Treatment of burns casualties after fire at Bradford City football ground

Plastic Surgery Response in Natural Disasters

Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

KAMEDO Report 89: Terrorist Attack in Bali, 2002

On 12 October 2002, two bombs exploded on the island of Bali in Indonesia, destroying two bars in the tourist district of the holiday resort Kuta Beach. The explosions killed 202 people from 21 different countries, and >300 people were injured. A team of observers conducted structured and unstructured interviews, and lessons learned from the experience were identified. This report summarizes various elements of the response including: (1) prehospital care; (2) coordination; (3) hospital response; and (4) Australia's efforts in air evacuation.

Burns Assessment Team as Part of Burn Disaster Response

With a huge, climactically hostile catchment area, limited retrieval options and finite resources at the only adult burns unit in South Australia, this paper discusses the case for the establishment and maintenance of a Burns Assessment Team in South Australia. The composition and role of the team and its relationship with other retrieval services, the primary care unit, and the proposed National Burn Coordinator also are discussed.

[2010 Love Parade in Duisburg: clinical experiences in planning and treatment]

BACKGROUND

Tragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners.

METHODS AND MATERIAL

A structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts.

RESULTS

We describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events.

CONCLUSION

Knowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.

30 years of burn disasters within the UK: guidance for UK emergency preparedness

AIM

To review casualty profiles of major UK burn disasters over the last 30 years in order to provide guidance to aid burn and emergency service planning and provision so as to improve emergency preparedness for future national disasters.

METHODS

A review of published literature was undertaken for disasters within the UK that had occurred between 1980 and 2009. Those producing 10 or more casualties with at least one sustaining cutaneous burns injuries were included. Frequency and extent of burns were recorded and analysed.

RESULTS

In total 37 disasters were included in this study, their frequency of occurrence falling over the 30 years reviewed. Burns tended to make up a small proportion of all casualties and were often relatively small in size with only 3 disasters having more than 5 patients with >10% burns.

DISCUSSION

This paper can help guide appropriate staffing and bed capacity planning for regional burns units and provide realistic figures to guide scenarios for national emergency training exercises. Due to the infrequent nature of major disasters, Critical Care, Trauma Care and Burn Care Networks will all need to be closely integrated and their implementation rehearsed so as to ensure optimal response to a major national disaster.

Patient care at the 2010 Love Parade in Duisburg, Germany: clinical experiences

BACKGROUND

The mass panic at the Love Parade 2010 attracted a great deal of public attention in Germany and abroad. The goals of this paper are to summarize the available data on the injured persons and their treatment, and to assess the preparations that should be made for such an eventuality and the acute measures that should be taken if it occurs.

METHODS

Patient data from the Duisburg hospitals were subjected to a structured statistical analysis, and all of the measures taken were assessed by qualified evaluators on the basis of questionnaires, a consensus conference, and individual interviews of the clinical coordinators.

RESULTS

A total of 250,000 persons took part in the Love Parade; 5600 patient contacts occurred at first-aid posts and 473 patients (mean age, 25.5 years; male:female ratio, 1.4:1) were treated in 12 hospital emergency rooms, 41.7% were admitted to the hospital. Among the admitted patients, 73% stayed in the hospital for less than 24 hours, and 41% signed out against medical advice; 62.2% had a surgical diagnosis, 40.6% a medical one, and 8.0% a psychiatric one (some patients had more than one diagnosis). 47.6% of the surviving patients were classified as mildly injured, 47.8% as moderately injured, and 4.0% as severely injured. Most medical activity was concentrated in three areas: the treatment of drug abuse, the care of many mild and moderate injuries, and Shock Room diagnostic assessment of patients potentially harboring serious injuries. Hospitals were subject to the highest strain 2 to 3 hours after the mass panic, at which time they received up to 20 new patients per hour.

CONCLUSION

These data permit a detailed view of the medical care that was provided. In situations of this kind, the main problems can be dealt with through targeted and structured preparation and optimized emergency plans which consider both foreseeable and unforeseeable events. Priority must be given to rapid diagnostic assessment and clinical decision-making; the prerequisites for these are transparent institutional structures and clear assignments of responsibility.

The teaching of denture marking methods in dental schools in the United Kingdom and the United States

Forensic organizations worldwide have recommended that dental prostheses should be marked with, at a minimum, the patient's name and preferably with further unique identifiers such as a social security number. The current study aimed to assess the denture marking practice of dental schools within the United States and the United Kingdom. A questionnaire-based survey was employed to gain both quantitative and qualitative data on the methods, practices, and ethos behind denture marking in 14 U.K. and 32 U.S. dental schools. One hundred percent of U.K. and 87.5% of U.S. schools returned surveys and the results suggest that, for dental schools where there is no legal or legislative need for denture marking, the practice is inconsistently taught and appears to be reliant on internal forces within the school to increase awareness. Among those schools practicing marking, only 18% employ a technique likely to withstand common postmortem assaults; this is a concern.

Management of multiple burn casualties from the Volendam disaster in the emergency departments of general hospitals

OBJECTIVE

To establish the level of medical care provided in the emergency department of general hospitals to the victims of the Volendam café fire on 1 January 2001.

METHODS

A retrospective review was done based on a standardized chart, for all victims seen at the emergency departments of 19 hospitals. Diagnostic findings and logistic aspects were inventoried. Treatment described in the Emergency Management of Severe Burns protocol was used as a gold standard against which the care provided to the victims was assessed.

RESULTS

Data from 233 patients were included in the analysis. The documentation rate was low. Suspected inhalation injury and burns were the most frequently documented diagnoses. Most patients with suspected inhalation injury, for whom treatment records were available, received oxygen therapy (81%). Intubation was performed in 43% of patients with suspected inhalation injury and 14% of the remaining patients required intubation after admission to the intensive care unit. Most patients with circulatory problems (83%) and/or more than 15% of total body surface area burned (97%), for whom treatment records were available, received intravenous lines. Pain treatment seemed to have had low priority. Two patients (3%) were re-admitted after having been released earlier from the emergency department.

CONCLUSION

Treatment and triage of the burn casualties after the Volendam café fire was adequate. The documentation rate was low. Not all steps in diagnosis and treatment may be of equal importance in disaster circumstances.

The Bali burn disaster: implications and lessons learned

In October 2002, a terrorist attack on a nightclub in Bali resulted in an explosion and fire, causing the deaths of more than 200 people, including 88 Australian citizens. After first aid and primary care, the injured were repatriated to Darwin for triage and continued treatment and were then disseminated to various burn units throughout Australia. At the Repatriation General Hospital Concord Sydney, we received 12 patients with burns and a variety of blast injuries. Their treatment was complicated by infection with multiresistant organisms that were previously unseen in our unit and the presence of complex shrapnel wounds. There were no deaths and, with two exceptions, all patients were discharged within 6 weeks. This incident had profound effects on our unit, particularly related to the management of high-velocity shrapnel injuries, serious ongoing septic complications, and the psychological effects on both patients and staff, all of which are detailed and discussed.

Emergency medical services systems and HAZMAT major incidents

Exposures to released hazardous materials (HAZMAT) pose an increasing threat to individual and public health, particularly in high population density. Any incident causing casualties on a scale which threaten or causes overload of the available resources of the emergency medical services (EMS) or associated systems (EMSS), constitutes a major incident (MI). Emergency services, including the EMSS, have a statutory duty to develop a comprehensive, integrated and flexible all-risk Major Incident Plan (MIP) for such an event. The MIP should also include developed management provision for HAZMAT incidents and in particular provision for safety and protection of both casualties and the EMSS personnel and systems, from secondary contamination by persistent, transmissible HAZMAT agents. This paper offers an outline review of contemporary policy and practice guidelines for the management of HAZMAT incidents and major incidents, with emphasis on the following: strategic and tactical preparation, integrated modular planning, communications, evaluation, training and equipment, including personal protection. In addition organisational aspects of the safe management and protection of the EMSS and personnel at the incident site, during transportation and at the receiving hospitals are considered. Safe and effective management of casualties requires adequate protection from further exposure, triage and synchronous decontamination and life support. Finally, the implications of conventional and unconventional conflict including terrorism and current unsolved problems are discussed.

Care of burns victims in Europe

There is no detailed information about the care of burns victims, in Europe, in the case of a fire disaster. Several countries have discussed how to treat burn victims, but only a little is known of their capacity to offer space to other countries in the event of a fire disaster outside the country in question. In Europe, most countries are dependent on England, France and Germany in such cases. Since "Los Alfaques", "Ramstein" and other examples of such disasters, we know how important it is to focus more on burn victims in Europe with respect to national and international cooperation.

The Hillsborough tragedy

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Fire in an intensive care unit: causes and strategies for prevention

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Burns caused by the terrorist bombing of the department store Hipercor in Barcelona. Part I

A retrospective study was made of the treatment of 20 of the 66 casualties resulting from the terrorist bombing of the department store Hipercor in Barcelona in June 1987. The additional pressure of the work imposed on several units in the Hospital including the Burn Centre, the Sterilization, Radiodiagnosis, Pharmacy and Medical Units, and nursing staff, and the Intensive Care unit is described. The types and volumes of fluid therapy administered are also reported. The results of the study indicated: (1) the need for a disaster plan; (2) that burn centres should be integrated in large hospitals able to provide assistance from several units, and (3) the management of burns should involve debridement and wound coverage as soon as possible.

The Peterborough lorry explosion, 22 March 1989: an analysis of the hospital response

As a result of the lorry explosion on the Fengate Industrial Estate, Peterborough on 22nd March 1989, 82 casualties arrived at Peterborough District Hospital. Despite the fact that casualties arrived at the A&E Department in large numbers before the Major Accident Plan could be implemented, all of the casualties had been assessed and either admitted or sent home within 3 h of the explosion. In the process several valuable lessons were learned, and their implications are discussed in this paper.

Fate of mass burn casualties: implications for disaster planning

A survey of 11 fire disasters which have occurred since 1970, showed that incidents occurring outdoors resulted in larger numbers of hospital admissions, with more severe injuries, than incidents occurring indoors. While the majority of burn casualties sustained burns covering less than 30 per cent body surface area (BSA), outdoor disasters resulted in the admission of a significant number of patients with burns covering more than 70 per cent BSA. Expert triage may therefore minimize the requirement for specialized burn beds. However, the scarcity of burn facilities is such that involvement of distant centres may be anticipated following large disasters. While effective early management extends the time available for the dispersal of casualties, delays may be avoided by prior planning, especially if the international transfer of patients is envisaged.

Tangential excision of scalp burns: experience from the Bradford fire disaster

Tangential excision of deep dermal scalp burns does not appear to be widely practised. During the Bradford Football fire victims sustained mixed depth scalp burns. These were mainly as a result of radiant heat, although falling molten bitumen was the cause of injury in a few patients. Deep dermal or full thickness burns of the scalp were tangentially excised and skin grafted. One patient did not have a graft applied after tangential excision. The early results of graft take were satisfactory. Subsequently, however, 56 per cent required further grafting; the reasons for this are discussed. Ten months after the incident there is no difference in appearance between areas of primary grafting and areas of secondary healing.