Annals of Burns and Fire Disasters - vol. XI - n. 1 - March 1998

ORGANIZATION AND TRANSPORT IN MASS BURNS DISASTERS

Hadjiiski 0., Dimitrov D.

Burn and Plastic Surgery Centre, Pirogov Medical Institute Pirogov, Sofia, Bulgaria

The Executive Board of WHO has defined disasters as situations in which there are unforeseen, serious and immediate threats to public health. Every year about 150 disasters of different kinds occur in various parts of the world.
The aim of the present study is to analyse people's behaviour in 28 mass burn disasters in Bulgaria that occurred over a period of 27 years (1968-1994). Our current position as regards first-aid organization and means of transport to hospital establishments of injured persons is discussed. Of the 28 disasters 23 were industrial, three involved means of transport, and two were domestic. As might be expected, the highest number of burn victims were involved in industrial accidents.
Of the 28 accidents, 11 occurred indoors and 17 outdoors. The total number of fatalities was 139: 103 were cases of industrial accidents, 30 of transport accidents, and six of household accidents.

Delayed treatment in burns can have fatal consequences. Likewise, the panic created during mass burn disasters, poor organization, and lack of co-ordination between care-giving units all have unfavourable effects on trauma outcome. In recent few years, a number of specialists` have recommended the following guidelines in the organization of procedures following mass accidents:

• immediate care - given at the site of the accident, usually by persons on the spot who are not affected by burns
• first aid - provided by people having both experience and medical knowledge (teams of physicians and nurses, Red Cross and Civil Defence volunteers). These are assisted by firemen, police, transport authorities, etc. Within 2-3 hours, these teams perform the triage of affected persons and determine necessary indications (respiratory tract condition, state of circulation, burn area size, need of intravenous treatment, administration of analgesics, immobilization). It is of paramount importance to indicate clearly where injured persons should be transported to.

• organized relief - provided by military and civil forces, which organize their work at the site of the accident (usually an industrial structure)

In Bulgaria, until a few years ago, the injured from mass burns accidents have been transported to the nearest hospital service, where they have been treated for 4-6 days, after which they have been sent on to specialized centres for further treatment. This procedure has the following disadvantages:

• treatment is initiated in a general surgery ward, where the operating teams are not very experienced
• the injured persons are hospitalized in rooms that are unsuitable for their traumas, without fluid beds or baths for topical therapy
• anaesthetic equipment and surgical instruments are insufficient
• supplies of medicines, dressing materials, and bioproducts are quickly exhausted
• specialists at the Burns Centres are simultaneously consultants in various surgical units near the place of the accident, and this circumstance impedes adequate working

Certain features of the organization of work during mass disasters, the above-mentioned shortcomings, the growing possibilities of up-to-date treatment provided at specialized burn centres, and the experience of other centres have made us change our tactics regarding the manner of transport of injured persons Bulgaria is rectangular in shape, with sides measuring respectively 400 and 200 km. The emergency medical service provides well-organized transport for patients, by ambulance cars as well as by ambulance aircraft. This facilitates the implementation of a new approach to the transport of individual patients with severe burns, including those injured in mass burns disasters. According to this new approach, if transport to the nearest specialized centre is expected to take less than 30 minutes injured persons are transferred there urgently, without any infusion therapy. During a fire accident in a steelworks, 22 km from the Sofia Burns Centre, eight persons were injured (age range 24-59 yr, TBSA burned 50 70%). All the patients were immediately transported from the place of accident to the burns centre, without any i.v. infusions. They suffered no complications either during transport or in the following days.  If the burns affect over 25% TBSA, if children are involved, or if transport is going to take much longer, i.v. therapy is introduced at the site of the accident, even in mass disasters. The injured are transferred to the nearest hospital facility, where they are resuscitated, their state is stabilized, and they are prepared for referral to a specialized burn centre. The terms for interhospital transport depend on several factors, but a good rule is that the patient should be transported within the first 24 h after the accident. In a mass disaster in a heating plant 250 km from Sofia, 19 persons were injured by hot water that had been spilt from a cistern containing 2000 tons of hot water. The patients were aged between 23 and 59 years, and suffered 80%-99% TBSA burns. All were admitted urgently to the nearest hospital, where treatment was given. Within 18 h of the accident, four of these burn victims had been transferred by helicopter to the nearest small burns centre, and 13 had been transported to Sofia by aeroplane, without any complications. Two moribund patients remained in the district hospital for treatment. The transport of patients with an indefinite diagnosis, as also that of moribund patients, is still a matter for discussion.

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