With the development and deployment of commercial jet aircraft in the mid 1950's, airline travel has become commonplace throughout the world. A rapid increase in the numbers of aircraft, airline routes, and flying time has occurred. New technology has added sophisticated and complicated gear to aircraft and their support systems. Every new system has the potential for failure and to some extent additional components increase the risk of technological breakdown. The increased chance of technological breakdown favors an increase in aircraft accidents. Fortunately, development and utilization of sophisticated redundant electronic and mechanical improvements aimed specifically at improving safety have also occurred. The results of these changes over the past twenty-five years has been a decreasing rate of accidents per mile flown. Due to the tremendous increase in flying, however, the absolute numbers of accidents associated passenger morbidity and mortality have risen (1). For the health care system, the major impact has resulted from the absolute increase in aircrash victims.

Aircraft accidents have regularly produced mass casualty incidents with the number of victims ranging from a few to several hundred. Aircraft accidents can be divided into essentially four types: mid-air crashes (so called “hard impact”); crashes on takeoff; crashes on landing; and on-ground accidents (“soft impact”). Mid-air accidents are frequently away from population centers and usually there are no survivors. The medical impact therefore is minimal. Accidents occurring on takeoff, landing, and on the ground, occur at or close to airports, and the nature of the accident is such that there may be many victims (1).