The airshow narrator is your only link to the spectators should unplanned incidents occur. 

Documentation

___________________________________________________________

MEDICAL RESPONSE TO RAMSTEIN AFB DISASTER:

(Extract, full text below)

The ranking medical officer and his aide had been watching the air show from the control tower. The aide had two hand-held radios: one to keep the officer in touch with the base central command post and the other to link him with the German Red Cross and the German and American medical nets. As the aide ran down the tower steps, she fell and broke both radios, seriously compromising communication through the event.

"For reasons that are still unclear," noted Capt. Cowan, "the air traffic (control) tower was out of communications for several vital minutes after the crash." The helicopter crews on the base tried to contact the tower for directions, but no one answered. An American pilot radioed to the other pilots and organized their flight into the crash site. They found the triage stations and lined up near them so that patients could be loaded.

___________________________________________________________

AN AIRSHOW INCIDENT

(Extract, full text below)

Lessons Learned:

Handheld FM and VHF communications radios were useless during incidence due to frequency congestion. Everybody was talking at once.

___________________________________________________________

 

Full text of Articles

Also located in Airshow Management by Linda & Hugh Oldham

___________________________________________________________

MEDICAL RESPONSE TO RAMSTEIN AFB DISASTER:

LESSONS TO BE LEARNED

 

by Linda Kesselring

 

(Reprinted with permission from Maryland EMS Newsletter, April 1989)

 

On August 28, (1988) more than 300,000 people gathered at Ramstein US Air Force Base near Frankfurt, West Germany. They had come to watch performances by aerobatic teams, the annual Flug Tag Air Show. The day turned to tragedy when three jets of Italy's Frecce Tricolor (Tricolor Arrows) collided above the crowd. Approximately 500 people were injured (most of them burned) and 69 people were killed at the base or died later from their injuries.

Following the crash Naval Captain Michael Cowan, MD, special assistant for National Disaster Medical System (NDMS) in the Office of the Assistant Secretary of Defense of Health Affairs, went to Germany with a team of surgery and burn specialists. They were to learn about the medical response to the incident and to find out how the actual triage and transportation mechanisms compared with the plans that had been established for such an event. Could any lessons learned be of value in modifying NDMS plans? Capt. Cowan described the crash and the response to it during Grand Rounds at the MIEMSS Shock Trauma Center in December.

The crowd at Ramstein lined the main runway. Frecce Tricolor began its maneuver called "arrow through the heart". Nine planes flew parallel to the ground and then went straight up in the air. They divided into a heart pattern perpendicular to the ground, four planes going one way, and four going the other. The ninth plane pulled away from the group and turned back to "pierce the heart" and fly over the crowd. "From the ground", stated Capt. Cowan, "it looks as though the planes pass very closely. The solo plane is actually to be several hundred meters above and behind the others."

By reviewing videotapes of the fated performance, Dr. Cowan and the other investigators saw that the pilot of the ninth jet came in too low and too fast. he hit the lead plane, which flipped to its left and hit another. Those two planes crashed along the runway, scattering burning debris for 500 meters. The solo plane landed about 50 meters from the crowd, broke into a ball of fire, bounced across the runway, and landed in a crowed concession area where refreshment trucks were parked. The plane slammed into one of the trucks, which stopped its progress and set the fire ball straight up. "The vertical containment created some ironic occurrences," noted Capt. Cowan. "Plastic mugs full of cold beer remained right next to where people were virtually incinerated by the 1600 degree fireball."

The lead and left wing planes crashed within 2 seconds after the mid-air collision. It was only 3.2 seconds from the mid-air crash until the solo plane traveled 1500 feet to the concession area.

The crew of the primary fire truck stationed at the base extinguished the fire within 92 seconds. The first med-evac helicopter arrived within 4 minutes. twenty helicopters would be ferrying people away from the site in the coming hour. Every injured person was off the base in 1 hour and 36 minutes. Within 2 hours, all receiving hospitals had triaged, treated, redistributed, admitted, or made some disposition of all the casualties.

In preparation for Flug Tag, security and emergency preparations were high. In the crowd were at least 1500 American and German uniformed police officers as well as a number of plain clothes officers. Four aid stations had been set up for the air show. Each was augmented with intravenous fluids and additional medications. The Ramstein clinic was about 1500 meter away; it has no in-patient facilities, but it is a large and well stocked air force clinic.

Videotapes showed that people in the crowd initially froze until the fireball went up and the danger passed. Then a large number of the 300,000 people surged forward to help in an almost simultaneous response.

The injured people who could walk started to move toward the clinic. Nearly all had been burned and many were naked because their clothes had been burned off by the intense heat.

The ranking medical officer and his aide had been watching the air show from the control tower. The aide had two hand-held radios: one to keep the officer in touch with the base central command post and the other to link him with the German Red Cross and the German and American medical nets. As the aide ran down the tower steps, she fell and broke both radios, seriously compromising communication through the event.

The physician began to intercept patients running up the road to the clinic, and he started a medical triage station. An oral surgeon from the crowd, who had been trained extensively in disaster management, set up a second triage station. Three more were established by ambulances from the aid stations. Within 5 to 10 minutes, there were five medical triage areas within 50 meters of each other. Each site acted autonomously, with little awareness of the others' activities.

From the systems view, it was a multiple casualty event with five triage sites. Those sites managed about 186 people. The other 300 injured people got to medical care on their own. They drove their cars, commandeered buses, or used government vehicles. They left the base, one of the tightest controlled grounded and air space in western Europe, before 1500 uniformed police officers could secure the site. The plan called for them to be quietly triaged into delayed categories and taken to hospitals in an orderly , convenient way.

"For reasons that are still unclear," noted Capt. Cowan, "the air traffic (control) tower was out of communications for several vital minutes after the crash." The helicopter crews on the base tried to contact the tower for directions, but no one answered. An American pilot radioed to the other pilots and organized their flight into the crash site. They found the triage stations and lined up near them so that patients could be loaded.

Almost all survivors suffered from burns. Those who also received severe trauma were in the center of the fireball and did not survive. One remarkable exception was a woman at ground impact. The solo plane dug up a berm of earth that buried her and then hopped over the runway, hit the truck, and burst into flames. She was severely traumatized but she was not burned.

The primary receiving hospitals for Ramstein Air Base is Landstuhl Army hospital, several kilometers away. Landstuhl activated its disaster plan without advantage of knowing how many patients would arrive. As patients began to arrive by helicopter, automobile, and ambulance, the disaster plan began to break down and was modified in the heat of the activities. At one time, 13 helicopters were siting on a landing pad designed for two.

In 1.5 hours, Landstuhl Hospital received about 120 patients in no particular order of priority. Most of the seriously injured were transported here: 14 were hospitalized and another 80 were transferred for hospitalization elsewhere. Only six needed immediate surgery (a laparotomy, several escharotomies, and the treatment of a compound femoral fractures), so the hospital's operating room capabilities were not overwhelmed.

Germany has a sophisticated distribution plan for burned patients. It was established in the early 1980's after an incident in which propane gas leaked into a campground in Spain an ignited; many people were horribly burned. In the current system, a staff member at each of the 20 burn units in the country calls a central phone number in Hamburg each day to report the number of beds available for burned patients. In a mass casualty incident, one call to Hamburg can allow the burned patients to distributed primarily.

After the Ramstein disaster, no call was made to the Hamburg distribution center. The physicians on the helicopters distributed patients themselves, presumably as the course "Advanced Burn Life Support" sponsored by the American Burn Association should be made widely available.

It seems to be a recurrent, even inevitable, observation that, during a disaster, command, control, and communication break down when needed most. Problems encountered at Ramstein could have hampered patient care but did not. The high level of training and medical readiness among both lay and medical people in the Ramstein community allowed adequate care for the victims. Disaster plans need to recognize the fragility of high technology during emergencies.

Lack of record keeping is a recurrent problem. Even trained prehospital care providers responding to disasters often overlook this vital aspect of emergency response.

Finally the "morbidity" of psychological devastating of individuals in the community, both survivors and health care providers, may eventually surpass that of the physical injuries. Psychological support and care must be built into emergency response plans.

The objectives of NDMS are to meld federal resources (for example, medical support, equipment, and supplies) into the local disaster response, to match patients with the facilities that can best treat them, and to financially support the hospitals that receive the victims of a disaster. By studying the responses to disasters, Capt. Cowan and his associates continue their efforts to design plans that are concordant with as the course "Advanced Burn Life Support" sponsored by the American Burn Association should be made widely available.

It seems to be a recurrent, even inevitable, observation that, during a disaster, command, control, and communication break down when needed most. Problems encountered at Ramstein could have hampered patient care but did not. The high level of training and medical readiness among both lay and medical people in the Ramstein community allowed adequate care for the victims. Disaster plans need to recognize the fragility of high technology during emergencies.

Lack of record keeping is a recurrent problem. Even trained prehospital care providers responding to disasters often overlook this vital aspect of emergency response.

Finally the "morbidity" of psychological devastating of individuals in the community, both survivors and health care providers, may eventually surpass that of the physical injuries. Psychological support and care must be built into emergency response plans.

The objectives of NDMS are to meld federal resources (for example, medical support, equipment, and supplies) into the local disaster response, to match patients with the facilities that can best treat them, and to financially support the hospitals that receive the victims of a disaster. By studying the responses to disasters, Capt. Cowan and his associates continue their efforts to design plans that are concordant with the facts and make the most efficient use of personnel, materials, time, and money.

 


 

AN AIRSHOW INCIDENT

by: Hugh Oldham

(Reprinted from World Airshow News, Sept./Oct. 1991)

The Fourth Annual County Airshow was expected to be a good one. The performance line up was outstanding: Kim Pearson, SF-260; Wayne Parrish, Davis Acro Pro; Jeff Davis, Pitts; Bill Johnson, SNJ; Bobby Hester, P-51 acro; Skip Homburg, JARRS Heilo STOL demo; M-1 Abram Tank Demo; an eight person female skydiving team; narration by Hugh & Linda Oldham. The two day airshow lived up to expectations, but a major incident, before the start of Saturday's show, created a potential for catastrophe.

What follows is a chronology of the major events at that show. Times are estimates.

Saturday

County Airport

0730: Temporary Air Traffic Control Tower starts operation.

0800: Volunteers, venders, staff, and performers are hard at work preparing for the Fourth Annual County Airshow planned to start at 1400. Minor SNAFU's but no major problems.

0830: Fire Dept. and EMS units move to staging areas.

0900: The crew of a ANG C-130, scheduled for static display, phones to report engine problems. Working on problem, will try to make show.

0930: Local vender begins to set-up a "Moon Walk" inflated children attraction in the vender/sponsor display area.

0945: The Memorial Hospital "Life Flight" helicopter lands in a special controlled access area for static display. Controlled access area necessary due to the state wide "on call" status of helio and crew.

1100: Gates open, spectators begin to filter into airport, PA system up, narrators begin normal pre-show chatter.

1230: Performer briefing begins in airport terminal building. Normal FAA stuff. Emergency plans discussed "Protect People before Property". Airshow incident media person introduced, incident media plan briefed.

1315: C-130 arrives over airport. Airshow director requests fly-by. Crew requests landing and static display. Staff discusses possible staging of C-130 into alternate static display site outside of spectator area. Control Tower and narrators informed to prepare to stage C-130 to alternate site.

1320: C-130 lands, taxies toward static display site with aid of many wing walkers and security personnel. Narration crew briefs spectators.

1322: C-130 turns tail to spectator/vender/sponsor area. Prop blast blows over vender tents, sponsor displays and then lifts entire 'Moon Walk" attraction completely into the air. The Air Traffic Control Tower and others call for engine shut down. The inflated castle like "Moon Walk" structure executes a 180 degree end over end roll while lower portion of structure is 10 to 15 feet above the ground and flies 75 to 100 feet laterally into asphalt parking lot. Unknown number of children fall to ground and asphalt while the structure in flight; adults and children on the ground are injured as the structure falls back to earth.

1322:30: Emergency Plan is self activated. EMS, National Guard, Army Band, security and spectator personnel begin moving to aid victims. Narration team goes into emergency routine to calm, inform, and control spectators. "Life Flight" nurses aid victims while flight crew prepare aircraft for possible transport.

1330: An altercation erupts between an airshow volunteer and a local newspaper photographer over photographing victims. Airport Manager strongly urges the photograph to remain outside of emergency area.

1340: All victims have been triaged, most have minor scrapes and bruises, several suffer major lacerations, and there is one possible serious head injury.

1350: Meeting in Airport Manager's office. Present: Airport Manager, Airport Commission Chairman, County Commissioner, primary airshow narrator. Decision is made to continue with show. Airport Manager and Commissioners briefed by narrator on media questions and techniques. Airport Commission Chairman is appointed spokesperson. Tentative press release prepared.

1410: All victims requiring transport are off the airport. Approximately 12 are transported by ambulance to the local hospital, treated and released. The possible head injury is air lifted to Charlotte Memorial Hospital and held for over night observation, released next morning. Many others with minor injuries elect to remain on site and see show. Incident scene is cleared of debris, tents re-erected, displays repaired.

1415: Airshow Starts.

1430: Major network TV station calls airport for info on "airshow plane crashing into the crowd." Airport Commission members and Manager begin calling ALL media outlets within a 100 mile radius to relate true facts of incident.

1650: Airshow completed without further incident.

2300: All area TV stations run item on 11:00 News about "freak accident" at the County Airshow. Report is factual and non sensational.

Sunday

0800: Sunday Morning Newspaper has story of incident on page 1 of the "B" section "Local News". Story is factual, non sensational, and reports that the airshow will run through that afternoon.

1100: Second day of the airshow opens with the previous days incident victims as Guests of Honor.

1400: Airshow starts and completed without incident.

Lessons Learned:

Handheld FM and VHF communications radios were useless during incidence due to frequency congestion. Everybody was talking at once.

The controlled access area for the "Life Flight" helicopter worked. The aircraft served two rolls, first as a static display and marketing tool for the hospital, second as a valuable asset during the incident.

All emergency and media plans must be discussed with all airshow participants. In an emergency, people will naturally look to the airshow performers for leadership. Make sure the performers as well as all airshow staff personnel know how to lead, follow, or get out of the way.

During this incident, the victims aided each other. This has been true in both Hugo and the SFO earthquake. This resource should not be discounted, minimized, or hindered in your emergency plan.

Someone must handle the media people during the incident, at the scene, and at the narrators station. The media people will want information. If you do not provide it, they will find a way to gather that info they feel they need. They will interfere with the narrators, EMS and other personnel's duties. This causes problems when they get in the way; or later when they fill in the gaps with vivid imaginations.

Get factual information distributed to the media outlets as quickly as possible. Media persons have radio scanners tuned to emergency dispatch frequencies. They will hear something has happened at the show site and the lack of factual information can cause a public relations nightmare.

 

COMMENTS

This incident, at a small airshow at a rural airport, demonstrates the necessity for disaster planning. The successful treatment of the injured is evidence that the emergency plans in effect worked. The professionalism of the emergency medical personnel was outstanding. The available resources were used to the maximum benefit of the victims; everyone did their job without panic or heroics. The airshow and airport management team remained in control, kept the priorities in order, and successfully managed a potentially catastrophic situation.

The major area overlooked in the emergency plan was media relations. This incident, if it had received national exposure, would have resulted in a negative blow to the airshow industry's public relations efforts. Quick thinking and reaction of the management team averted both the negative national publicity and blunted the impact on the local level.

The circumstances leading up to the incident will be subjected to investigation by numerous boards and agencies. It can be assumed that the injuries and property damage could result in litigation. But once the events began to unfold, the prior planning and professionalism of the personnel involved minimized the suffering of the victims and the possible serious consequences to the airshow industry.