A multiple patient incident involving a commercial airliner is a challenge for any community EMS system. When the community is on a remote island in the North Pacific Ocean, where there is no hospital and only a small clinic staffed by just one physician and several nurses and technicians, the challenge is much greater. The incident described herein necessitated providing emergency care at the airport, and at the same time, activating a response capability from hundreds of miles away to transport the patients to definitive care. The situation was compounded further by the fact that most of those injured spoke little or no English. This paper reviews the events that occurred and the lessons learned..

To identify the events that occurred when a commercial airliner, with more than 250 passengers and crew aboard, experienced an in-flight “upset” that resulted in many being injured. What was learned may help other areas be better prepared for such events.

A commercial airliner incident that occurred in April, 1993 resulted in the need for emergency medical care at the remote island location of Shemya, Alaska initially, and fixed-wing transport of the injured to definitive care in Anchorage, Alaska, USA, which is about 1,300 miles (2,130 km) from Shemya.

A case review methodology was used that included interviews with key persons involved in the response to this incident to learn first-hand what occurred; by review of the National Transportation Safety Board (NTSB) reports, and by having agencies involved in the event review draft report materials to ensure accuracy.

This study showed how a remote site with a small cadre of medically trained personnel could organize and effectively provide initial emergency care for >200 persons, an have them transported more than a thousand miles to definitive care.

Valuable lessons were learned from this incident that may help other areas be better prepared, particularly in remote areas, for large multiple patient events.