Environmental insults: smoke inhalation, submersion, diving, and high altitude

Disaster preparedness: experience from a smoke inhalation mass casualty incident

OBJECTIVE

We describe a modified triage system used in managing a smoke inhalation mass casualty incident that we recently encountered at our community hospital.

MATERIALS AND METHODS

The patients were triaged as priority 1, 2 or 3 on the basis of their symptoms, signs and circumstances at scene. In addition, the use of fibre-optic examinations of the upper airway, chest radiography and carboxyhaemoglobin levels with arterial blood gas analyses were used to aid in disposal plans.

RESULTS

Of the 22 patients evacuated, 15 were triaged as priority 2 and the remaining seven as priority 3. None of the patients was identified as priority 1. All the priority 2 patients underwent further investigations. Those with mild upper airway oedema (four patients) or raised carboxyhaemoglobin levels (two patients) were admitted. Only one patient had both. Another patient who was a known asthmatic developed bronchospasm and was admitted as well. All six were admitted to the general ward with subsequent good recovery and were discharged within 3 days. The remaining nine priority 2 and seven priority 3 patients were discharged from the emergency department.

CONCLUSIONS

These modified triage criteria, with selective use of fibre-optic examinations, chest radiography and arterial blood gas analyses with carboxyhaemoglobin levels, are useful in smoke inhalation mass casualty incidents without dermal burns. Systemic injury and poisoning by toxic fumes often coexist with airway burns and should not be overlooked. Lastly, disaster planning and frequent drills at both local and national levels will optimize the response to future mass casualty incidents.

Epidemiologic characteristics of death by burn injury from 1991 to 2001 in Korea

This study was designed to investigate the epidemiologic characteristics of death from burn injury in Korea. We recoded the death certificate database from 1991 to 2001 inclusive based on the short version of the International Classification of External Causes of Injuries (ICECI). Using variables such as sex, marital status, educational level, location of residence (metropolitan versus provincial), injury mechanism, and year, we calculated and compared the mortality rates and percentiles because of burn injury, and determined the adjusted odds ratio (OR) to assess the effect of socioeconomic factors on suicide deaths. The total number of deaths because of injury was 346,656, and the number of deaths because of burn injury was 9109 (2.6%), making burn injury the sixth leading cause of death from injury during the study period. The mortality rate due to burn injury was 1.8 per 100,000 person-years in 2001, without long-term change from 1991. Major mechanisms of death included surface burns (80.7%), smoke inhalation (14.4%), respiratory burns (1.5%), and associated trauma (3.5%). The number of the suicide deaths was 466 from 1993 to 2001 inclusive, and the adjusted OR for suicide burns compared to accidental burns was significantly larger in the more highly educated, metropolitan, and married and divorced groups than it was in the never-attended-school, provincial, and never-married groups, respectively.