There remains a challenge to improve worldwide, the medical response, and the ground safety response to the disaster of an aircraft crash. Statistically more survive all crashes than perish, and if an aircraft crashes with survivors, in most cases there will be more survivors than dead.

The challenge of survival is to ensure that if an aircraft does crash, the medical and rescue response to this disaster must be immediate, competent, technically skilled and adequately equipped to save the maximum number of lives possible, and to help preserve the quality of life for all who survive. Improving safety standards has been stimulated by the excellent work of the Flight Safety Foundation, the International Civil Aviation Organization (ICAO), the United States Air Line Pilots Association — in particular by Captain John Stefanski and by the World Association for Emergency and Disaster Medicine.

Many will recall that at the meeting of the Club of Mainz Association held in Monaco in 1979, a committee was appointed to investigate aircraft crash management at 100 international airports. The task of the Airport Disaster Workshop was to develop a model of emergency care for large and smaller airports, in order to produce a standard for the various groups of airports. The Club of Mainz Association has been concerned with the poor standard of medical response that has been shown at recent flight disasters. As a member of this consultant committee, it was obvious even from very early days of my research that the medical response to aircraft crash in some countries with high air traffic flows is incompetent, inadequate, and demonstrates little awareness of advances in resuscitation and on-site care of aircraft crash survivors.