title: Patient distribution in a mass casualty event of an airplane crash.
abstract: BACKGROUND
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Medical Center, Trauma Unit Department of Surgery, Amsterdam, The Netherlands. Electronic address: 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; D000552:Ambulances; D004189:Disaster Planning; D004190:Disasters; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D054527:Mass Casualty Incidents; D009426:Netherlands; D010360:Patient Transfer / Q000458:organization & administration; D012189:Retrospective Studies; D014218:Triage / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality / Q000628:therapy
keywords: Airplane crash; Critical mortality rate; Disaster; ESC; Emergency Services Centre; ISS; Injury Severity Score; MCI; Mass Casualty Incident(s); Mass casualty incident; PDP; Patient Distribution Plan(s); Patient distribution