photo courtesy Darrel Kohls
Initial EMS Response
SCEMS’ initial response included the automated response of two ambulances and an EMS division leader, who quickly requested additional ambulances. EMS command staff began setting up support functions and requested mutual aid within the first five minutes–before the first ambulance was on scene and a total patient count was available. The goal was to get ahead of the curve; command officers, because of their training and past MCI drills, operated under the philosophy that resources need to be dispatched early and in sufficient quantity. They could easily be turned around if they weren’t needed.
Planning & Mutual Aid
Kansas is fortunate to have a state law that automatically includes surrounding agencies in mutual aid agreements. Agencies have to actively opt out in order to not participate as a mutual aid partner.
However, it’s important to note that simply having a mutual aid agreement is nothing more than a good start. Mutual aid partners must communicate and train with each other to understand the roles they must play in each other’s plans. In this particular incident, the two agencies had just recently discussed a mutual aid request for airport disasters.
SCEMS takes a unique approach in the way mutual aid agencies are used. In most EMS systems of its size, all available local resources are sent to the disaster scene to provide care and transport. The mutual aid resources are then used to respond to the background calls going on around the rest of the jurisdiction while local units handle the disaster. As an example, there’s an average of 165 calls per day that have to be covered even when there’s a large-scale event occurring. This methodology requires the mutual aid units to respond to multiple unfamiliar addresses.
SCEMS has taken the opposite approach, sending mutual aid units directly to the mass casualty site while most local units continue to run the system’s daily calls. A few of our local units are used to establish and operate the triage, treatment and transport groups at large-scale incidents and mutual aid units are used to transport patients from the scene. Using this method only requires the mutual aid units to respond to one unfamiliar address, and they can then be used in an ongoing loop from the disaster site to the hospital and back to the disaster site.
First responders transported five patients to a local burn center and hospital. AP Photo/Roxana Hegeman
During MCIs, agencies have to be able to talk to each other on the right channels. As referenced, before the first ambulance arrived at the crash site, Butler County resources were requested and sent to the scene. Direct communication for the mutual aid response was possible thanks to the state’s investment in a statewide P-25 radio system. The digital radio systems have helped many agencies solve the interoperability issues that have plagued large-scale responses in the past; however, the systems are complicated and user familiarization must be maintained.
The mutual response radios had 40 zones, each with 16 channels. That represents a total of 640 channels. So, without a plan, protocols and practice, this can also be a recipe for disaster as units try to find and use the right ones.
Fortunately, the agencies involved in the incident were familiar with the disaster communications plan and, most importantly, the individual crews knew the proper channels to use, so communication wasn’t an issue.
An inverted funnel was established for the entry point into the treatment area. Caution tape was used to direct incoming responders and patients into the funnel. Photo courtesy Dalene Deck
Arriving on Scene
Emergency vehicles were responding from across the Wichita metro area and soon began pouring into the Mid-Continent Airport. Acting Division Leader Tom Seyfert on Medic 2 was the first EMS supervisor on scene along with Medic 25, 35 and 29.
Seyfert had incoming units staged approximately a quarter mile north of the crash site due to the size of the fire and volume of incoming fire equipment. He then established the medical branch under the ICS structure and had the EMS units switch communications to a tactical channel. The ambulances remained in staging until the medical branch director coordinated with incident command.
As with all large MCIs, the first few moments were chaotic as the event began to take shape. Evacuees were exiting the FlightSafety building as fire units began attacking the fire, which was primarily in the area of the simulators.
Firefighters pulled one of the first patients out of one of the simulator rooms. The patient had sustained severe burns and traumatic injuries after jumping approximately 15 feet from the simulator after the impact of the aircraft.
One ambulance was requested by the fire department crews to move up for transport of this patient. Despite heavy fire still coming from the building, Medic 25 was moved to the northeast corner, a position that, in hindsight, was too close to the impact zone. However, the patient was quickly treated and transported to St. Francis Burn Center.
The medical branch director then began making assignments for triage, treatment and transport groups. Medic 3, a supervisor vehicle with two division leaders on board, was assigned to the treatment group along with two ambulances. The Sedgwick EMS disaster medical support unit (DMSU) also arrived on scene quickly with additional personnel and disaster equipment.
The triage area was established early to start triaging patients as they were removed from the building. Photo courtesy Dalene Deck
An Improved Response
At the time of the crash, training was being conducted for the SCEMS biosafety transport team (BSTT) at their EMS administrative offices. The BSTT specializes in the safe treatment and transport of patients with suspected highly infectious diseases, such as Ebola. Ten members of the BSTT were also members of the SCEMS DMSU. This extra complement of personnel was immediately sent to the incident and improved the timely disaster response of personnel and support units.
The DMSU is outfitted with a deployable trailer that includes multiple patient conveyance devices along with caches of trauma and other medical supplies, and is a force multiplier that allows transport ambulance crews to provide the necessary treatment and transportation of patients while DMSU members complete mission support functions.
The planned operational response time for DMSU team is 45–60 minutes in optimal conditions with the intent to support a large-scale incident for up to 72 hours. The full response to this incident for the DMSU team was just 30 minutes. In addition to the DMSU team, others attending the training were available with an ambulance ready for immediate deployment.
The division leader vehicles are equipped with basic MCI kits to assist in establishing the medical branch and the groups under the branch director. The physical setup of the airport crash scene began with the triage group that was positioned on the northwest corner of the FlightSafety building. The triage group initially utilized colored tape to triage patients and was responsible for obtaining an accurate number of patients. Triage tags were then affixed to patients once they were moved to the treatment section area’s entrance. Once patients were triaged, the group then helped move patients into the treatment section if they weren’t able to walk.
It’s important to minimize the distance patients have to be physically carried from triage into treatment because carrying patients can quickly fatigue responders and can consume a lot of manpower. The crash area was concentrated enough that a treatment area could be established close to the triage area. Simple conveyance devices, such as Med Sleds and large-wheeled stretcher carriers, assisted in the movement of patients because these devices only require two responders to use.
An inverted funnel was established for the entry point into the treatment area. Caution tape was used to direct incoming responders and patients into the funnel. Colored tarps were used to mark the appropriate patient collection sections and leaders were assigned to each. An officer stationed at the entry point ensured patients had been triaged and had triage tags affixed before they entered the treatment area. The patients were then directed to the appropriate section–immediate, secondary or delayed.
Treatment Group Do-Over
A large percentage of responders had participated in a full-scale airport disaster drill a month earlier, so disaster training was still fresh in the minds of most SCEMS responders. During the drill, the red, yellow and green treatment sections had been positioned too close together and we quickly ran out of space. At the airport incident, the crews learned from their previous experience and provided more than adequate spacing.
Local protocols, established to provide guidance on the distribution of patients to prevent overloading of one facility, were initiated, and the transport officer contacted local hospitals early into the incident to determine their capabilities to receive incoming patients. The treatment group rapidly processed three code red (first priority) patients with burns and inhalation injuries and transported them by waiting ambulances to the burn center.
Watch Out for That Hose
Even when being extremely mindful of where to set up treatment and transport areas, there can be hiccups. In the case of this response, a five-inch supply hose was laid alongside the treatment area, initially trapping units in the area.
The hose was needed because of the fire’s size and because firefighters were making an entry into the building to search for victims. Units in the treatment area were able to find an alternate route and the transport area was adjusted around the supply line.
Anticipating where water supplies will be positioned during large events is difficult, and once they’re on the ground and charged, crews must make adjustments. Hose ramps can help provide an exit strategy but must be added to the agency’s equipment inventory.
This sudden MCI involved only nine total victims–five patients were transported from the scene, four were immediate patients and one was a delayed patient. Four deceased victims were later recovered; one was the pilot of the aircraft and the remaining three were trapped inside a flight simulator. The community was fortunate the number of injuries and loss of life was low considering the gravity of the incident.
MCIs such as this happen fast and are often in unexpected locations. Their successful management requires a well-coordinated dispatch, response and quick effort by multiple agencies. Our incident management was successful because of the planning and training local agencies had participated in together over the past several years.