Management of burns in major disasters

doi:10.1016/0020-1383(90)90152-K

Injury

Volume 21, Issue 1, January 1990, Pages 41-44

https://doi.org/10.1016/0020-1383(90)90152-K Get rights and content

Abstract

This paper discusses the problems of handling major burns in disasters with particular reference to the disaster that occurred in Bradford. Several major features of the Bradford fire, in which 56 people died, made its management much simpler than might be expected in subsequent burns disasters; these are discussed. Lessons that have been learned from handling this disaster are indicated.

References (3)

J.P. Bull
Revised analysis of mortality due to burns
Lancet
(1971)

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Cited by (17)

Plastic surgery and burns disasters. What impact do major civilian disasters have upon medicine? Bradford City Football Club stadium fire, 1985, King's Cross Underground fire, 1987, Piper Alpha offshore oil rig disaster, 1988
2009, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
To deal with the large number of casualties and to complete the early aggressive treatment of tangential excision (a 2–5 day window), a large team of plastic surgeons was brought together – overall it was estimated that 10% of all trained plastic surgeons in the UK attended the incident. This reflected a new approach that found it was more efficacious to bring expertise to the area rather than send patients to distant centres which could adversely affect their prognosis.31 Communication was identified as potentially problematic after Bradford, and efforts were subsequently made to define best practice in this area.
Major disasters involving multiple casualties are neither new nor infrequent. Such events have important implications for medicine and can provide crucial lessons for the future. However, while the medical aspects of war have received considerable attention, rather less is known about civilian disasters. To redress this imbalance, this article reviews three major British disasters of the 1980s where serious burns injury was a significant feature of the human casualty: the Bradford City Football Club fire of 1985, the King's Cross Underground fire of 1987 and the Piper Alpha oil rig disaster of 1988. Four related themes are used to examine in detail the ways in which these events impacted on medicine: plastics and reconstructive surgery, clinical psychology, disaster management and long-term structural change. Drawing on articles in specialist burns and psychiatric journals, together with the personal communications and recollections of surgeons and psychiatrists involved, it is revealed that while ground-breaking advances are a relative rarity in medicine, numerous small but significant lessons did emerge from these events, although often in subtle and highly specialised fields of medicine.
Burn management in disasters and humanitarian crises
2007, Total Burn Care
Fire disaster in Gothenburg 1998 - Surgical treatment of burns
2003, Burns
A tragic in-door fire disaster took place on 29 October 1998 at a discotheque in Gothenburg, Sweden. Nearly 400 youths attending a Halloween party were inside the building when the fire started, killing 61 people and injuring another 213 persons. A total of 154 youths were admitted to hospital care. Twenty-three patients requiring primary reconstructive burn surgery were followed and their records from the different burn units were examined. Total body surface area (TBSA), burn depth, surgical treatment, hospital stay, and complications were studied. In contrast to what is normally encountered in burn patients, well circumscribed predominantly full-thickness burns covering 1–40% TBSA were observed while partial-thickness burns only comprised 1–7% TBSA. Exposed bone was seen in 10 out of 23 patients. Escharotomies were performed in 11 patients, in six of whom that fasciotomies had to be performed. Primary excisions and skin grafting were performed in 22 patients. Five patients acquired amputations. Eight patients required local flaps and two had free flap coverage. Thoracic surgery was performed in one patient due to endocarditis. Severe infections occurred in eight patients. Hospital stay varied between 21 and 164 days.
Planning for major burns incidents in the UK using an accelerated Delphi technique
2002, Burns
Background: Major incidents require careful planning if they are to be managed well. Although a generic plan to deal with all major incidents is essential, a number of “special incidents” deserve special consideration because of their potential to impact on specialist services. This paper examines the problems of managing a major incident involving large numbers of burns casualties.
Method: A three-round Delphi study was conducted using a multidisciplinary panel of experts from prehospital care, emergency medicine, burns surgery, intensive care and emergency planning.
Results: A series of consensus statements on the management of burns incidents are presented. An accompanying paper describes the practical implementation of this guidance.
Conclusion: Specific consideration should be given to the problems of managing a major incident involving burns casualties.
Prehospital care of burns: An analysis of 3 years use of the emergency physician system (EPS) Cologne
1993, Burns
Little information is available about the vital parameters of burns victims shortly after the accident. Therefore cases of burns, electrical and caustic injuries presenting to the Cologne Emergency Physician System over 3 years (n=262) were prospectively studied and analysed. The average incidence in Cologne, Germany (population 1 million), of burns victims attended by the Emergency Medical System and emergency physicians at the scene was 74 adults and 14 children per year. Children are mainly injured by scalds (41.4 per cent); adults by fire accidents (43 per cent). A classification of the victims at the site of the accident according to their vital signs (Trauma Score (TS) after Champion H. R., Sacco W. J. and Carnazzo A. J. et al. (1981) Trauma Score. Crit. Care Med. 9, 672) showed, that inspite of a major burn injury, the vital signs were usually not or only slightly impaired. Subsequent measurements instituted by the emergency physician at the scene increased with decreasing initial TS. With TS=14, 50 per cent of the patients were intubated; below 14 points nearly 100 per cent. The fluid administered also increased with a decreasing TS.
Burns assessment team as part of burn disaster response
2006, Prehospital and Disaster Medicine

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Management of burns in major disasters

Abstract

Lancet