Field Medical Response to Aircraft-Related Mass Casualty Incidents: A Narrative Scoping Review

Introduction: While statistically uncommon, aircraft-related MCIs pose a wicked challenge for disaster response systems because the sudden surge of numerous critically injured patients can quickly overwhelm local healthcare resources. Aircraft disasters present unique and specific considerations like jet fuel fires, debris, and multi-agency involvement. No study thus far has systematically examined current literature to consolidate best practices for an optimal field medical response to an aircraft-related MCI. This narrative scoping review aims to analyze lessons learned from previous incidents and exercises to guide future preparedness efforts. Methods: Following the PRISMA-ScR guidelines, the authors systematically searched PubMed and Cochrane using MeSH keywords. A total of 29 out of 518 retrieved articles were eventually included in the qualitative synthesis. Results: This review utilized the CSC-ATT/ETHANE framework advocated by Major Incident Medical Management and Support. Command and control is the most critical element to ensure coordinated responses across various agencies. In the SQ006 crash, the airport fire department was designated as the lead agency but focused solely on fire suppression and failed to establish incident command. Safety concerns include hazards like spilled aviation fuel, toxic gases, live ammunition (e.g. the Pope Air Force Base crash), and environmental factors (hypothermia, lightning, heat exhaustion). Maintaining communications can be challenging due to ambient noise and radio-traffic congestion (e.g. the 2015 TransAsia crash), worse since crash sites typically span large search areas and may have scant cellular reception. Efficient triage, treatment, and transport systems can improve outcomes for survivors, who often suffer from spinal injuries, head trauma, and extremity fractures. Conveyance with spinal immobilization should be considered, as a significant proportion (18% in the TK1951 crash) may sustain spinal injuries. Conclusion: By analyzing experiences learned from previous incidents, this scoping review provides actionable insights to better optimize the field medical response in the chaotic aftermath of an aircraft MCI.