Medico-tactical characteristic of transport catastrophes.

THE PLAN OF LECTURE

1. Aviation accidents.

2. Road-transport accidents.

3. Accident on river and sea transport.

4. Railway accidents.

1. Aviation accidents.

The transportation of the passengers and cargoes by air (planes and helicopters) have got vast scales in all advanced countries, including Ukraine. The failures and accidents may occur, since the moment of start of engines, and then at a take-off and landing strip, on the take-off, during flight and at landing, right up to shutting down. The world statistics testifies that almost half of failures and accidents occurs on an airfield and half in air at various heights of flight of the flying device, quite often above sparsely populated (almost inaccessible) territory or above a water surface. From the point of view of number of injured at air accidents, a principle "all or nothing" works here.

In connection with that the number of the passengers placed in the modern plane, considerably has increased, the number of victims of air accidents has increased also. The fall of the flying vehicle, which has suffered failure, can be the reason of victims both on its board, and on ground (at the falling down on the inhabited buildings), can result in destruction of industrial buildings and infringement of productions. The falling of planes on APS and objects of a chemical industry is especially dangerous, because the outflow of RS and HATA is possible. Hence, the air accident can be aggravated by accident on ground.

The civil aircrafts are maintained in the extremely intense mode, frequently even over the term, stipulated by a construction, and on a number of airlines the planes work in extreme conditions.

The cases of terrorism on airlines – the explosions of bombs in planes, their stealing is frequent.

According to calculations the number of the passengers transported by planes all over the world will be doubled by the year 2000 and will make more than 2 billion people. In the same proportion, as it is supposed, the number of incidents will be increased. It is strange, but the planes represent smaller danger, than other types of transport.

Probability to be lost in result of the air accident has made 1 person per every 500 thousand passengers. Really, for last 20 years this number changed from 1:500 000 to 1:250 000. If we compare these figures to car accidents, the number of deaths per 1000000 passenger-miles on a car is 30 times higher, than on air transport. It does not mean, that the airflights could be safer. Many steps directed on reduction of number of failures, caused by weather conditions or mistake of the man, and also modernization of the airports, the application of computers and other newest means is carried out constantly, however, there are factors constraining this process.

The major step on a way to increase of safety of flights is made in struggle with such severe phenomenon, as a vertical gradient of a wind, which represents sharp vertical moving of air weights, which speed reaches 80 km/h and more. This phenomenon especially is dangerous at take-off and landing of the plane and frequently it is the reason of destruction of the plane. In this connection a number of large American firms, such as «Honawail», «Sunstraid», «Safe Flight Instrument» have produced experimental groups of devices, which signal about hit of the plane in a zone of a vertical gradient of a wind. The pilot who has received a hit signal in a dangerous zone have only some seconds for acceptance of the decision, but it is enough for the experienced pilot to rescue the plane.

In USA the newest monitoring system of passenger luggage is created, in which the basic principle is the thermal neutron irradiation. The system reacts to presence of explosive substances at luggage.

Table 5. Major factors - sources of failures on airlines:

The reasons of failure Share of the factors in %

Mistake of the man (pilot, dispatcher, members of crew) 67

Weather (thunder-storm, icing, fog, gradient of a wind) 12

Sabotage and military actions 11

Maintenance service 7

Malfunction of construction’s elements 3

The main kinds of affections in passengers and crew are the trauma and thermal burns, less often - oxygen starvation due to the depressurising of a cockpit or passengers saloon. The traumas may be complicated by burns.

The sizes of sanitary losses can reach 80-90 % of general number of the people which are taking place on an air vehicle. The maximum number of victims may reach: on the plane АN-2 - 12 men, АN-24 - 47 men, Yak-42 - 113 men, ТU-154 - 168 men, IL-86 - 324 men. Among injured persons the people with mechanical damages can make 90 %, including in a condition of a shock - 10 %, with a cranial-brain trauma - 40 %, in 10-20 % the combined trauma and burns may occur. About half of injured can have a heavy and heaviest degree of a trauma. Accordingly to the received trauma about 40% of the victims will need in dressing wounds, 50-60% - injections of anesthetics, 35% - immobilization of fractures and 60-80% - evacuation on stretchers and boards.

The organization of urgent medical aid during air accidents.

At the catastrophe of the flying vehicle in territory of the airport the alarm is lifted by a dispatching service. The attendant on communication transfers a signal of an alarm to UMA station of the city and in medical establishment of the airport. The medical teams of UMA arrive to the airport medical center by machines of UMA, which becomes the medical reception center. The movement of any sanitary machine with the medical personnel to the crashed plane (helicopter) is authorized only by person answering for a movement of transport. The first medical is rendered to the victims on a place of accident. The sorting of them is made according to the severity of condition. Thus the persons in a condition, menacing to life, and with heavy injuries are evacuated to a first-aid post of the airport. The medical teams of UMA evacuate passengers of the average degree of severity on stretchers or in a sitting position in the second turn by the ambulances. Lightly injured are evacuated to a first-aid post independently or in the car in sitting position. At the first-aid post of the airport (or on a platform near it) the medical team of UMA will examine the patients, allocate from them numbers of the persons requiring urgent measures of the first medical aid, will carry out such measures, register the patients and define the sequence of their evacuation to the medical establishments. The evacuation of injured to medical establishments is carried out by sanitary transport (in laying or sitting position), thus the support of the medical stuff (doctor, medical assistant, nurse) is necessary. The rendering of the medical help if necessary proceeds on the way, the intensive therapy is carried out. In case of accompanying the patients by the middle medical stuff, it receives the instructions from the doctor of their team. The speed of a movement of the machine depends on a condition of injured. The basic accompanying documents are the primary medical cards of patients and general list of the patients (evacuation passport). At once after the delivery of injured in medical establishment the UMA machine comes back to a first-aid post of the airport.

At air accident outside of a zone of the airport the organization of UMA for injured in many aspects depends on local conditions. However in all cases after rendering the first medical help to injured they are transferred to the places of gathering, stay in which should exclude the repeated influence of the affecting factors, for example the explosion of the plane, fire, outflow of fuel etc. The places of the gathering of injured are defined according to an entrance of transport and conditions for work of medical teams of UMA.

The principles of rendering of the medical help, the medical-evacuation maintenance remain the same in airport area as at air accidents.

The survival of the passengers and the crew at the air accident which has occurred over the little populated territory or above the water surface, in many aspects depends from the experience of crew in such situations, speed of search and correct organization of rescue work. In deserted districts the environment frequently becomes a source of danger for life (absence of water, food, cold, heat etc.).

At the forced landing the crew should inform the passengers about it and recommend to take a proper pose in an armchair, require to fasten seat belts, remove artificial appliances from a mouth cavity, to untie a tie, to take off shoes on a high heel etc. In such conditions it is very important not to allow panic among the passengers, that should be done with quiet and precise information outgoing from the members of crew. At once after the forced landing the crew must quickly (for 1,5-3 min) evacuate the passengers, take out injured, using exit doors and emergency hatches. If possible, it is necessary to take out food products, water, medicines and emergency radio station. In connection with possibility of explosion and fire the passengers should be removed from the crashed airplane to the safe distance.

To preserve the life of the passengers in conditions of independent existence the pilot stuff should undergo regular training beforehand.