Should there be a serious emergency at the Daniel Oduber Quiros International Airport (LIR) in Liberia, the province of Guanacaste would be ill-prepared to save lives. Such was the assessment recently made by journalist Carlos Eduardo Vargas of national newspaper La Nacion in Costa Rica. This theoretic evaluation was based on an estimate of casualties made by the International Civil Aviation Organization (ICAO).

The triage situation posited by La Nacion consists of an aviation accident involving a commercial airliner carrying 150 passengers. Such flights are common for LIR, an airport that is partially owned by Canadian pension funds and that is quickly becoming a favorite among North American visitors to Costa Rica. On such a flight, the average number of life-threatening injuries among survivors would be 23. The problem is that the closest triage hospital in Liberia can only handle 10 of these patients.

The Enrique Baltodano Hospital is located in downtown Liberia, about 12 kilometers from the airport. This is the largest hospital in the Chorotega health region, but it does not have the capacity to handle a major aviation emergency. Other hospitals include the one at Nicoya, which is 70 kilometers away from LIR. The hospital in Puntarenas is 90 minutes away, and it has not yet fully recovered from damages caused by the September 2012 earthquake felt across Costa Rica. To make matters worst, specialist physicians at Enrique Baltodano are not always on duty due to payroll cuts made by La Caja, Costa Rica’s public health system.

Flights from 15 airlines in Canada and the United States carrying up to 180 passengers routinely land at LIR. Transporting patients from this airport to San Jose via air evacuation would take about 45 minutes. Within LIR, the Red Cross has a permanent post, but it can only handle one patient in serious condition at a time.

The airport management firm at LIR is only contractually responsible for handling emergencies within the passenger terminal; an accident on the tarmac would fall under the responsibility of Costa Rica’s Civil Aviation Administration and may require cooperation by the excellent private hospitals in Guanacaste.