It’s not yet clear how old the child is (early reports said the child was 5--and male; more recent reports point to a 14-year-old girl), and This child is now said to be a 14-year-old girl, but we know little else at the moment. Still, it seems like a good excuse to talk about how children fare in plane crashes in general.

The answer: not well, alas. But before we even go there, a quick reality check: Children are hardly ever in plane crashes, it’s worth remembering. Car crashes are what we should be talking about night and day. Among those 2-12 years old, car-crash injuries are the leading cause of death. Each year about 1,800 children aged 14 and under are killed in cars, and more than 280,000 are injured. Let me say again: 1,800 children.

So we’re way off in the far reaches of low-risk/high-fear land here. But OK, let’s do this. So hardly any kids are ever killed in plane crashes. But what to make of the Yemeni crash? If it is true that the sole survivor was a child, does that mean children may be better off in some plane crashes?

No. In general, children--especially small children--are at special risk in a lot of accidents, including plane crashes. They may need extra help to escape, and they may be more prone to secondary complications (as are older people). They may not understand the safety instructions (like many grown ups) and they are accustomed to being told what to do--always dangerous in a plane crash.

We don’t know what happened in the Indian Ocean, but it’s a safe bet that the most important factor was luck. The survivor’s seat may have been located in just the right spot. But not even that can be predicted. What is the safest part of the plane in a water crash? I asked Dr. Dan Johnson, an aviation safety expert who wrote the highly readable book, Just in Case: A Passenger’s Guide to Airplane Safety and Survival. And he gave me the secret. Are you ready? “Sometime the overwing is safer, but sometime the back of the plane is safer, and other times the front is safer.” That pretty much sums it up. There’s no way to know, because it depends on the crash. In general, being closer to the exit is better, but there’s no telling which exit (until it’s too late).

But here’s one thing we do know about very small children in planes: they are safer if they are strapped in. Seems obvious, and yet you are still allowed to hold a child under 2 on your lap on planes. The research shows that there is no way you will be able to hold onto that child in a crash or sudden deceleration, but you can still try. And given the price of seats, I can see why this is still allowed. But parents should know that it is not nearly as safe as having the child in a car seat--in a separate seat.

In 1995, a mother held fast to her 9-month-old during a crash landing in Charlotte, NC, but she physically could not compete with the G-forces of the violent landing. Her child went flying out of her arms and died of massive head trauma. The mother lived. After that, the National Transportation Safety Board recommended that all children be restrained, no matter their age. The FAA objected with an interesting line of reasoning, according to a 1995 New York Times article:

“The agency contends that if families have to buy tickets for babies, some will drive instead and as a result more will die. The agency maintains that the problem of child safety in aviation barely exists; for a 15-year period beginning in 1978, a study the agency commissioned found, only one child death would have been prevented, along with one serious injury and three to six minor injuries in aviation accidents involving United States air carriers.”

Of course, if we are worried about plane tickets being so expensive that they force people to drive...well, the FAA should’ve gotten into the price-fixing business a long time ago. The debate over lap-babies has continued, but the bottom line is clear: it’s safer to have your kid in a seat of his or her own, and in a seat belt.

But if you really want to protect your child, nevermind all that: Put your kid in the back seat of your car when you’re driving to the airport. Buckle everyone’s seat belts and turn off your cell phone. Now we’re getting somewhere.

I’m not saying it was easy; the woman was under surveillance by her own government and she lost as many battles as she won. But she and her husband did pull it off for 12 years. And then, after he died, she became even more influential--at the UN, the NAACP, in her six-days-per-week nationally syndicated column (which reads like a blog, but not a terrible one), and on and on.

I do think that the cliché is true: No other First Lady resembles Eleanor Roosevelt so much as Hillary Clinton. Both were smart, ambitious, guarded women with charismatic husbands who could not be trusted around attractive women. Both were workhorses who cared about policy as much as politics. And both were more powerful after their husbands’ presidencies were over. One difference is that Hillary Clinton was more honest--she did not try to hide her influence. And she was probably less powerful in the White House as a result.

It’s ridiculous to predict Michelle Obama’s tenure this early on. But reading the histories of First Ladies, I did notice how almost every one is alleged to have “broken the mold” at one point or another. Michelle Obama already “broke the mold"--just because of her skin color. I suppose the reason for this neverending mold-breaking is that there really is no mold for First Lady. It’s a job without a mandate or a mission. So each woman reinvents it, like it or not. So far, Michelle has two things in common with Eleanor: They both planted gardens a the White House, and they both made a point of being a citizen of Washington, DC--the city, not the theme park. But these are early days…

Some Twitter users posted the traditional responses:  “My prayers and thoughts are with the families of the dead & injured due to the Metro train accident on the Red Line here in the DC area.” Others commented on their experience with the red line, however brief or seemingly unimportant: “Slightly horrified by DC metro crash yesterday. Rode the red line when I was there for inauguration. Prayers for the peeps.” or “The pics from the Metro accident are disturbing. My bro just took the red line to the zoo a few days ago. Prayers out to everyone affected.” Even one ride on DC’s red line qualifies you to join the “What If?” debate (i.e., “What if I had been there?” “What if this had happened when I went to the Inauguration?").

Why do we do this after every tragedy? I heard the story of a Washington, DC, mom who on Monday decided to drive instead of hopping on the red line during rush hour, thus essentially avoiding the crash. Certainly she’s justified in wondering what would have happened had she taken the metro instead. But that’s not the same thing as visiting DC and riding the red line to the zoo for a mere 15 minutes.

Or maybe it is. The brain needs predictability.  We want our subways to arrive on time, make the same stops and generally be the thing helping us get to and from work each day.

Unfortunately, events like Monday’s accident aren’t predictable. Perhaps to make sense of what feels like a random disaster, we have to attach it to something familiar.  In this particular instance, if you’ve ever been on the red line, it’s suddenly clear that this could easily happen to you. The brain is unsettled by this notion, so we marvel at it, trying to resolve the dissonance-- trying to come up with some way to find (or create) causality: “Will be sitting in the absolute middle of metro cars in the future. Scary, sad events on the Red Line yesterday.”

A revealing chronology of alerts in the Washington Post today. You can see that the people given the least amount of information last night were the passengers riding Metro--who received the “WMATA Alerts” listed below. In fact, the WMATA press releases were much more honest and detailed than the alerts that went out to the public. It appears that Metro authorities trusted reporters (of all people) more than their customers.

Excerpted from the Post‘s chronology:

5:00 p.m.: Approximate time of crash between Fort Totten and Takoma stations.

5:18 p.m.: WMATA Alert:(ID 55699) Disruption at Fort Totten. Trains are turning back at Brookland and Takoma due to a train experiencing mechanical difficulties outside of Fort Totten station. Shuttle Bus service has been requested.

5:29 p.m.: Washington Post confirms crash and derailment.

5:36 p.m.: WMATA Alert: (ID 55699) Disruption at Fort Totten. Trains are turning back at Rhode Island Ave and Silver Spring stations due to a train experiencing mechanical difficulties outside of Fort Totten station. Shuttle Bus service has been requested.

5:36 p.m.: WMATA Press Release on derailment and “collision.”

6:03 p.m.: WMATA Press Release confirms first two fatalities.

6:07 p.m.: WMATA Alert: (ID 55699) Disruption at Fort Totten. Trains are turning back at Rhode Island Ave and Silver Spring stations due to a train experiencing mechanical difficulties outside of Fort Totten station. Shuttle Bus service has been established. Customers should add an additional 30 minutes to their travel time.

This is a familiar pattern in the history of disasters. The people in charge are often very reluctant to share information with the most important actors--the regular people at the scene. Why is that? What is the built-in bias at work here?

People in positions of authority have a tendency to distrust the public. They believe that, given frightening information, the public will panic.

It’s a prejudice that pervades many bureaucracies, even on a normal day. In my book, I write about one of the routine announcements used on the Metro system: “In the event of a fire,” the taped announcement warns, “remain calm and listen for instructions.” That’s it. Hundreds of conversations and thoughts were interrupted for that announcement. What was the message? That the officials who run the subway system do not trust me. They think I will dissolve into hysterics and ignore instructions in the event of a fire.

Consider what the people who created this announcement did not do: they had an excellent opportunity to tell me how many subway fires happen in the D.C. system each year. That would have gotten my attention. They also had a chance to explain why it’s almost always better to stay in the subway car in case of a fire (because the rails on the track can electrocute you, and the tunnels are, in some places, too narrow to fit through if a train is coming). But instead, they just told me not to panic.

The panic myth is pervasive, but the research reveals it to be false: Panic is extremely hard to find in the history of disasters. Why? Because it’s not in our survival interest to panic. Groups of frightened humans (like frightened chimpanzees and other animals) tend to form groups, stick together and show each other unusual courtesy. That is the kind of behavior that Metro should plan for.

People will do remarkable things when they have information. On 9/11, the people who saved the most lives were regular people who had information. Passengers on Flight 93 had time and ability to learn what had become of the other hijacked planes. They considered their options, discussed a plan and took action. It was regular people who prevented a plane from plowing into Congress or the White House--the headquarters, ironically, of the people in charge. Regular people must be trusted.

But it’s already clear that as in most sizeable emergencies, regular people did the hardest work in the most important moments--before rescue workers arrived. Getting out of a wrecked subway train is extremely difficult. Between the darkness (due to the loss of power) and the twisted cage of metal, it is very hard to get oriented.

It doesn’t help that subway cars in general are challenging to evacuate. If you’ve ever looked at the instructions for escaping from a Metro train, you’ll see what I mean. It involves finding the center door, lifting the cover of an emergency door-release handle, pulling the lever and then sliding open the LEFT (not right) door. If you want to know more, you can check out this very irritating Flash animation on the WMATA site. As with many of the announcements on the Metro, a good deal of time is spent telling you to listen to the people in charge (even though, in major emergencies, the people in charge are unlikely to be able to help you for a good long while).

One eye witness told the Washington Post that people inside one of the wrecked cars were beating on the windows, trying to get out. Many were on their cell phones. As is so often the case in disasters, people did remarkable things for one another. Survivors report fear, confusion and kindness--but not panic:

“In the moments after the crash, passengers made tourniquets out of T-shirts, struggled to pull debris off others and sought to calm the hysterical and the gravely wounded. Inside the worst-hit car, waiting on ambulances and the “jaws of life,” an Anglican priest led a group in the Lord’s Prayer. On the ground below, a civilian Pentagon employee told a wounded girl he wouldn’t accept her last wish—she was going to live.”

I’m struck by the similarities to the behavior of passengers in London after the 7/7 transit bombings in 2005. This description is from the foreword to the invaluable Report of the 7 July Review Committee:

“What is clear is that the humanitarian response to these events was astounding; from the passengers who helped and supported each other, to the underground workers, ‘blue light’ response teams, shop staff, office workers, hotel employees and passers-by who offered what help they could. The individual acts of bravery and courage are too numerous to list. Often the heroes have been reticent to come forward and have stayed silent about the role they played, known only to those that they helped.”

But the part of this report that I think of most often is the section that explains the fundamental flaw of most emergency plans. We don’t know yet whether this lesson applied today in DC, but it’s worth repeating. I have yet to see a big disaster in which this was not true on some level:

“There is an overarching, fundamental lesson to be learnt from the response to the 7 July attacks, which underpins most of our findings and recommendations. The response on 7 July demonstrated that there is a lack of consideration of the individuals caught up in major or catastrophic incidents. Procedures tend to focus too much on incidents, rather than on individuals and on processes rather than people. Emergency plans tend to cater for the
needs of the emergency and other responding services, rather than explicitly addressing the needs and priorities of the people involved.”

Lenell, who served 32 years as a Continental pilot, was 60 and apparently healthy (per FAA rules, commercial pilots over 40 are required to undergo twice-yearly physicals). He died of a heart attack. According to CNN, of the five pilots who have died in-flight since 1994 (when the FAA began tracking this information) all were filed under the category “cardiac.”

Just like more firefighters die from heart-related conditions than fires, more pilots die from heart attacks than plane crashes. In this case, it’s hard to say if age was a factor. Up until two years ago, Lenell would have been forced to retire at 60. But in 2007, Congress voted to raise the mandatory retirement age to 65. Proponents of the change say that age is a positive, rather than a negative: more experienced pilots are typically safer pilots. The average age of pilots in the US has been gradually rising (check out the FAA stats here), and CNN predicts that Thursday’s death will revive the debate over pilots’ mandatory retirement age. 

Citizen Corps was created after 9/11. In some towns and states, Citizen Corps is doing remarkable things--building rock-solid resilience by mobilizing and connecting regular people to take more responsibility for their own preparedness and survival. In other places, it’s, well, somewhat less impressive.

The organizers are also expecting Craig Fugate, the new head of FEMA, to talk, along with an audience of about 750 state and local officials, emergency management, first responders, private business and industry, advocacy groups, and members of the public. Stay tuned…

Yes, very different. And the differences make children both better and worse at responding to disasters. It depends on the age of the child and the type of disaster, of course, along with a million other caveats. But here’s what we know:

* Before a disaster strikes—Young children have extremely plastic brains. They can learn faster than adults, making them ideal targets for hands-on training. They are also free of the baggage that adults carry--the fear of looking foolish or overreacting. That’s why firefighters visit schools. Children stop, drop and roll. They don’t just talk about it. And the brain learns much better by doing than by talking. To quote this Time story on a child’s brain:

“While new synapses continue to form throughout life, and even adults continually refurbish their minds through reading and learning, never again will the brain be able to master new skills so readily or rebound from setbacks so easily.”

* During a disaster—As with adults, children will draw upon whatever patterns were in their heads before a disaster strikes. They have fewer patterns in there, however, which can help or hurt. In fires, frightened children sometimes hide in closets--making them hard for firefighters to find. They may be afraid when they see a firefighter in full gear. But again, there is opportunity. If a child has rehearsed evacuating her house from her bedroom in advance, that will help. If a child has seen a firefighter in full gear, that gives the brain something to work with. You can now buy smoke detectors that let you record a voice message. This is a fabulous idea. A child will respond much better to a parent’s specific, aggressive command--in a very serious voice--than to a loud beeping squawk.

* After a disaster—Research into why children develop posttraumatic stress disorder is actually very encouraging, I think. It shows that the two things that correlate with stress symptoms are under our control: 1) Amount of TV coverage of the disaster viewed by the child and 2) Parental distress.

Those two factors can matter more than almost anything else. If a child sees TV coverage of a building collapse, that child may think the building is collapsing over and over again. If it were up to me, CNN and FOX would run ticker warnings to this effect during coverage of disasters. That’s how dangerous this footage can be.

Likewise, if a parent over-shares his fear and anger over a terrorist attack with a child, the child may have no way to put that into perspective. As the National Center for PTSD explains in an extremely helpful fact sheet:

“Although you yourself may be anxious or scared, children need to know that attacks are rare events. They also need to know that the world is generally a safe place.”

After Katrina, Congress created a National Commission on Children and Disasters to study how we can build children into smarter preparedness and response plans. They are supposed to send their recommendations to Congress next year. I look forward to seeing what they come up with. Here’s hoping they are creative--and built around the way children’s brains actually work. 

I am relieved to hear that the shooter was quickly disabled by security guards and is now at GW University Hospital, just around the corner from my office. It sounds like a security guard is in worse shape, and we can only hope for the best.

We will need to learn more about what happened. But there are a few things we may want to keep in mind: Almost all the major museums in DC already have metal detectors and guards. The monuments and museums have been heavily fortified with Jersey barriers and other obstacles since 9/11.

But they are still relatively open, free spaces for reflection and learning, and that’s what makes them precious. Spaces thronged every day by school children and visitors from around the world. It will be important, I think, to be smart in responding to this shooting. Or else we risk giving the shooter exactly what he wanted--magnifying his spasm of violence into a lasting legacy.

Stay tuned. 

Thanks to John Solomon for flagging last week’s 5-day nationwide drill in Israel as a model for a meaningful drill. Imagine: a drill that includes the entire population--and features surprise scenarios that require people to take action.

This is the way the brain works. The brain doesn’t learn by reading lists and listening to occasional public statements of officials in grey suits. The brain learns by doing. If we want to train the people who matter most in major disasters--the people who do the majority of life saving--we should invite them to the drill. Otherwise, we’re just play acting--designing emergency plans for emergency officials. Round and round the meta emergencies go.

It’s worth pointing out that Israel’s Home Front Command (similar to our Homeland Security Department) figured this out a long time ago. Human behavior matters more than technology. Look at the English version of their web site and notice the large button at the top labeled: “How to Act in an Emergency.” Click here to find out “How to Behave in a Terrorist Attack” or an earthquake or a fire or a flood. Downright elegant.

In general, I am not quick to point to Israel as a model for the U.S. The threats and context are very different, and I think some of our police departments tend to over-learn from Israel. But not in this case. On this subject, we under-learn.

Israel has got this exactly right. By comparison, DHS offers a mind-numbing list of preparedness and response publications, resources and regulations. From NIMS to NIPP to HSEEP. Ugh. I am unusually obsessed with this subject, and even I cannot bear to stay on this page for more than 6 seconds. 

“Mr. Crawford, 61, who makes do on $1,800 a month in Social Security and veterans’ benefits, decided he could afford only the heart, blood pressure and acid reflux pills. ‘If I can rob a bank,’ he said, chuckling, ‘I’ll be back for the others.’ Before leaving, he handed over yet another prescription, just for safekeeping. It was for Plavix, an anticlotting drug that helps coronary patients avoid new blockages, and it had been written in early February after Mr. Crawford’s second heart attack. At $160, the co-payment was so high he had never considered filling it.”

Now consider an alternate universe: When I lived in France in 2003, I got sick. I put off going to the doctor because I didn’t know how much it would cost. I had health insurance through Time Magazine, but I had to submit claims on my own because I was living abroad, and I had no idea how good my coverage would be. Anyway, when I didn’t get better after a couple of weeks, I gave in and called a doctor in the village of Fontainebleau, where I lived.

I made an appointment for the same day. On my way there, I stopped at an ATM and took out about 100 Euros, just in case. When I got to the doctor’s office, I filled out a short form and then went in to the exam room, without waiting. The doctor checked me out and decided to prescribe antibiotics and a couple other things. (One of the downsides to universal health care is that a lot of doctors go nuts with the prescription pad.)

Then he apologized. He looked somber. He said that since I was not a French citizen, I would have to pay for the visit out of pocket. I nodded and said I understood. Then he asked me for the equivalent of $20. I handed it over. It was less than I might pay for a co-pay back home. Then he gave me a wad of prescriptions and sent me to the pharmacy next door.

At the pharmacy, the woman who filled my prescriptions also apologized. Because I was not covered by the French health care system, she said, I’d have to pay out of pocket. She looked almost ashamed. Again, I swallowed hard. She gave me a bill for… the equivalent of $15. For three prescriptions including antibiotics (which I did need) and a couple silly things I didn’t need.

I walked out and understood what health care could look like. I had gotten more service for less money than I ever got in the States. I didn’t even bother submitting those claims to my health insurance company. For $35, I’d gotten more than my money’s worth.

I know France has its problems. Believe me. I could go on for days about the excessive strikes, the culture of labor entitlement and the bureaucracy, not to mention the implications of a population that does not clean up dog poop from the sidewalk. I know their health care system isn’t perfect, either. But I am telling you: Americans are getting screwed. Most of us don’t even know what a good health care system would look like anymore.

In France, Mr. Crawford would have gotten his drugs. Why couldn’t he get them here? Because we subsidize the rest of the world (including France) by refusing to negotiate as a country for lower drug prices. We pay more and they pay less. Because our doctors expect to make more than French doctors expect to make, partly because they pay an ungodly sum for medical school. When US docs find they can’t make as much as they expected, they overbook and overcharge. Because of a long list of reasons that are no longer mysterious or acceptable.

So it kills me to read about people in America having to leave life-saving prescriptions unfilled because of the greed and ideology of a minority of politicians and businesses. It pains me to read about the opponents to health care reform dragging out the same old, fear-mongering stories to try to prevent America from joining the rest of the civilized world. Seems to me that Americans deserve a system that is at least as good as the one in France or the UK. (Check out this interactive chart comparing the US health care stats to those of other nations.)