Kozhikode crash co-pilot couldn't be saved due to shockingly inept emergency response

Thirty-two-year-old Akhilesh Kumar was rushed to a hospital 25 km away, which is an hour's drive, on the backseat of a private car

Kozhikode crash co-pilot couldn't be saved due to shockingly inept emergency response
The crashed Air India Express Flight IX-1344. Image courtesy: Twitter/@akshay_rudhan

The crash of an Asiana Airlines Boeing 777 on July 6, 2013, in San Francisco killed three and injured more than 180 people. The first police and fire personnel arrived at the crash scene in about two minutes and local officials said brave rescue efforts and effective triage of the many wounded are likely to have saved lives. 

A stark contrast was the Air India Express Flight IX-1344 accident at the Calicut airport on August 7, 2020, in which the aircraft plunged 35 metres, killing 21 people, including the pilots. The Dubai to Kozhikode Vande Bharat Mission (VBM) flight skidded off the tabletop runway and slid down a slope. 

The victims were transported to various hospitals in ambulances and private vehicles. While ambulances are equipped with life-saving medical equipment, the co-pilot, 32-year-old Akhilesh Kumar, was put on the backseat of a car and rushed to a hospital 25 km away, which is an hour's drive, thereby depriving him of the critical life-saving equipment. 

While it was apparently a helping gesture, whoever decided to mete out this inhumane treatment to the co-pilot contributed to the demise of the young pilot. The airport emergency response plan, which is mandatory and is rehearsed periodically, failed miserably. A separate investigation to determine the effectiveness of the Airport and Airline Emergency Response Plan is also required to save lives in the future.

The probable route to the hospital

The site of an aircraft accident is quite chaotic with multiple agencies rushing in to perform rescue and firefighting services. Emergency Medical Service (EMS) providers arrive on the scene of a Mass Casualty Incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group. Tagged patients arrive at the hospital and are assessed and treated according to their priority.

Triage

Triage is an inherent part of mass casualty response that prioritises patients and the care they should receive based on the number and type of casualties and resources available. Triage is dynamic and ongoing, and not a discrete activity. The thoroughness of patient assessment will vary based on scene safety, the number of patients, personnel available to participate in the triage process and other factors. Having scalable and flexible triage protocols allows emergency medical service providers to respond to any kind of incident.

Also read: India’s air safety incidents surged 150% during Covid-19 year

Triage depends on the service provider’s assessment and interpretation of the patient’s prognosis based on that assessment, that is what care the patient needs and his estimated likelihood of survival and what is required to deliver that care in terms of

Time – How much time is required to provide the intervention and how quickly does the intervention need to be initiated to be effective?

Treater – How much expertise is the healthcare provider required to possess?

Treatment – How many resources are required to achieve the desired outcome?

The Dutch emergency response plan, according to which the Turkish Air accident at Amsterdam's Schipol Airport was handled, lists out the following medical and equipment requirement:

The first report of the Turkish Airlines crash came into the Emergency Services Centre (ESC) one minute after the accident at 10.27 am. Eighty-two ambulances from different regions were dispatched, as were medical officers and three Helicopter Emergency Medical Service teams. 

Response time at Calicut

The location of the air traffic control tower at Calicut is towards the approach end of where the ill-fated aircraft arrived and at some distance from the crash site. The height of the control tower is lower than usual since the runway is higher than the apron where the tower is constructed. It is highly unlikely that the air traffic controllers would have noticed that the aircraft had met with an accident on that rainy night.

The airport rescue and firefighting services are expected to reach the accident site within three minutes of receiving an alert. The rescue services probably reached between 12-15 minutes after being informed. 

Also read: Aviation deaths increase in 2020 even as fatal incidents, flights fall

Since the air traffic controllers did not have a direct view of the crash site, they would have been informed by the security guards at the airport perimeter via their reporting chain. The time taken for the airport rescue and firefighting services to reach the accident site could have been as much as 30 minutes from the time of the accident. This is owing to the probability that the fire tenders rushed to the far end of the runway where they expected the aircraft to be located. However, the aircraft had slid down and there was no direct access. The fire tenders would have had to rush back to where they started and take the perimeter road to the accident site.

The probable route followed by airport rescue and firefighting services

The local fire tenders were seen in media footage spraying water on the aircraft fuselage whereas foam is the recommended fire retardant agent for aircraft accidents. This is proof that the local rescue and firefighting services were active before the airport's emergency response was activated.

The triage was in all probability not implemented and the co-pilot, unfortunately, was put in the backseat of the private car by people who were not aware of segregation of casualties based on their medical status. 

The Air India Express co-pilot being brought to the hospital. Image courtesy: Manorama News

A precious life that could have been saved by providing timely medical intervention was lost due to negligence.

Philadelphia scoop and run

Philadelphia in the US has a high number of gunshot victims every year and a number of them are saved by police officers transporting the victims in the backseat of their cars. 

According to some trauma doctors, the lack of medical intervention that victims receive during the typical scoop and run is part of what makes the practice beneficial. Advanced procedures like breathing tubes and Intravenous (IV) fluids, while helpful for certain kinds of patients, may actually do more harm than good for shooting and stabbing victims in urban areas. 

"I’d love to debunk the myth that you need a person on the scene who has all this advanced medical training and that is going to make the difference for this specific kind of injury," says Dr Elliott Haut, a Johns Hopkins trauma surgeon. For a presentation he gives at conferences, he shows a slide that asks what is the best fluid to give victims of penetrating trauma. Then he clicks to the next slide, which reads "diesel fuel". Haut says, "Yes, you’re going to get less medical care on the street and in the back of the car, but I’m OK with that because the shorter time is going to make a difference."

This works when the time taken to drive to the medical care centre from the accident site is not more than four minutes. Not an hour's drive as was the case of the Air India Express co-pilot.

(This article first appeared in avobanter.com)