On January 15, 2023, a fatal aircraft crash in Nepal killed 72 onboard. The committee investigating found an issue with the engine of the aircraft and is further investing human and technical errors associated with the air crash.  In the last three decades, 52 flights have crashed in Nepal ranking it 33 out of 207 countries with the most air crashes between 1990 and 2023. An aircraft crash is a highly visible event that gathers intense public and media scrutiny. Response activities are carried out by untrained local first responders, emergency managers, local leaders, and security agencies. Though a majority of aircraft crashes (80%) occur during takeoff and landing at an airport or nearby, a potential threat of crash always lies in the community with aircraft flying overhead.  The potential for fatalities and injuries is both for passengers flying and the local populace at the accident site.

Pre-incident preparedness consideration includes considering the size, capabilities, and ability of medical facilities closest to the airport as a response may begin from Airport Firefighting (ARFF) services but will quickly escalate to a mutual aid response. Planning considerations also include planning for trauma centers near the airport and transportation services. Airports must have an Airport disaster management plan updated regularly with drills and simulation exercises. As the scale of aircraft crashes is often large, they require support beyond the airport authority, so drills and exercises must involve local and regional hospitals, emergency operation centers and managers, fire, and security forces, and public health services. Local experts in disaster medicine should be invited to planning, training, and testing exercises. The size of the airport, the size of the aircraft, passenger capacity, and the types of aircraft landing will determine the nature of fatalities and injuries and they should be kept in planning consideration. Improved structural integrity, enhanced occupant protection mechanisms, improved fuel cutoff, and fire extinguishing capabilities, and suppression of toxic fumes from burning cabin materials, and aircraft conditions during and immediately after an air crash, all determine the survivability of passengers. Risk to passenger safety increases with fire or explosion as trauma is compounded by burns and rapid incapacitation by heat, smoke, and toxic fumes.

Post-incident air crash operations are likely to follow four distinct operational phases: emergency response, transition, stabilization, investigation, and recovery. In the emergency response phase, the focus is on lifesaving, firefighting, and safety-related operations involving unified command center establishment, on-site management, passenger tracking, and safety and security of the incident site. The emergency phase ends when the last surviving passenger is transported from the scene and all hazards at the crash site are eliminated. The transition and stabilization phase occurs simultaneously with the emergency response phase. The disaster site is assessed, recovery plans are developed, morgue operations are established, a family support center is established and forensic support is initiated. This is a collaborative phase of air crash response where airline representatives, health executives, law enforcement agencies, and transportation authorities all work together to help with forensic services like identification of victims, counseling relatives, and communicating with foreign governments. The investigation phase will initiate after the stabilization of the crash site and may last for several days to months. This will determine the cause of the aircraft crash. The final phase of recovery starts with the end of the investigation and may also last for days to months and begins with the transition to normal flight operations. This also means clean-up operations at the crash site, demobilization of resources, and finalization of all reports with proper documentation. This is completed by an after-action review of the accident.

Types of injuries in an air crash are primarily related to a combination of blunt, penetrating, and thermal injuries during explosions as well as during the evacuation process. Fractures are the most common injuries followed by head trauma, thermal and burn injuries, and inhalation injuries. In catastrophic crashes, no chances of survival are expected.

The first responders on aircraft crash away from the airport are always from the community and are neither trained to manage the incident nor maintain personnel safety during response. Hence, appropriate community awareness programs should be conducted by authorities and community engagement during exercises and drills is important.

Naveen Phuyal
NSEDRM