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Thesis on Medical Care Following an Airplane Crash UvA-DARE (Digital Academic Repository) Brace for impact! A thesis on medical care following an airplane crash Postma, I.L.E. Publication date 2014 Document Version Final published version Link to publication Citation for published version (APA): Postma, I. L. E. (2014). Brace for impact! A thesis on medical care following an airplane crash. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:04 Oct 2021 25-04-14 18:15 Ingri Postma Brace For Impact! For Brace A thesis on medical care following an airplane crash following A thesis on medical care Brace For Impact! A thesis on medical care following an airplane crash Ingri Postma 28993 Postma cover.indd 1 Brace For Impact! A thesis on medical care following an airplane crash Ingri Louise Esther Postma 28993 Postma V1.indd 1 01-05-14 20:30 ISBN/EAN: 978-90-6464-783-3 © 2014 Ingri Postma Een elektronisch versie van dit proefschrift is beschikbaar op de volgende websites http://www.orthopeden.org/wetenschap_en_opleiding/proefschriften http://www.annafonds.nl/pagina/Voltooide+proefschriften/1942/ http://www.trauma.nl/proefschriften/all Cover design & lay-out: Ferdinand van Nispen, Citroenvlinder-dtp.nl, Bilthoven, The Netherlands Printed by: GVO drukkers & vormgevers B.V. | Ponsen & Looijen, Ede, The Netherlands The publication of this thesis was supported by: Annafonds, AMC Graduate School, Biomet, Chipsoft, Chirurgie AMC, Depuy Synthes, Leuk Orthopedie, Medirisk, Nederlandse Orthopedische Vereniging, Nederlandse Vereniging voor Traumatologie, Neuro Orthopedisch Centrum, POCO, Schiphol Group, Stimuleringsfonds Spaarne ziekenhuis, VUMC Netwerk Acute Zorg. 28993 Postma V1.indd 2 01-05-14 20:46 Brace For Impact! A thesis on medical care following an airplane crash ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. D.C. van den Boom ten overstaan van een door het college voor promoties ingestelde commissie, in het openbaar te verdedigen in de Aula der Universiteit op vrijdag 6 juni 2014, te 11:00 uur door Ingri Louise Esther Postma geboren te Rotterdam 28993 Postma V1.indd 3 01-05-14 20:30 Promotiecommissie Promotor: Prof. dr. J.C. Goslings Co-promotores: Dr. F.W. Bloemers Dr. T.S. Bijlsma Dr. M.J. Heetveld Overige leden: Prof. dr. C. Breederveld Prof. dr. C.N. van Dijk Prof. dr. T.M. van Gulik Prof. dr. M. Maas Prof. dr. P. Patka Prof. mr. P. van Vollenhoven Faculteit der Geneeskunde 28993 Postma V1.indd 4 01-05-14 20:30 28993 Postma V1.indd 5 01-05-14 20:30 Contents List of abbreviations 8 Part 1. General Events Chapter 1 General introduction and outline of the thesis 13 Chapter 2 February 2009 airplane crash at Amsterdam Airport 19 Schiphol: An overview of injuries and patient distribution Prehosp Disaster Med. 2011 Jul-Aug;26(4):299-304. Part 2. Pre-hospital Phase Chapter 3 Mass casualty triage after an airplane crash near 33 Amsterdam Injury. 2013 Aug;44(8):1061-7. Chapter 4 Patient distribution in a mass casualty event of an 51 airplane crash Injury. 2013 Nov;44(11):1574-8 Chapter 5 Preparing for mass casualty incidents and disasters. 65 Part 1: How to determine hospitals’ critical treatment capacity Chapter 6 Preparing for mass casualty incidents and disasters. 81 Part 2: How to design a patient distribution protocol in a high risk area like an international airport Part 3. In-hospital Phase Chapter 7 Radiological work-up after mass casualty incidents: 91 are ATLS guidelines applicable? Eur Radiol (2014) 24:785-791 Chapter 8 Spinal injuries in an airplane crash. A description of 105 incidence, morphology and injury mechanism Submitted for publication Chapter 9 Delayed diagnosis of Injury in survivors of the 121 February 2009 crash of flight TK 1951 Injury. 2012 Dec;43(12):2012-7. 28993 Postma V1.indd 6 01-05-14 20:30 Part 4. The Aftermath Chapter 10 Analysis of biomechanical aspects of non-fatal 137 Injuries in a major airplane crash Submitted for publication Chapter 11 The risk of PTSD and depression after an airplane 159 crash: how is it associated to physical injury? Submitted for publication Chapter 12 Summary, general conclusions and future 175 perspectives Samenvatting en conclusies en vooruitzichten 185 Dankwoord 197 CV 200 28993 Postma V1.indd 7 01-05-14 20:30 Definitions and abbreviations Abbreviated Injury Scale: A numeric system to categorise injuries according to body region and severity. Every injury corresponds to a 6 figure number, with the last number on a scale of 1-6. A minor injury is coded with number 1, 5 is a critical injury and a 6 is lethal. Hospital Trauma Level: Hospitals are designated a trauma care level by the Dutch government, were Level I hospitals have a coordinating role in the regional trauma network. Level I hospitals are equipped with all trauma care facilities; Level II hospitals have “certain” trauma care facilities, some of which are extensive, almost to the standard of Level I hospitals; and Level-III hospitals contain basic trauma care facilities. Injury Severity Score: A score combining the 3 highest scores on the Abbreviated Injury Scale (AIS), of 3 different body regions of a patient. The squares of these 3 numbers are added to calculate the Injury Severity Score (ISS). Multiple Casualty Incident: A hazardous impact with as many casualties that the available orginazational and medical resources, or their management systems, are severely challenged. Multi Trauma patient: (Dutch: poly-traumatisée) severely injured patient with multiple injuries leading to an ISS above 16. Occupants: All people occupying the airplane. Triage Categories: In case of a mass casualty incident (MCI), casualties are triaged at the scene following the critical/ immediate (P1), serious/urgent (P2), minor/delayed (P3) triage classification according to the Triage Sieve and Sort system used by the MIMMS (Major Incident Medical Management and Support). 8 28993 Postma V1.indd 8 01-05-14 20:30 Definitions and abbreviations Abbreviations AIS: abbreviated injury scale ATLS: advanced trauma life support® CCC: critical care capacity (Dutch: kritische opvang capaciteit) CCS: casualty clearing station (Dutch: gewondennest) CHS: community health service (Dutch: GGD) C-Spine: cervical spine CST: critical stabilisation time (Dutch: kritische stabilisatie tijd) DSB: Dutch safety board (Dutch: Onderzoeksraad voor Veiligheid) ED: emergency department (Dutch: SEH) EDC: emergency department capacity (Eerste hulp capaciteit) EMS: emergency medical services (Dutch: Meldkamer ambulance diensten) FAA: Federal aviation administration FAST: focused abdominal sonography in trauma FDR: flight data recorder ICU: intensive care unit ISS: injury severity score MOTAC: medical research Turkish Airlines crash MCI: mass casualty incident MIMMS: major incident medical management and support MVA: motor vehicle accident NLDB study group: Nottingham, Leicester, Derby, Belfast study group NTSB: National transportation safety board PDC: patient distribution coordinator (Dutch: gewonden spreidingscoordinator) PDP: patient distribution protocol (Dutch: gewonden spreidingsprotocol) PSU: passenger service unit P1, 2, 3: priority 1,2,3 (triage category) (Dutch:Triage T1, T2, T3) TAC: Turkish Airlines crash 9 28993 Postma V1.indd 9 01-05-14 20:30 28993 Postma V1.indd 10 01-05-14 20:30 Part 1 General Events 28993 Postma V1.indd 11 01-05-14 20:30 28993 Postma V1.indd 12 01-05-14 20:30 Chapter 1 General introduction and aims of the thesis 28993 Postma V1.indd 13 01-05-14 20:30 Chapter 1 At 10:26 am, on February 25, 2009, a Boeing 737-800 crashed 1.5 km from the runway of Amsterdam Schiphol Airport. Because of the proximity of the motorway reports of the crash were almost instantaneous and photos and videos made by bystanders were displayed on the internet and television in several countries. While the media was busy covering the crash, telephone communication at the regional emergency services centre was overloaded. The news reached some hospitals quicker through the media and by word of mouth than through the official channels. Nine people died, and 120 were injured. Everybody can remember major disasters like the 2004 Madrid bombing, Hurricane Katrina in 2005, or the Japanese earthquake and tsunami in 2011. But besides these disasters, large scale accidents with multiple casualties happen more often. In 2013 at least 9 major railway accidents occurred in Europe, with 6 to as many as 200 injuries at a time. (1) The World Health Organization regional office for Europe reported 636 major (man-made) accidents from 1990-2012; either industrial or transport accidents. In these accidents 17,910 people died and they affected 105,865 people. (2) Since 2000, the Netherlands has had an average of 13 major incidents (involving ≥10 injured casualties) a year, with a peak of 19 accidents in 2003 and a peak of 945 people injured and 21 deaths in one incident in 2001. (3) In the Netherlands, multiple or mass casualty incidents (MCI’s) happen on a monthly basis.
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