Medical Disaster Management at Frankfurt Airport

Transcription

1 Medical Disaster Management at Frankfurt Airport (Strategies and Concepts in Case of a Major Number of Injured Persons or Imported Infectious Diseases) W. Gaber, Director of Medical Services, Fraport AG, Frankfurt Airport Published in NOTFALLMEDIZIN 2003; 29 1

2 Fraport AG, the operator of Frankfurt Airport, is well prepared in regard to medical treatment in case of a disaster or emergency event. Nonetheless, all responsible persons (government agencies, politicians, cities and communities) must know that Fraport or the Fire Control Center or another medical organization could not handle a disaster (airplane crash with 100 seriously injured persons) on their own. The politicians must ensure mutual training and cooperation and see to it that there is an end to reducing staff and transportation capacities. The surrounding cities and communities must realistically deal with the possibility of a disaster. This calls for preparation of disaster plans, exercises and continuous review or updating of the plans. All national and international airports are subject to national (Frankfurt: certification by the State of Hesse Ministry of Economy, Transportation and Urban and Regional Development) and international (ICAO International Civil Aviation Organization) requirements, regulations and laws in regard to personnel and equipment that must be on hand. The national and international requirements (ICAO) do not amount to much more than having some Band-Aids or bandages at the airport and a physician on call. The responsibility for the Frankfurt region is in the hands of the Fire Control Center Frankfurt/Main. Specific Considerations at a Big International Airport Fraport AG (previously Flughafen Frankfurt Main AG) is generally required to observe regulations and requirements of the government authorities in regard to emergency events. Consequently, Fraport must be prepared and organize medical staff and equipment to deal with emergencies. The actual responsibility for rescue and emergency physician services is in the hands of the Fire Control Center Frankfurt/Main. Fraport AG has independently organized qualified chief emergency physicians and chief paramedics with the necessary medical equipment for major disasters. At Fraport, all doctors in the Airport Clinic are qualified as chief emergency physicians. All paramedics are or will be qualified as chief paramedics in The objective is to make these emergency physicians and paramedics available to the authorities in Frankfurt and the State of Hesse. Once being transferred in case of an emergency to the authorities, these colleagues will be able to assist emergency management in handling a disaster. Rescue services at Fraport operate in 3 shifts and are equipped with ambulances (all equipped as emergency physician vehicles according to DIN standards). One to eight emergency physicians can be contacted via Swissphone immediately during regular working hours and would rush to the airport. Further physicians would also be on hand as a result of the cooperation with the medical services of Lufthansa, Federal Border Police and the US Airforce. Since 2

3 2001, a so-called disaster truck is available which contains medical material and supplies for 180 patients, two tents with an independent power unit for lights. 1. Medical Services Figure 4: Emergency rescue vehicle of Fraport AG Fraport AG has developed an extensive program for best medical treatment of our patients and offers a complete package in the sectors emergency treatment, rescue services and industrial medicine. Fraport s Medical Services are recognized nationally and internationally as state-ofthe-art in the sector Medical Consulting including Medical Disaster Management and Training at major airports (Lima, Manila, Antalya, Vienna among others). Further training and participation as speakers at international and national conventions or workshops, for example at the European Union level, are a top priority of Medical Services at Frankfurt Airport. The medical team of Fraport is an integrated part of the State of Hesse Ministry of the Interior and the State of Hesse Medical Association when it comes to disaster planning. 3

4 Clinic for Emergencies The emergency clinic at the Airport Clinic is contacted daily around the clock for all emergency cases that occur between heaven and earth. The clinic ensures first aid, sends out ambulances and emergency rescue vehicles thus providing immediate medical care for passengers on the ground and in the air. Care is provided likewise for airport employees that become ill or have an accident on the job. At the emergency clinic ( Airport Clinic ) up to 36,000 patients are treated yearly (365 days a year and 24 hours a day).three full time emergency doctors and 14 external specialists (all with the additional qualification chief emergency physician) work together with a team of 10 nurses and medical assistants to ensure emergency services around the clock. Figure 1:Intensive care unit and quarantine area 4

5 Figure 2 Rescue Team The work and responsibilities of the emergency clinic include: General and emergency medical care for all Fraport and airline employees. General and emergency medical care for all passengers, visitors, cargo workers, employees and guests of the hotels. Emergency medical care for Frankfurt Airport location and upon request for neighboring communities, highways, US airbase and the city of Frankfurt. Supervision of the hygiene and sanitary regulations including prevention of epidemics. The emergency clinic is a branch of the City of Frankfurt Health Services and all doctors at the clinic are authorized to act as official health services doctors at the airport. 5

6 Inoculations and inoculation information officially registered clinic with permission to give yellow fever inoculations. Medical tests and examinations upon request of the government authorities (e.g. police, Federal Border Police, customs), airlines, special tests (e.g. divers). Medical and emergency care for persons seeking asylum. Organization of catastrophe prevention. The following facilities are available: X-ray area (figure 1) and shock room, two operation units (figure 2) as well as treatment compartments (e.g. for the eyes), quarantine area with resting area, external lab possibilities. Rescue Services The Rescue Services of Fraport AG do not only service the airport grounds but also the surrounding highways and communities upon request of the responsible emergency and rescue management centers. The Rescue Services team (including personnel for the transportation of persons with a disability) has more than 30 rescue specialists and assistants who operate around the clock in 3 shifts. Most all of the rescue services personnel are also qualified as emergency organization managers and thus, in case of an emergency event, make up the technical operations control team (TEL) together with the chief emergency physician and technical operations manager. With average arrival times (arrival of rescue personnel at location of patient) of only four minutes the rescue services stay far below the required arrival time of maximum ten minutes. 6

7 Figure 5: Rescue vehicle with trailer equipped with special equipment The motor pool of rescue services consists of six rescue vehicles which are all equipped as emergency doctor vehicles. Furthermore, rescue services has several more vehicles, for example a low lift platform truck or the vehicle for the rescue chief. In case of major emergencies a rescue vehicle equipped with special equipment is available to help prevent catastrophes. The equipment in this vehicle is sufficient to handle and treat approximately 50 to 100 injured or sick persons. In 2000, the rescue services recorded a total of 22,450 rescue operations which included the transportation of 12,000 persons and 740 rescue missions of the emergency doctor. Danger of Infectious Diseases A major airport having the size of Frankfurt Airport can easily be the entrance door for infectious diseases of any kind. Known infectious diseases (e.g. measles, chicken pox, German measles, polio, cholera, meningitis, SARS etc.) can quickly become a problem for an airport. For example, the spread of measles among asylum seekers from countries in which measles hardly ever occur may lead to major medical problems. One must still expect epidemics even in the age of inoculations. More and more people also simply no longer bother to get proper inoculations (spread of measles in Italy). 7

8 Highly contagious and life-threatening diseases can be a major problem. We are also talking about viruses that can cause hemorrhage fevers (Ebola, Lassa, Marburg, Krim-Kongo etc.) as well as pneumonic plague and infections by orthopox viruses. All these infections are past on from person to person and have a high mortality rate. It is decisive to quickly take all necessary measures once making the suspected diagnosis in order to initiate competent management of the life-threatening infectious diseases. Who suspects such an infectious disease? If there is a doctor on board he or she communicates the first suspicion. Should a doctor not be on board then the crew informs the captain who then informs the ground station. The ground station ensures that the aircraft is parked at a more distant parking position and that nobody leaves the aircraft. The airline will have contacted the doctor on duty at Medical Services. What does the doctor on duty at Medical Services do? After checking the situation on site (self-protection by wearing protective suits) and making the suspected diagnosis the aircraft is put under quarantine. The City of Frankfurt Health Services and the emergency unit at the University of Frankfurt Hospital (infection ward and possibly intensive care unit) are informed and the management center of the City of Frankfurt Health Services will take charge. All persons having contact with the sick person(s) will be determined and registered. All medical care and measures will be closely coordinated the City of Frankfurt Health Services who are in charge of determining and supervising the extent of ordered disease prevention and hygienic measures. As soon as the isolation ward has been set up in the clinic, the sick person(s) will be transported by special transport. For this a special vehicle of the City of Frankfurt Fire Department with trained personnel is available with specific protective equipment (mouth and eye protection, gloves, protective suits etc.). Following transportation the required disinfection will be done. This is the ideal case or procedure (aircraft parks at a distant parking position, nobody leaves the aircraft, sick person(s) and contact persons are transported directly to the clinics). What if sick persons have already left the aircraft? If sick persons walk into the emergency room at the Airport Clinic or have been taken there the quarantine unit of Medical Services is activated. Here infected persons can be serviced under optimized and protective conditions until suitable transport is organized. Unfortunately, it is not always possible to catch sick persons at the beginning stage of the disease they got infected with and provide immediate medical care. Passengers despite not reporting to the Airport Clinic although being sick can leave the airport and report to a hospital in their hometown (such cases have happened, e.g. Lassa 8

9 fever). It is thus very important to follow the route of the sick person(s) to find all conceivable contact persons and implement far-reaching disinfection measures. Frankfurt Airport is equipped for handling highly infectious diseases. In the age of globalization one must, however, always expect new infectious diseases which will no longer be simply viewed as a regional problem in a far away foreign location. Frankfurt Airport and Frankfurt City Health Services are ready to meet the challenge and will react the best possible way. Major Number of Injured Persons Is Fraport sufficiently prepared in the eyes of the fire department and rescue services? In cooperation with authorities and cooperation partners, Fraport set up emergency event guidelines and regulations (BANOT) which take different disaster and emergency situations into consideration. Furthermore, we have qualified medical staff and high tech medical equipment near or at the location of the fire department and rescue services. Are there catastrophe prevention plans? The emergency event guidelines and regulations (BANOT) must be observed by Fraport and all companies and airlines located at the airport. Off airport grounds the communities and cities are responsible. What happens if a big airplane crashes into Terminal 1 or Terminal 2? Here the emergency event guidelines and regulations (BANOT) apply. This means there will be a major alarm for surrounding communities and medical staff. The emergency management would be the responsibility of the Fire Control Center in Frankfurt. What happens if a big airplane crashes on the Autobahn? The responsibility for emergency measures is in the hands of the community or city (Frankfurt, Offenbach, Mainz, etc.). Fraport will always be of assistance with its available resources. Considering the different scenarios inside airport grounds and also outside the responsibility areas of Fraport, some questions must be posed to the responsible persons? 1. Are there agreements as to assisting one another? 2. Are scenarios practiced continuously and with all participants? 3. Are exercises conducted regularly? 4. Are these exercises evaluated by all participants? 5. Is there a higher-ranking government agency that coordinates everything? Considering the variety of given responsibilities at the political and local community levels it must be allowed to ask the question about a high-ranking and coordinating 9

10 office or agency that can disregard any vanity or egotistic thinking in the case of a disaster. The patient must be the first and only concern. Summary: Fraport AG, the operator of Frankfurt Airport, is well prepared in regard to medical treatment in case of a disaster or emergency event. Nonetheless, all responsible persons (government agencies, politicians, cities and communities) must know that Fraport or the Fire Control Center or another medical organization could not handle a disaster (airplane crash with 100 seriously injured persons) on their own. The politicians must ensure mutual training and cooperation and see to it that there is an end to reducing staff and transportation capacities. The surrounding cities and communities must realistically deal with the possibility of a disaster. This calls for preparation of disaster plans, exercises and continuous review or updating of the plans. As in the past, Fraport AG will provide its expertise free of charge. Dr. med. Walter Gaber Director of Medical Services Fraport AG Frankfurt Airport w.gaber@fraport.de 10