Jaffe W., Lockyer R., Howcroft A.

SUMMARY. In 1984, 44 people were involved in an underground explosion in which 16 people eventually died. We report on the history of the disaster and the preliminary results of the morbidity as noted after ten years.

A disaster is defined in a number of ways - such as "a sudden or great calamity". Medical emergency plans may specify a disaster as a number of serious casualties. Many United Kingdom hospitals have major accident plans which state twenty serious casualties as their definition.
In the last ten years the United Kingdom has witnessed a number of disasters involving its people. Many will remember the harrowing television pictures from the Bradford Fire Disaster and the Hillsborough Stadium Disaster. The Abbeystead Explosion occurred before all these, but despite extensive national media coverage at the time it has been swamped by subsequent events and is barely remembered in the United Kingdom.
In 1980 Her Majesty Queen Elizabeth 11 officially opened the Abbeystead water pumping station, on the Duke of Westminster's estate in the Lancashire countryside. The purpose was to pump water from the River Lune to the River Wyre, from where it could then be pumped out for domestic usage. The underground waterpumping station lies on a hillside between the two rivers.
The villagers of St Michael's on Wyre, a small picturesque village of 500 inhabitants in the Wyre valley, were concerned that the pumping station could have been responsible for the flooding that had occurred in recent years in their village. The local parish council were invited to visit the underground water station in May 1984. A group of thirty-six villagers, including a 12-year-old boy, and eight Water Board officials attended the visit on May 23. Unusually for the area there had been a drought and the pumps had not been switched on for the preceding seventeen days. Unknown to the forty-four people in the underground complex there had been a slow build-up of natural methane gas from the earth and this had collected in the passages and tunnels. The group was assembled inside the underground valve house, which was dug into the hillside. When the pumps were switched on nothing happened - no water was pumped. The engineers then switched a second set of pumps on. Something somewhere emitted a spark and this ignition caused an explosion. A fireball swiftly erupted through the complex. The buried concrete roof was blown off, and people were subjected to blast injuries, crush injuries, and burns. Some were blown through into water chambers. One man was blown back outside and landed on the ground as a car which had also been lifted by the blast landed on top of him.
All forty-four people present that evening were injured (Table I). Eight, including the young boy, died at the scene from blast and crush injuries. That left thirty-six casualties to be treated. The nearest hospital was Lancaster Royal Infirmary, eight miles away to the north. This is a typical District General Hospital. The Royal Preston Hospital, eighteen miles away to the south, has plastic surgery and neurosurgery on site. The ambulance service operated a scoop-and-go policy and the majority of patients were taken to the nearer hospital at Lancaster. These were mostly the burns patients, with an average total body surface area burn of 25%. The other patients were evacuated to the Royal Preston Hospital. The plastic surgeon on call from Preston was alerted by Preston. There were seven patients arriving at Preston as he did, and word got through that Lancaster Royal Infirmary had a further twenty-eight, mostly burn patients. He then travelled up to Lancaster. In Lancaster, as the casualties were brought in, the Doctors

Mess had organized a social event and junior medical and nursing staff were just about to board the coach. This meant there were many extra hands available as the casualties arrived.
Following an assessment of the injuries a decision on the further management of these patients was taken. The decision was that the burns patients required evacuation to burns units. Nearly all were shock cases. The choice was whether to admit all patients to one unit and import medical staff, as was to happen in Bradford, or to share the workload between the three nearest units. The decision was to spread the workload between Preston, Liverpool and Manchester. This was because of the close proximity of the three units - it was felt the logistics of so many shock cases in Preston would have swamped the hospital. In hindsight, some errors in transferring patients were made. Some husbands and wives were split up, and some were sent to the unit not nearest their home or relatives.
Out of the thirty-six survivors, thirty-five required inpatient treatment. One survivor suffered minor flash burns to the face and was discharged direct from the casualty department. The remaining thirty-five were all placed in the regional burns units except for one patient with significant leg and back injuries who stayed at Lancaster until discharge. Eight patients subsequently died of their injuries. The last death occurred at 13 weeks, from sepsis. The majority of late deaths were due to sepsis and affected the patients who were blown into the underground water chambers, suffering contamination of their burns. The twenty-eight survivors were eventually discharged from hospital and then from follow-up.
The official report into the disaster blamed a design fault which did not allow the methane gas absorbed into the tunnels to be vented. There then followed protracted legal discussions on liability. This was complicated because there were three parties denying negligence - the owners of the site, the builders, and the architects who were subsequently deemed liable. It took a high court ruling preventing any further appeal that allowed settlement to be finally made in November 1989, 5.5 years after the incident. Both the Manchester Airport and the Bradford tragedies, which occurred in 1985, had already been settled.

With the help of local media coverage we traced twenty-seven out of the twenty-eight survivors. Two declined to partake, and one who had moved to Scotland corTesponded by post. We were unable to trace one survivor but he had recently been heard of by other survivors. The study involved a plastic surgery out-patient visit where a detailed examination was performed, and a series of psychological questionnaires were given to the patients to complete. Ethical approval was obtained from the Medical Ethical Committee (Table II).

Every patient was was asked to record his/her ongoing disabilities (Table III). Further history and examination were performed by two plastic surgeons including the senior author, who had treated many of the patients ten years previously.

At the follow-up of the twenty-four survivors who attended, twenty-three had required hospital admission, staying an average of 5.5 weeks. All the survivors suffered burns, with four suffering fractures as well. Fifteen out of the twenty-four survivors required surgery, the majority for burn shave and graft. Eight of these required secondary surgery. These secondary procedures were carried out between three and sixty months after the explosion. The majority were for web contracture releases of the fingers. All were assessed for hand function problems. The results of the hand therapist's assessment of hand function showed that ten patients had no problem with either hand and that ten had some minor problems that did not concern them. Four patients had functional hand problems for which they did not want any further intervention. It is worth noting that in this predominantly outdoor working group of patients, those who had their hands grafted have had more durability.
One patient suffered retinal damage and requires sunglasses in all but low lighting conditions. One patient has suffered hearing loss since the blast.
Two out of the twenty-four patients had already retired from work, while the remaining twenty-two were mostly farmers and outdoor workers. Twenty of these returned to some work after an average of eight months following the accident, fifteen of them requiring light duties initially. Four of these patients never achieved their normal preinjury duties. Two were eventually retired on medical grounds.
Pressure garments were worn by seventeen patients for an average of 16.5 months.
At the ten-year year follow-up the majority had no, or just superficial, scars. Cold intolerance affecting the hands and sunlight avoidance in previously burned skin were other problems frequently cited. We noted that the group of patients who suffered smaller area burns were wearing natural fibre clothes that did not catch fire.
No formal counselling was given to these patients by trained counsellors. However, the nursing and medical staff in attendance offered support, as also the hospital clerics. Furthermore - and in these circumstances probably more importantly - the patients counselled themselves as they lay next to each other recovering from their burns.
It is also important to appreciate that the diagnosis "post-traumatic stress disorder" was accepted only in 1980 (Diagnostic and Statistical Manual for Psychiatric Disorders, DSM-III). Formal counselling was not the highprofile therapy it is today after a disaster. There are no long-term data, and there is no accepted methodology for the late assessment of post-traumatic stress disorder.
The psychological assessment initially involved a number of questionnaires being given to the patients to fill in. Preliminary data from these suggested the need for further detailed assessment. This has involved a lengthy structured interview and further clinician- administered questionnaires. The results and detailed statistical analysis are to be published separately.