Burns mass disasters : Aetiology, predisposing situations and initial management

Many agents that are encountered daily are liable to cause burns mass disasters. These include flames, hot water and stem, combustible gases and liquids, molten liquids, boiling liquid expanding vapour explosion, chemicals and explosives. They result in disaster when certain alcks in safety occur. The proper management of such burns victims begins with rescue. At the disaster site, triage is important to separate the living from the dead, decide on priorisation for initial treatment and then evacuation to an appropriate facility. Proper management requires team effort and should be continued en-route to hospital. Repeat traige and use of clear guidelines in the Emergency Department ensure optimal and rapid care of the casulaties. Finally psychological support for victims, relatives, recuers and health workers must not be forgotten (AU)

Anatomy of a burns disaster : The Miri Bank explosion

A bank explosion in a neighbouring country over 1000 km away resulted in ten badly burned victims being airlifted to the Burns Centre, Singapore General Hospital (BCSGH) for treatment. The severely injured included patients with 90, 80, 74, 66, 45, 33 and 31 per cent burns. Nine had respiratory burns (four severe, one moderate, four mild). One patient died, thus, the mortality rate for the six most severely injured was 16.7 per cent. This differs from predicted mortality rates of 78 per cent according to McCoy or 54 per cent according to Thompson, Herndon et al. The factors contributing to this result were the small size of the disaster, the use of an established Burns Mass Disaster plan and an individual management policy that incorporates carefully monitored fluid resuscitation, recognition of respiratory burns with early treatment by intubation thuspre empting complications, early surgery and a multidisciplinary approach to complications such as infection and renal failure. The average length of stay was 43 (range 5-122 days). The cost of the hospitalisation of the ten casualties was $ 312,317.00 (AU)

Project L.I.F.E : Local involvement in fire education

Project L.I.F.E., an acronym for local involvement in fire education, is one such program. Project L.I.F.E's unique approach to firesafety and burn prevention education combines fireburn safety concepts within a sound educational framework and uses local community resources to deliver the programs to targeted community groups

Atención de pacientes quemados en situaciones de desastre

El autor ofrece recomendaciones y medidas a tomar en el tratamiento de pacientes con quemaduras provocadas por cualquier accidente o desastre. Se tratan varios aspectos: clasificación prehospitalaria de los pacientes quemados, transporte de pacientes con quemaduras, exámenes requeridos de acuerdo a la situación del paciente, équipo para la atención inmediata y para la reanimación inicial y medicamentos para utilizar en el sitio de la emergencia y durante el transporte

Tratamiento de las quemaduras / Treatment of burns

Al encontrarse frente a un quemado, hay que tener la seguridad de que la víctima no está en peligro de muerte observando con rapidez las vías respiratorias, su pulso y cualquier hemorragia externa, y tratando los trastornos que podrían amenazar su vida. Deben extinguirse las llamas. Se quitarán los anillos, las pulseras y cualquier otra joya antes de que el edema plantee dificultades. Se quitarán las ropas quemadas cortando alrededor de la tela que permanezca pegada a la herida. Se determinará la causa de la quemadura. No se pondrá vaselina, mantequilla ni remedio antiquemadura de ningún tipo. En la mayoría de las quemaduras pequeñas, un chorro de agua fría del grifo hará cesar el dolor. Refrescar rápidamente la lesión puede disminuir la destrucción total de los tejidos y la gravedad de la quemadura. Si en los 30 segundos que siguen al accidente se enfría la piel quemada, su temperatura desciende al nivel normal en menos de tres segundos. En el curso del transporte de la víctima hacia un centro de emergencia, se aplicarán bolsas de hielo cerradas herméticamente o hielo envuelto en varias capas de toallas

Burn injury and prevention in the Lebanon war, 1982

Burn injury and prevention in the Lebanon war, 1982: measures taken during the Lebanon war 1982, to prevent and minimize the extent and severity of tank-crew combat burns proved to be of value. Since 98 percent of tank crewmen who were burned were wearing fireproof suits at the time only 12 percent sustained abdominal burns; 77 percent had facial burns, as nome of the were wearing fireproof masks, only 9 percent of the burned soldiers who wore fireproof gloves sustained hand burns, compared with 75 percent who did not wear the gloves. A comparison of the extent of tank-crew burns in the Lebanon war and the October 1973 war revealed that 51 percent of the burns in 1982 were minor compared with 21 percent in 1973. Of the burns sustained in the 3,29 percent covered 40 percent of the body surface area compared with 18 percent in 1982 (AU)

Various approaches to burn care in the Lebanon war, 1982

All soldiers severely burned during the Lebanon war, 1982, were hospitalized in one of four facilities, in each of which different methods of burn care are practiced. These methods represents the various approaches to burn care in different centers in the world and in the literature. Resuscitation was adequate in all facilities oral hyperalimentation, although administered in different ways, is recognized as a main factor in preventing infections and enhancing healing in burn victims. The main aspect in which opinions differ is the care of the wound itself. However, was clear after examining many of the patients from the different centers that tangential excision is superior to delayed excision, and certainly to conservative treatment. The difficulties in comparing different methods of treatment are discussed. Early and continuous psychological surveillance is necessary for the successful recovery and rehabilitation of burn patients; a special team work model was developed to promote this approach

Casualties from terrorist bombings

The physical factors responsible for injury following an explosion in a room or building are: direct exposure to overpressure; blast-induced whole body displacement; impact od blast energized debris; burns from flash and hot gases. The patterns of injury seen in the casualties from four terrorist bombings are described to illustrate the types and severity of particular wounds. The most common fatal injury is brain damage; blast lung is uncommon in civilian terrorist bombings; flash burns, fractures, serious soft-tissue damage, and eardrum injuries are seen in people close to the bomb, who usually require hospital admission; many others taken to hospital can be treated for injury by debris and released. The environment and its internal structure and the position of the occupants of the space can influence the type and severity of injuries (AU)

Pyroclastic flow injury : Mount St. Helens, May 18, 1980

Three patients who were on the periphery of the pyroclastic flow of the Mount St. Helens eruption on May 18, 1980 were treated for severe thermal and inhalation injuries. Although exposed in identical manner, two patients arrived with heavily colonized burn wounds and developed adult respiratory distress syndrome leading directly to their death, whereas the third patient, with a noncolonized burn wound and little evidence of adult respiratory distress syndrome, survived. Evidence of inhaled ash complicating various stages of adult respiratory distress syndrome was confirmed by energy dispersive roentgenographic analysis. In the Pacific Northwest, Alaska, and the aleutian islands, potential for further injuries of this type in even larger numbers exists. Should these occur, those who treat the victims should be aware of the potential for severe inhalation problems in addition to the obvious burns