title: Mass casualty triage after an airplane crash near Amsterdam.
abstract: BACKGROUND
  Triage 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.
  
  
  METHODS
  Retrospective 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  After 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.
authors.affiliation: Academic Medical Centre, Trauma Unit Department of Surgery, Amsterdam, The Netherlands. i.l.postma@amc.nl
authors.forename: Ingri L E
authors.initials: IL
authors.lastname: Postma
authors.forename: Hanneke
authors.initials: H
authors.lastname: Weel
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heetveld
authors.forename: Ineke
authors.initials: I
authors.lastname: van der Zande
authors.forename: Taco S
authors.initials: TS
authors.lastname: Bijlsma
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000401:Aircraft; D004282:Documentation / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007103:Immobilization / Q000379:methods / Q000592:standards; D015601:Injury Severity Score; D054527:Mass Casualty Incidents; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000628:therapy; D014218:Triage / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality / Q000628:therapy*