[citation needed] The disaster revealed serious shortcomings in the handling of large-scale medical emergencies by German civil and American military authorities.

US military personnel did not immediately allow German ambulances onto the base, and the rescue work was generally hampered by a lack of efficiency and coordination.

[5] The rescue coordination center in Kaiserslautern was unaware of the disaster's scale as much as an hour after it occurred, even though several German medevac helicopters and ambulances had already arrived on site and left with patients.

American helicopters and ambulances provided the quickest and largest means of evacuating burn victims, but lacked sufficient capacities for treating them, or had difficulty finding them.

The plane hit the ground ahead of the spectator stands, exploding in a fireball and destroying a police vehicle parked inside the concertina-wire fence that defined the active runway area.

The plane continued, cartwheeling for a distance before picking up the three-strand concertina-wire fence, crossing an emergency access road, slamming into the crowd, and hitting a parked ice cream van.

In April 1991, Werner Reith, a German journalist from the newspaper Die Tageszeitung, suggested in an article that the Ramstein disaster could have been caused by some sudden technical problem—or even sabotage—in Nutarelli's plane.

Reith pointed out that Lt. Col. Nutarelli and Lt. Col. Naldini were supposed to know details about another air disaster, the 1980 Ustica massacre, citing Italian press sources.

[9] Judge Rosario Priore, who was investigating the case at the time, found that they were performing training flights nearby minutes before the Ustica incident, but he definitely rejected their deaths as sabotage.