US Airport Emergency Response Capabilities Flawed
The ABC television affiliate in Denver recently ran a “CALL7” investigative story about the fire and EMS response to Continental Airlines Flight 1404, which went off the runway and caught fire at the Denver airport in December 2008. The report says that within seconds 25 firefighters based at the airport were racing to the scene. It goes on to fault Denver Health for taking 32 minutes to get the first ambulance to the scene. The television station’s investigative reporters did a multi-part series, declaring Denver Health’s EMS system “broken.”
For sure, the city’s joint dispatch center, located 26 miles from the airport, should have reacted differently to the first call. It took 12 minutes to dispatch the first ambulance, partly due to no information about the airplane or the number of passengers on board from the airport’s 9-1-1 call, and partly due to flawed internal dispatch procedures.
Unfortunately though, the television reporters placed blame in the wrong place. Flawed Federal Aviation Administration (FAA) rules – rules that do a great job requiring the protection of property at the Nation’s primary airports while completely ignoring the protection of life – are really to blame for the delay of getting ambulances to the crash site.
Under FAA rules (download pdf), Class I airports like Denver, where aircraft of at least 200 feet in length are operating at least five departures a day, are required to have a minimum of three firefighting vehicles operating with a variety of firefighting equipment. It’s likely the public mistakenly believes that Class I airports have at least the same minimum number of ambulances on site.
The actual minimum number of ambulances required at a Class I airport: ZERO. The actual minimum number of paramedics required at a Class I airport: ZERO. The only requirement for medical staffing at a Class I airport is that only one of the firefighters staffing one of the three fire trucks is required to have the basic equivalency of a 40 hour medical responder training course; no ambulances, no paramedics.
Reality is that Denver Health actually overstaffed the Denver airport with medical personnel – two paramedics without an ambulance performing public health functions inside the terminal building. The staffing of those two paramedics at the airport by Denver Health exceeded the FAA minimum requirements by two.
The closest Class I airport to where I live is Minneapolis-St. Paul International (MSP). Like Denver, MSP is a Class I airport. The airport here is staffed with paramedics identically to Denver (two of them in the main terminal building), but at MSP the paramedics also have an ambulance to use for response to the runways.
There is a major difference between these two airports. MSP is adjacent to the City of Minneapolis, squarely inside the metropolitan area. Denver’s airport is 26 miles out of town. Should a similar event occur in Minneapolis, there are a host of ambulances in the metropolitan area 24 hours a day that can respond and be on site in well under 10 minutes. Not true in Denver.
The states are currently trying to extricate themselves from the provisions of airline deregulation which is managed by the Office of the Secretary of Transportation. Last year was the deadliest year of air ambulance crashes in the Nation’s history. It was so bad, the National Transportation Safety Board recently conducted hearings on air ambulance safety. A bill (H.R. 978) that would ensure states maintain oversight of air medical services has recently been introduced in Congress. Over 70 air medical programs, the National EMS Management Association, the National Association of State EMS Officials, the American College of Emergency Physicians, the National Association of EMS Physicians and a host of other EMS and medical groups and associations favor such state oversight and support this legislation.
The incident in Denver points to another critical area where aviation crosses medicine. The FAA would be well served to consult with another Department of Transportation entity, the National Highway Traffic Safety Administration (NHTSA), when writing rules about airport safety. Curiously, the Nation’s main federal EMS support office is located within NHTSA, which can provide the FAA with the resources it needs to update its regulations.
Congress is currently going through the process of reauthorizing the FAA. The story the TV station in Denver should have solicited is a call to action for modernization of the FAA rules surrounding the protection of life – using the opportunity of the FAA reauthorization to require at least as many ambulances dedicated to airports as there are fire trucks.
At a minimum, the FAA should adopt rules requiring two paramedics at each non-contiguous terminal that have both internal (e.g. golf cart) and external (e.g. ambulance) transport capabilities and a transportable cache of mass casualty incident equipment. The already required emergency plans should also include a component of the kinds of information that are supplied to 9-1-1 dispatchers about any request for services not based on site, including aircraft type and number of passenger seats at a minimum, followed up as soon as possible with information as to the actual number of passengers and crew on board. I am interested to hear other readers’ thoughts on the current emergency response capabilities at airports around the Nation.
I think that putting an equal number of ambulances as fire trucks at airports and could be a major cost that no one wants to pay for. I work as firefighter/paramedic for a municipality and some of the talk around nationally is decreasing services. Another issue is that in an aircraft incident you are looking at a mass casualty incident. In such an event, the first ambulance would be medical command and/or triage until a supervisor arrives. It is the second or third ambulance that starts treating and/or transporting patients. Improving the call and information process to include automatic and mutual aid agreements combined dispatch training might go alot farther. Another feather in the cap of Emergency Services at airports might be to train all firefighters to the levels of EMT and Paramedic and run specialized ALS Rescue Companies to start the process of triage and treatment while transport ambulances are coming to you.
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Airport towers have a difficult time assessing the need for emergency response and then alerting the appropriate first responders. We see this early in the sales process for our crash phone product with just about every airport that inquires.
The emergency call typically originates in the control tower, which is already spread thin keeping aircraft moving in the air and on the ground. As a result, it is tough for those not in the tower cab to know what resources are needed, as was seen in the Denver incident.
In the major airports that have on-site ambulances, they are kept busy tending to airline passengers and maintenance workers who need medical attention each and every day. It should be easy to justify the addition of at least one ambulance, crew, and supplies for this reason alone. This can be done as a partnership with the surrounding jurisdiction to divide the cost and share the availability of the ambulance between the airport and the nearby community.
The benefit of rapid response to a major incident becomes icing on the cake at that point. I suppose all it takes is money, as usual.
VoiceInterop crash phone
Gary,
Thank you for informative and a well thought out presentation of several issues regarding Denver EMS. You bring out the root of the complaints we continue to strive to try to resolve, the focus/blame/efforts are misdirected. I’m not sure we need to regulate “doing what’s right,” yet without regulatory change we, as a society don’t seem to take “right” into our own hands.
Take care,
Bob