Rescue workers who dealt with the carnge of the crash of American Airlines flight 191 at Chicago's O'Hare International Airport in May should be considered crash victims with special psychological injuries, says a psychiatric consultant to the National Transportation Safety Board.

Dr. John Duffy, a former U.S. military flight surgeon studying the psychological impact of crashed on survivors and witnesses, says the airlines and general community largely ignore the special needs of these workers.

Some physicians assume that rescue personnel who deal with such a tragedy do not have special psychiatric needs because they are used to dealing with death and destruction.

But such comments, said Duffy, a professor of psychiatry at the Unifromed Services University School of Medicine in Bethesad, "is the height of naivete. To suggest that these individuals are trained to walk among that carnage -- burning human tissue, skulls, body parts -- is ludicrous.

"Some of the pararescue people" at the O'Hare crash were "very upset," said Duffy, who arrived on the scene with the NTSB investigation team.

The local rescue workers had "arrived on the scene almost immediately after the DC10 lost an engine ad crashed, he said, "ready to apply their tourniquets, start their IVs and use their backboards. But there was nothing for them to do," he said, there was no way they could even relate their hundred of hours of training to the sea of shattered bodies surrounding them.

"The fireman were better off because they were constantly working," said Duffy, whose own air disaster work is financed by a grant from the National Institute of Mental Health. "The policemen, although they were working double shifts, were very often standing around," and thus had more time to thing about the sights and smells inundating them.

Duffy has begun a multi-year study of the mental healt of 42 rescue workers involved in the cleanup after the midair collision over San Diego last September, which claimed more than 150 lives.

Of the 42, "four are suffering from major mental illness and 13 of the 42 are in some sort of counselling," following their duty at the crash scene, Duffy said. He said that only about 5 percent of the 42 workers had any previous history of psychological problems.

One fire official, the psychiatrist said, "can no longer bring himself to go to the supermarker with his wife, because he can't stand passing the meat counter."

Rescue workers involved in the California disaster "typically had nightmares for some weeks afterwards and [other] sleep disturbances."

The horror of a major airline accident is virtually impossble for the outsider to comprehend, said the psychiatrist, who said the remains of the 274 victims of the Chicago crash wre stacked in the makeshift morgue at O'Hare in 438 body bags.

Duffy recalled "standing beside this pathologist and there was a torso, a hand and an extremity on the table. I feld him perceptible stiffen," Duffy said. "I looked down at the table and there was a ring on the hand, it was a very ornate ring. He (the pathologist) stepped back from the table and ripped off his glove (with a jerk). And on his left hand he had the same ring. His wife had given it to him as an anniversary present," said Duffy, "how does he deal with that?"

Common wisdom, said the psychiatrist, holds that a 'basically healthy person can weather the storm" when faced with the psychological stresses of a disaster situationo But such theories ore more often applied to actual survivors of a crash, who have support systems in their communities and families.

What is often forgotten, he said is that the crash survivor's memories are often limited to his own horrible expriences, while rescue personnel share in the horror of all the deaths and injuries caused by a crash.

According to Duffy, "when an aircraft accident occurs, the airline industry simple doesn't have a protocol that addresses the human element.

When relatives first began calling the airlines for information about the Chicago crash, Duffy said he was told later, the airline "had people making statements two hours afterwards about a 'possible accident," saying 'an accident might have occurred.'

"In Los Angeles, flight 191 disappeared from the [arrivals] board, just disappeared," said Duffy shaking his head in disbelief. Later he said a notice appeared "Flight 191 . . . see the agent. . . Relatives had to run a gauntlet of Hari Krishnas and the media" to get to an area where they could be given information.

According to Duffy 60 percent of airline accidents occur within the immediate vicinity of the airport, but airlines and airports have no plans for dealing with the psychological aspects of a crash.

According to James Arey, director of corporate public relations for Pan American, "one of the things we have is an emrgency planning manual that's telephone book size. It's a step-by-step outline of who does what, where and when."

But Pan Am's preparations are related to the disaster itself, said Arey, rather than to its long term aftermath. While Pan Am employes must be cleared physically and psychologically before returning to duty after injury in an accident, the airline does not feel its responsibility extends to firemen and policemen working the scene.

Dr. John Wick, medical director for American Airlines, totally discounts Duffy's theories. "It's not shocking or surprising for disaster workers to see this kind of thing," said Wick. . . These people are professionals. They have a job to do and they do it."

According to Dr. David K. Wiecking, Virginia's chief state medical examiner, the stresses are different for rescue workers and pathologists who do body identification.

Wiecking, who worked under trying conditions to identify the bodies of those killed in the crash of TWA flight 514 in Bluemont, Va., five years ago, said "it's just more of the usual type of case. We're sort of professionally trained and hardened for it. The only stress for me is getting more work out in a shorter period of time."

Wiecking said that while there may be some rescue workers who would benefit from psychological counseling after an airlined disaster, to begin with, rescue work sometimes attract some persons with personality problems. It is extremely difficult to tell, he said, whether a particular worker brought his problems with him to the job, or gained them on the scene.

Duffy first began trying to interest the airlined in the problem when he organized a conference on the subject in late 1977.

The psychiatrist requested NIMH funding for the meeting, and two weeks after he submitted his request, two 747s collided on the runway at Tenerife in the Canary Islands, killing more than 570 persons. A week later he had his funding.

Duffy sent invitations to the conference to the medical directors of all the nation's major airlines, but the response was far from overwhelming. Rather than acceptance he said, he received hate letters, "saying I was picking on them and why was I drawing attention to this."

Of all the airlines in this country, only United and Northwest Orient sent representatives to the conference which was also attended by personnel, from British Airways, EL, AL. Lufthansa, the American Red Cross, and the insurance industry.

Accoding to Duffy, the main suggestions to come out of the conference were that:

The airlines have a responsibility to devise plans for handling accidents, which include responding to the needs of relatives of survivors and victims.

Airline personnel be provided with crisis intervention training so that they don't do things such as hang up on persons calling for news of victims, which Duffy was told happened following the Chicago crash.

The National Transportation Safety Board safety team should include a psychiatrist.

Community mental health centers and services should be included in airport disaster planning.

Rescue personnel should be given opportunities to talk about their experiences in order that they not bottle them up to the point where they create serious psychological problems.

Thus far, said Duffy, the suggestions have fallen on apparently deaf ears. Airliner representatives have said their chief concern is for the victims of a crash and their next concern is to see that bodies are returned to families as quickly as possible.

If rescue workers lose sleep and suffer psychological damage cleaning up one major airline disaster, how is John Duffy affected by attending and talking about every disaster he can find?

I had nightmares," after the O'Hare crash, he said and in the dreams "I had made all the bodies whole and none of them were burned. I had that nightmare for a few days."

But the dreams have stopped since he returned from Chicago to Bethesda, Duffy said, and he believes they've stopped "because I've been able to talk about it."