PEDIATRICS Vol. 92 No. 1 July 1993, pp. 105-110
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The Avianca Plane Crash: An Emergency Medical System's Response to Pediatric Survivors of the Disaster

Robert H. van Amerongen MD1, Jeffrey S. Fine MD1, Michael G. Tunik MD1, Grace M. Young MD1, and George L. Foltin MD1

1 From the Department of Pediatrics, Division of Ambulatory and Emergency Care, New York University School of Medicine-Bellevue Hospital Center, New York, NY 10016

Objective. On January 25, 1990, a jetliner crashed on Long Island, New York. Twenty-two children survived the crash. The purpose of this study was to evaluate the emergency medical system's response to these pediatric survivors.

Methods. A questionnaire was sent to all local, acute care hospitals to determine their specific pediatric capabilities and to rank them as level I, II, or III pediatric centers; level I centers are tertiary care facilities. A second questionnaire was sent to all hospitals that received pediatric survivors to collect specific clinical information for each patient. Based on this clinical information a Pediatric Trauma Score (PTS) was assigned to each patient. Children with a PTS le8 are considered to be at increased risk of trauma-related mortality. The assigned PTS was compared to the level of the pediatric center to which each patient was transported.

Results. Of 25 children on board the plane, 22 (88%) survived the crash; of 135 adults on board, 70 (52%) survived (khgr2 = 9.9, P = .002). Seven children had a PTS le8; only 1 of these high-risk patients was transported directly to a level I pediatric center, and only 2 of the 5 high-risk children initially transported to level III facilities were transferred to higher level pediatric centers.

Conclusions. Pediatric survivors were neither adequately triaged nor transported to appropriate facilities which could optimize their care. Possible explanations for this include (1) unique features of the rescue operation, (2) limited pediatric training of prehospital personnel, and (3) deficiencies of the regional disaster plan. Emergency medical services systems and disaster plans can be made more responsive to children's needs by (1) acknowledging that children have special needs requiring referral, (2) improving the training of prehospital personnel in pediatric emergency care, (3) classifying ill and injured children according to appropriate triage criteria, (4) recognizing existing tertiary care pediatric centers as the optimal location for the treatment of critically ill and injured children, and (5) designating these centers as the appropriate transport destination for critically ill and injured children.

Key Words: disaster planning • emergency medical services • Pediatric Trauma Score • prehospital care

Submitted on May 15, 1992
Accepted on February 3, 1993




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