Plane Crash in the Rift Valley

“Mayday, Mayday, small aircraft has crashed at Waso Airstrip. Plane destroyed. No fire. Four casualties taken to Entasopia clinic in a pickup truck. All have survived. Pilot has a bad head injury. One passenger severe back pain. The other two have limb injuries. Please send air ambulance to Entasopia airstrip immediately.”

So that’s my Monday afternoon call. I had spent the morning lazily looking through some case notes when this pulse-quickening call came through. Air crashes of small aircraft are not all that uncommon out here. The combination of poorly tended airstrips, poorly maintained aircraft and poorly trained pilots means that AMREF FD attend at least one air-crash per year. Of course, some good pilots in good planes can just be unlucky. Freak winds, dust devils and large animals are just some of the hazards a pilot must face working out here. But really, given the distances and quality of the roads, flying is the only way to do it! Kenya has such a wonderful tradition of small aircraft aviation and there are so many little airstrips that it just makes sense. If you come to Nairobi, come down to Wilson Airport and visit the Aeroclub of East Africa to get a glimpse into the crazy ex-colonial aviation history of the place.

Locals came from all around to take a look

Both Waso and Entasopia are pretty close to Nairobi, down in the Rift Valley about 25 minutes in the slow but versatile Cessna caravan. For their closeness they may as well be on another planet. It’s a stunning area but rather poor, inhabited by mostly Masai pastoralists. It seems that 4 chaps who worked for a tourist lodge further toward the hills, were in the process of doing a resupply in the little company airplane. On take-off , at the level of the low tree tops, for some reason the plane was witnessed to veer off to the left side of the runway and bits of plane were all that was left. On our way in we were rushing to the patients, so didn't get a chance to inspect the crashsite. Mercifully the wreck had not burst into flames or it would have been a more familiar story of four critical or, more likely, dead patients.

We loaded and were leaving Wilson airport within 30 minutes. I was entirely expecting to do two runs back and forth for both pairs of patients especially if any of them were critical. We were told to fly into Entasopia airstrip and while Kisito and I were in the back preparing for the worst case scenario, our pilot Phil started banking back and forth trying to find it. I’m generally pretty good with motion sickness but after the third aggressive, tree skimming, banking maneuver trying to find this airstrip, I was on the verge of re-examining my lunch. Soon Phil found it and lined up like he was going to take a crack at landing there. As we descended Kisito’s eyes widened and he said “That’s not a runway; that’s a driveway!” Calling it a driveway was generous. That strip had not been used for years. It was overgrown with bushes, bumpy and completely unsuitable to land a plane. Phil already knew this of course. He had no intention of attempting a landing, he just wanted a closer look. I wished he had told me that before I considered adopting the brace position and kissing my arse goodbye. As we flew very low along the old runway we terrified three Masai tribesmen who jumped from the bushes and ran for their lives. Whoever had told us there was a usable strip at Entasopia needed to do some more research!

For all those with a 4x4 in London - this is what they are for!

We flew over to look at the nearby airstrip at Waso where the crash had actually occurred and found it clear and usable so we landed there. We were met by a friendly conservationist who is currently studying lions; working out ways to stop them killing livestock and therefore keeping both man and lion separate and safer. He offered to drive us to Entasopia with our kit and we could also use the pick up there to bring the guys back. Phil offered to call in a helicopter as well but we opted to check out the patients first.

The road was as bad as I’m sure you can imagine and wound its way uncomfortably through the stunning countryside. There was a giraffe standing by the side of the road, and chewing contentedly, watched us go by with all the outward anxiety I would expect from a Devonshire cow.  We passed small herds of livestock with their tenders until it took us into the village where they were replaced by small herds of children instead. There was a big crowd gathered at the clinic. I don’t care where you are, a plane crash is pretty big news and the word had definitely got around. We were greeted by the AMREF clinic nurse who had done a grand job on her own for
the four men. The first, the pilot, had suffered a head wound and had briefly blacked out after the crash. But now he was orientated and able to tell us that he had had a brief period of unconsciousness but now just had a headache. He had a slightly mashed left arm but otherwise was unscathed. Given the mechanism of injury was such that (by most normal rules of the universe) he should be dead, we were unable to rule out an injury to his cervical spine according to the Nexus/Canadian C-spine protocols. So he had to go in a collar. He really didn't want to go in a collar. Protesting to us that his neck was fine. 'Look' he said, as he happily rolled his head around and up and down. Now this causes EMS providers a dilemma...

Now I really shouldn't go into my feelings about routine spinal immobilisation (the collar, head blocks etc) on the basis of mechanism of trauma alone but, at the moment, that’s the rule so that's what you do as a pre-hospital provider. Imagine you have been in a car crash and have got yourself out of the vehicle. You are walking around, even chatting on your mobile. Then the paramedics come along. Even if you have no pain, no tenderness on examination, no problem with your nerves, have a full free range of neck movement and are completely conscious, paramedics will still probably strap you down, force your neck into a collar and you will stare at the sky/ceiling until someone has taken some pictures in hospital. I am never surprised I have so many irritable, claustrophobic, uncomfortable patients brought in to the Emergency Department by paramedics. Don't get me wrong, there's still a tiny tiny chance you could have an occult fracture but it really won't be unstable, the collar provides little benefit in those cases and can often cause harm (especially in the elderly, I've written a paper about that incidentally)

and there is no evidence to say that comfortable conscious patients can't be allowed to sit up and just keep their head still if they really want. Their head will not fall off, trust me. Anyway, I think I may be drifting into a characteristic controversial Dr Edwards rant about Evidence Based Medicine, pseudoaxioms and my issues with the medical behemoth that is Advanced Trauma Life Support so I will stop. I would like you to enjoy reading my blog and I suspect I may have just lost you.

So, back to the story, Kisito managed to persuade him that, quite rightly, he had just been in a horrible plane crash, we couldn't 100% exclude neck injury and the road was really bumpy and his head probably would fall off, so he accepted the collar. The other stretcher case had some para-spinal tenderness in the lumbar region but no suggestion of spinal injury or an unstable fracture. He was otherwise unharmed. The other two men

between them, had a hand injury and some mild lower rib pain but that was it. So we took two out on stretchers, utilising the local tribesmen as extra manpower and the other two men simply walked out to the 4x4.

On the long ride back to the plane, the pilot was able to explain to us what had happened. As the plane left the ground, the pilot’s seat lost its grip on its runners and suddenly slid backwards. All he was holding onto was the controls so they went back  with him and the plane's nose pitched up. He lost control of the plane and a wing clipped a tree. The fuselage rolled along the side of the runway about three times coming to rest in some shrubs having thrown off its other wing, the tail and the engine. It was a sorry sight and difficult to imagine how anyone had survived. I don't use the word miracle but they were lucky beyond anything I've ever seen. Look at the picture below and you will see what I mean. So maybe the neck collar wasn't such a bad idea after all, (he says rather sheepishly.)
I can tell you they are all making a full recovery with only minor fractures and two are already discharged.