Page 102 - Journal of Special Operations Medicine - Winter 2014

Pilot Ejection, Parachute,
and Helicopter Crash Injuries

Colleen M. McBratney, MD; Stephen Rush, MD; Chetan U. Kharod, MD, MPH

ABSTRACT
USAF Pararescuemen (PJs) respond to downed aircrew patients may salvage neurologic function in severe cases.
as a fundamental mission for personnel recovery (PR), If such packaging requires any kind of risk to the medic
one of the Air Force’s core functions. In addition to re- or pilot, abandon attempts at spinal immobilization in
sponding to these in Military settings, the PJs from the favor of a prompt return to safety.
212 Rescue Squadron routinely respond to small plane
crashes in remote regions of Alaska. While there is a If there is injury by ground fire, rapid hemorrhage con-
paucity of information on the latter, there have been ar- trol will make the difference between life and death.
ticles detailing injuries sustained from helicopter crashes
and while ejecting or parachuting from fixed wing air- Factors affecting pilot ejection injuries include the air-
craft. The following represents a new chapter added to craft (speed, altitude, attitude) and the pilot (extraneous
the Pararescue Medical Operations Handbook, Sixth or poor fitting gear, harness, helmet, body position in
Edition (2014, editors Matt Wolf, MD, and Stephen ejection seat). All of these are affected by the pilot’s level
Rush, MD, in press). It was designed to be a quick refer- of consciousness.
ence for PJs and their Special Operations flight surgeons
to help with understanding of mechanism of injury with Causes of known combat ejection injuries include flail
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regard to pilot ejection, parachute, and helicopter ac- (33%), enemy-inflicted injury (17%), ejection-seat G
cident injuries. It outlines the nature of the injuries sus- forces (14%), struck an object (13%), parachute land-
tained in such mishaps and provides an epidemiologic ing (11%), fire (10%), parachute-opening shock (2%),
framework from which to approach the problem. and vertebral injury.

Keywords: Pararescuemen, helicopters, parachutes, fixed Pre-ejection Injuries
wing aircraft, injury prevention Pre-ejection injuries occur in the time from initial air-
craft emergency until ejection is initiated. These include
injuries due to fire; negative G forces; ejection injuries;
parachute-related injuries; and generalized shock from
Introduction
the trauma of the aircraft escape event.
As PJ first responders, it is very helpful to understand
mechanism of injury (MOI) and patterns of associated • Injuries caused by fire can include burns, smoke in-
injuries. An understanding of MOI helps to identify halation, blindness, and loss of consciousness. Ex-
what injuries to look for and to anticipate those that plosion injuries range from lacerations to multiple
might be life threatening. This is especially important extreme injuries, as well as shrapnel wounds. “Pilots
in circumstances when verbal communication with sustaining shrapnel wounds from primary or second-
the patient is limited, as in the back of any type of ary projectiles usually die.” 1
aircraft. • Negative G forces can cause head or neck strain, cer-
vical fracture, and loss of consciousness.
Pilot Ejection Injuries
Ejection Injuries
When treating ejection injury patients, be prepared for Ejection injuries can result from ejection seat forces or
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penetrating trauma: lives are saved during the “golden being struck by a seat, cockpit object, or the canopy.
hour.” Airway injuries are common, as is head trauma. They also include airstream injuries.
Be aware that the pilot may be unable to walk.
• Ejection seat forces include pelvis fracture and spinal
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Pilots surviving aircraft ejection frequently sustain ver- compression fracture. Catapult forces from the ejec-
tebral and extremity fractures. Proper packaging of such tion seat can cause internal organ injuries.

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