Aircraft Disaster Readiness is traditionally considered as a preparation for a prompt reaction to an aircraft disaster situation with the purpose of saving lives.

As all emergency or disaster readiness requires planning and preparatory actions before an emergency occurs, the planning process should include attempts at prevention of the accident as well as a proper rescue plan for any airport, small or large. Further, a rehabilitation program should be included for those who subsequent to the event may suffer from physical or psychological lesions.

The exercise held at Brussels Airport was carried out by inexperienced personnel to highlight the most common errors and shortcomings of an existing disaster plan.

INCIDENT COMMUNICATION

Once an aircraft is known to be in trouble, all the nearby fire brigades are alerted by means of the unique call number 900 and move to take up their stand-by position close to the landing point. The Military Hospital is also alerted and sends out a liaison car, with a doctor among its occupants. This car joins the stand-by position. Once the aircraft has crashed, the fire engines rush to the site and all the major university hospitals and the Military Hospital are notified by the same 900-code number. Disaster teams arrive by road.

This report is almost exclusively limited to aspects of rescue, triage, on-site stabilization, and evacuation of the casualties.

In defining our terms we must ask ourselves—how many aircraft accidents occur and where do the majority of them happen?

Figure 1 shows the total number of losses to be 318 over a 25 year period, the average being around 12 per year. While 1984 was a better than average year when only 7 losses occurred.

Dangerous situations, violent incidents and accidents are part of our existence, are part of the reality and the conditions under which we exist as human beings. We can do much to limit the possibilities of accidents happening, but we cannot avoid them. It is a fact that we must ascertain and accept that accidents happen. It is not a question of “IF” but “WHEN”.

Within aviation we also have to face the fact that dangerous and stressful situations occur—and when accidents occur within the field of aviation, the consequences are often grave.

The events in Bhopal in December 1984 shook the world out of its sense of complacency about modern technology in general, and about the chemical industry in particular. This information was gathered from hundreds of interviews with doctors, Union Carbide officials, medical students, voluntary aid service workers and many others. There is a publication embargo on the medical establishment in Bhopal, but we need to plan in the light of their experience.

Most natural disasters that occur frequently may be classified into four main categories: floods, earthquakes, cyclones and famine. Other catastrophic events, such as land slides, avalanches, snow storms, fires occur at rarer occasions and threaten smaller proportions of the populated world. The destructive agents in the above categories are wind, water (a lack or excess thereof) and tectonic force. While all of these cause structural damage, their mortality and morbidity effects are varied both between them and over time. The disaster cycle can be differentiated into five main phases, extending from one disaster to the next. The phases are: the warning phase indicating the possible occurrence of a catastrophe and the threat period during which the disaster is pending; the impact phase when the disaster strikes; the emergency phase when rescue, treatment and salvage activities commence; the rehabilitation phase when essential services are provided on a temporary basis; the reconstruction phase when a permanent return to normality is achieved. The disaster-induced mortality and morbidity differ between these phases and are also a function of the prevailing health and socioeconomic conditions of the affected community. As a result of this, global statistics on disasters seem to indicate a significantly higher frequency of natural disasters in the developing countries than in the industrialized world.

The famine presently ravaging the population of the Sahel belt in Central Africa is not a new occurrence. In the last 15 years, hundreds of thousands of people have died because of malnutrition and disease, caused by the successive failure of crops. In addition to the lack of adequate rainfalls, many other factors have contributed to the present situation:

• Overgrazing of available land by increasing numbers of livestock.

• Failure of the governments involved to modernize their agriculture by irrigation programs, fertilization, etc.

• Consummation of grains for seeding and livestock by the famine stricken population—preventing rehabilitation.

The constant increase of accidental and selfpoisoning has become one of the most important problems of clinical practice and the institution of specialized centers for the care and prevention of these cases has become necessary.

The problems of providing information for clinical, diagnostic, and therapeutic uses are several:

— the number of data required to identify a poison

— the synonyms of generic products and commercial preparations

— the need for a data bank with continuous updating

— the need to provide the information in real time

The use of a computer in an anti-poison center has been potentially rewarding for solving these problems.

In Emergency Medicine the need for information is vital.

Our experience is mainly concentrated in the use of computers in the Intensive Care Unit (ICU), the Laboratory and the Anti-Poison Center. We have gained experience with several different types of computers: Personal computers, interfaced with analytical instruments and equipped for graphic representation, have been used in the ICU and the Laboratory. In the Anti-Poison Center terminals connected to a main frame with virtually an unlimited memory and capacity allows the storage of a large amount of data and the performance of complex permutations.