Complex chemical burns following a mass casualty chemical plant incident: How optimal planning and organisation can make a difference

• Published in: Burns Vol. 38; no. 5; pp. 713 - 718
• Main Authors: O’Neill, Tomás B, Rawlins, Jeremy, Rea, Suzanne, Wood, Fiona
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2012; Elsevier
• Subjects: Accidents, Occupational; Adult; Australia; Biological and medical sciences; Burn Units - organization & administration; Burns; Burns, Chemical - etiology; Burns, Chemical - therapy; Chemical burns; Communication; Critical Care; Disaster management; Disaster Planning - organization & administration; Emergency Service, Hospital - organization & administration; Epidemiology; Explosions; General aspects; Humans; Interdisciplinary Communication; Male; Mass casualty; Mass Casualty Incidents; Medical sciences; Middle Aged; Planning; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sulfuric Acids - toxicity; Traumas. Diseases due to physical agents; Australia; Mass casualty; Chemical burns; Planning; Disaster management; Communication; Skin disease; Clinical management; Chemical burn; Disaster; Epidemiology; Incidence
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2011.12.010

Abstract Introduction Four employees at a chemical plant sustained extensive chemical burns following the explosion of a pipeline containing 100% sulphuric acid. We describe the management of these patients from the initial ED triage through to discharge from hospital in life and limb threatening chemical burns. Methods Four patients who sustained chemical burns to the torso and extremities are reviewed. Data was retrieved from patient case notes and operating theatre logbooks. Results Four patients sustained chemical burns during the blast and were immediately transferred to a local ED where a prompt referral was made to the burns service. All patients were male aged 25–59 years (mean 46.5). Burn size was 2–50% BSA (mean 22.5). Following RFDS transfer to the state burns service two patients required immediate excisional surgery. In these patients the chemical burn involved full thickness skin loss with extensive underlying muscle and neurovascular damage. One patient required immediate above knee amputation of one leg and fascial burn excision of the other. The other patient required fascial burn excision of both legs followed by Integra placement 24 h later. Both patients had prolonged hospital stays due to the complex nature of their injuries requiring multiple trips to theatre and lengthy rehabilitation. The two patients with smaller burns had straightforward surgery and an unremarkable recovery. Conclusion Early communication following this mass casualty incident allowed for organisation of tertiary services and early radical surgery which was life saving. Management lessons were learnt following this mass casualty chemical burn incident.