In 2009, a commercial airplane crashed near Amsterdam. This longitudinal study aims to investigate (1) the proportion of survivors of the airplane crash showing a probable posttraumatic stress disorders (PTSD) or depressive disorder, and (2) whether symptoms of PTSD and depression were predicted by trauma characteristics. Identifying these trauma characteristics is crucial for early detection and treatment. Of the 121 adult survivors, 82 participated in this study 2 months after the crash and 76 participated 9 months after the crash. Risk for PTSD and depression was measured with the self-report instruments Trauma Screening Questionnaire and Patient Health Questionnaire-2. Trauma characteristics assessed were Injury Severity Score (ISS), hospitalisation, length of hospital stay, and seating position in the plane. Two months after the crash, 32 participants (of N=70, 46%) were at risk for PTSD and 28 (of N=80, 32%) were at risk for depression. Nine months after the crash, 35 participants (of N=75, 47%) were at risk for PTSD and 24 (of N=76, 35%) were at risk for depression. There was a moderate correlation between length of hospital stay and symptoms of PTSD and depression 9 months after the crash (r=.33 and r=.45, respectively). There were no differences in seating position between participants at high risk vs. participants at low risk for PTSD or depression. Mixed design ANOVAs showed also no association between the course of symptoms of PTSD and depression 2 and 9 months after the crash and ISS or hospitalisation. This suggests that health care providers need to be aware that survivors may be at risk for PTSD or depression, regardless of the objective severity of their physical injuries.

OBJECTIVES:In mass casualty incidents (MCI) a large number of patients need to be evaluated and treated fast. Well-designed radiological guidelines can save lives. The purpose of this study was to evaluate the Advanced Trauma Life Support (ATLS) radiological guidelines in the MCI of an aeroplane crash.METHODS:Medical data of all 126 survivors of an aeroplane crash were analysed. Data included type and body region of the radiological studies performed on the survivors, Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) codes and trauma care level of the hospitals.RESULTS:Ninety patients (72 %) underwent one or more imaging studies: in total 297 radiographs, 148 CTs and 18 ultrasounds were performed. Only 18 % received diagnostic imaging of all four body regions as recommended by ATLS. Compliance with ATLS was highest (73.3 %) in severely injured victims (ISS ≥16); this group underwent two thirds of the (near) total body CTs, all performed in level I trauma centres.CONCLUSION:Overall compliance with ATLS radiological guidelines was low, although high in severely injured patients. Level I trauma centres frequently used (near) total body CT. Deviation from ATLS guidelines in radiological work-up in less severely injured patients can be safe and did not result in delayed diagnosis of serious injury.KEY POINTS:• Radiological imaging protocols can assist the management of mass casualty incidents needs. • Advanced Trauma Life Support (ATLS) radiological guidelines have been developed. • But radiological guidelines have not frequently been applied in aeroplane crashes. • Aircraft accidents are of high energy so ATLS guidelines should be applied. • Following mass casualty incidents total body CT seems appropriate within ATLS protocols.

IntroductionTriage is an important aspect of the management of mass casualty incidents. This study describes the triage after the Turkish Airlines Crash near Amsterdam in 2009. The results of the triage and the injuries of P3 casualties were evaluated. In addition, the role of the trauma mechanism and its effect on spinal immobilisation during transport was analysed.MethodsRetrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash. Outcomes were triage classification, type of injury, AIS, ISS, emergency interventions and the spinal immobilisation during transport.ResultsA minimal documentation of prehospital triage was found, and no exact numbers could be recollected. During inhospital triage 28% was triaged as P1, 10% had an ISS ≥ 16 and 3% met the modified Baxt criteria for emergency intervention. 40% was triaged P3, 72% had an ISS ≤ 8 and 63% was discharged from the Emergency Department after evaluation. In hospital over-triage was up to 89%. Critical mortality rate was 0%. Nine per cent of P3 casualties and 17% of ‘walking’ casualties had serious injuries. Twenty-two per cent of all casualties was transported with spinal immobilisation. Of the casualties diagnosed with spinal injury 22% was not transported with spinal immobilisation.ConclusionAfter the Turkish Airlines Crash documentation of prehospital triage was minimal. According to the Baxt criteria the overtriage was high. Injuries sustained by plane crash survivors that seem minimally harmed must not be underestimated. Considering the high energy trauma mechanism, too little consideration was given to spinal immobilisation during transport.

Introduction: Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam.Methods: Analysis of the patient distribution of 126 surviving casualties of the crash by collecting data on medical treatment capacity, number of patients received per hospital, triage classification, Injury Severity Score (ISS), secondary transfers, distance from the crash site, and the critical mortality rate.Results: The PDP holds ambiguous definitions of medical treatment capacity and was not followed. There were 14 receiving hospitals (distance from crash: 5.8-53.5 km); four hospitals received 133-213% of their treatment capacity, and 5 hospitals received 1 patient. Three hospitals within 20 km of the crash did not receive any casualties. Level I trauma centres received 89% of the 'critical' casualties and 92% of the casualties with ISS >= 16. Only 3 casualties were secondarily transferred, and no casualties died in, or on the way to hospital (critical mortality rate = 0%).Conclusion: Patient distribution worked out well after the crash as secondary transfers were low and critical mortality rate was zero. However, the regional PDP was not followed in this MCI and casualties were unevenly distributed among hospitals. The PDP is indistinctive, and should be updated in cooperation between Emergency Services, surrounding hospitals, and Schiphol International Airport as a high risk area. (C) 2013 Elsevier Ltd. All rights reserved.

Na de crash van Turkish Airlines in 2009 is het grootschalige hulpverleningsproces door meerdere instanties geëvalueerd. Hierbij zijn verschillende problemen in communicatie, werkprocessen en protocollen aan het licht gekomen. Triagekaarten zijn nauwelijks gebruikt en de gewondenspreiding verliep niet volgens plan. Er waren negen doden, allemaal overleden op de ongevallocatie, en 120 gewonden, die zijn behandeld in vijftien verschillende ziekenhuizen. Zesenzestig slachtoffers werden opgenomen in het ziekenhuis en er werden meer dan 80 operaties uitgevoerd. Er wordt nog nader onderzoek gedaan naar de letsels, zoals de vele hoofdletsels en wervelfracturen, om in de toekomst letsel bij slachtoffers van een vliegtuigongeval te voorkomen.

Introduction On 25th February 2009, a Boeing 737 crashed nearby Amsterdam, leaving 126 victims. In trauma patients, some injuries initially escape detection. The aim of this study was to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the tertiary survey on the victims of a plane crash, and the effect of ATLS® implementation on DDI incidence. Patients and methods Data from all victims were analysed with respect to hospitalisation, DDI, tertiary survey, ISS, Glasgow Coma Score (GCS), injuries (number and type) and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. The data were compared to a plane crash in the UK (1989), which occurred before ATLS® became widely practiced. Results All 126 victims of the Dutch crash were evaluated in a hospital; 66 were hospitalised with a total of 171 clinically significant injuries. Twelve (7%) clinically significant DDIs were found in 8 patients (12%). In 65% of all patients, a tertiary survey was documented.The incidence of DDI in patients with an ISS ≥16 (n=13) was 23%, vs. 9% in patients with ISS <16. Patients with >5 injuries had a DDI incidence of 25%, vs. 12% in patients with ≤5 injuries. Head injury patients had a DDI incidence of 19%, patients without head injury 10%. Fifty percent of patients who needed an emergency intervention (n=4) had a DDI; 3% of patients who did not need emergency intervention.Eighty-one survivors of the UK crash had a total of 332 injuries. DDIs were found in 30.9% of the patients. Of all injuries 9.6% was a DDI. The incidence of DDI in patients with >5 injuries was 5%, vs. 8% in those with ≤5 injuries. Conclusion DDI in trauma still happen. In this study the incidence was 7% of the injuries in 12% of the population. In one third of the patients no tertiary survey was documented. A high ISS, head injury, more than 5 injuries and an emergency intervention were associated with DDI. The DDI incidence in our study was lower than in victims of a previous plane crash prior to ATLS implementation.

Abstract Objective: The objective of this study was to describe the injuries and distribution of casualties resulting from the crash of Turkish Airlines flight TK 1951 near Schiphol Airport in the Netherlands on 25 of February 2009. Methods: This was a retrospective, descriptive study. Based on a review of the hospital records for all casualties of the airplane crash, triage at the scene, time to emergency department, Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), mortality, length of hospital stay and surgical procedures were abstracted. Results: Of the 135 passengers, nine died on-scene. A total of 126 survivors were examined in 15 hospitals; data for all survivors were available for the study. Median time between crash and arrival at an emergency department was 3.5 hours (range 1.25-5.5 hours). Six passengers were uninjured and 66 were admitted to hospital. A total of 305 injuries were recorded. The majority were head and facial injuries (92), spinal injuries (35), and fractures of extremities (38). Eighteen percent of the patients had a spinal injury. The mean ISS was 6.3 (range = 1–57). The ISS score was >15 for 13 patients. Surgical procedures (80) were necessary in 23 patients. There was no in-hospital mortality. Conclusions: Although the accident was in an urban area, there was a significant delay between the time of the accident and the arrival of the casualties at hospital emergency departments. The Turkish Airlines crash provides extensive information for research into mass-casualty or disaster management, triage, plane crash injuries, and survivability. The “Medical Research Turkish Airlines Crash” (MOTAC) study group currently is investigating several of these issues.

IntroductionTriage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?MethodsA retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.ResultsThere was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.ConclusionsAfter the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.

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BackgroundDifficulties have been reported in patient distribution during mass-casualty incidents (MCIs). In this retrospective, descriptive study, the regional Patient Distribution Protocol (PDP) and the management of the patient distribution after the Turkish Airlines airplane crash on 25 February 2009 near Schiphol Airport in Amsterdam were analyzed.MethodsAnalysis of the of PDP involving the 126 surviving victims of the crash, by collecting data on Medical Treatment Capacity (MTC), number of patients received per hospital, triage classification, Injury Severity Scale (ISS) score, secondary transfers, distance from the crash site, and critical mortality rate.ResultsThe PDP holds two inconsistent definitions of MTC. The PDP was not followed. Four hospitals received 133–213% of their MTC, and five hospitals received one patient. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); thre hospitals within 20 km of the crash did not receive any patients. Major trauma centers received 89% of the “critical” casualties and 92% of the casualties with ISS score ≥ 16. They also received 10% of “minor” casualties and 29% of casualties with ISS score < 8. Only three patients were secondarily transferred, and no casualties died in, or on the way to, the hospital (critical mortality rate = 0%).ConclusionsPatient distribution was effective, as secondary transfers were low, and the critical mortality rate was zero. The regional PDP could not be followed during this MCI. Uneven casualty distribution was seen in the hospitals. The regional PDP is inconsistent, and should be updated in a new cooperation between Emergency Services, surrounding hospitals and vSchiphol Airport, a high risk area, for which area-specific PDPs must be designed.