The emergency department is a major gateway of the hospital, where unexpected illnesses are triaged and vague complaints are teased out. I especially appreciate the specialty because emergency physicians know how to initially evaluate just about any kind of patient who shows up at the door. Although I knew EDs were used to dealing with unexpected patient flow, what I didn’t fully appreciate until recently was that top hospitals like Stanford are also well-versed in mobilizing for massive unexpected illness or injury – and the subsequent onslaught of dozens, or even hundreds, of patients without appointments.

“We have a busload of wounded passengers on the way, ETA 15 minutes,” the loudspeaker crackled, as I arrived on my shift in the emergency department on July 6. Asiana Airlines flight 214 had just crash landed at SFO, and the Stanford ED had already initiated “Code Triage.” This activates a set of multi-team hospital protocols to respond to a mass casualty event.

Expecting a loud, chaotic scene, I instead walked in on a machine made of well-rehearsed professionals. From triage to trauma assessment, the hands on deck made disaster response look more like business as usual.

‘We have a busload of wounded passengers on the way, ETA 15 minutes,’ the loudspeaker crackled, as I arrived on my shift on July 6. Asiana Airlines flight 214 had just crash landed at SFO.

I was quickly put to work and assisted with about a dozen patients with a chief complaint of “Airplane Crash,” and through a Mandarin or Korean interpreter performed a crash-focused history and physical exam.

Using bedside ultrasound I also helped check for traumatic internal bleeding, which helped show us who needed to go to the OR immediately.

While most victims were stable enough to be released same day, a common injury pattern spoke to how violently the plane tossed and tumbled passengers.

The most serious injuries appeared to affect those in the rear of the aircraft, presenting with head lacerations; these reflected the catastrophic trauma resulting from the loss of the plane’s tail section.

As skeletal imaging revealed, other patients were primarily victims of the massive torsional and deceleration forces generated when the plane spun and lurched to a halt.

This spinal jarring led to vertebral fractures and even paralysis. The majority, however, described similar patterns of left-sided body pain, likely from being flung into the armrest while wearing a lap belt.