Ann. Medit. Burns Club - vol. VII - n. 3 - September 1994

BOOK REVIEWS

The Management of Mass Burn Casualties and Fire Disaster. M. Masellis and S.W.A Gunn, editors. Kluwer Academic Publishers, 1993, 239 pages, $125.

This text supports two trends in modern medicine and applies them to burn victims: 1) that an organized and scientific approach to prehospital care impacts heavily on overall patient outcome, and 2) that disasters are not simply random, ill-fated events - their outcomes can be pre~ dieted and largely controlled with proper prevention and preparation. The focus on one type of disaster for development of a specific management plan is a tribute to the rapid progress that the science of disaster medicine has made in the last two decades. In recognizing multiple factors that distinguish burn disasters from all other types of disasters, this book makes a significant contribution to trauma literature.
An attempt has been made throughout this work to bridge the gap between prehospital and hospital care of the burn victim. The long-standing separation of two disciplines that have worked in parallel to alleviate the suffering from burns is broken by integration of fire-fighting and burn medicine into a unified management approach. As simply stated in the foreword, the world of medicine, in which doctors continually strive to increase the survival of burn victims, and the world of fire prevention, in which fire chiefs work to protect society from the increasing hazards of fire disaster, have similar goals but have rarely combined forces to the extent evident in this book.
The Mediterranean Burns Club, identified by the United Nations as the premier scientific body in its field, through its efforts in organizing the First (1990) International Conference on Burns and Fire Disasters held in Palermo, Italy, is responsible for this unique look at a ubiquitous problem. The book is the compiled highlights from the conference.
Dr. Michele Masellis and Dr. S.W.A. Gunn present an excellent example of theory hardened by practical experience. As authors and editors, they head an impressive international list of more than 114 contributors who represent a tremendous reservoir of experience in disaster management and the treatment of burn injuries.
The extensive lessons learned are applicable to burn disasters that occur worldwide. The book is therefore valuable reading for the serious student of disasters and disaster management and of burn prevention and treatment.
The first section applies the generic theories of disaster medicine specically to fire disasters and then analyzes 14 separate incidents that resulted in 40 or more burn patients. The gravity of burn trauma; the need for early, if not immediate, therapeutic intervention beginning at the scene; and the partcular medical and surgical requirements of this type of disaster are stressed. Whereas the traditional disaster response has depended more on goodwill than knowledge, the approach promoted by Masellis and Gunn is preparedness and prevention based on scientific data.
Section II describes fire disasters in various countries: forest fires, domestic fires in third world countries, fire aboard ship at sea and in port, at a motor racing track, and even in a hospital. Specific high-risk situation such as petrochemical plants and butane gas explosions are also described. Although this section is somewhat incongruent and lacking in overall direction, the individual insights and lessons learned from these experiences may prove to be life-saving in similar situations around the world.
Section III is composed of several chapters describing methods of preparing for fire disasters but focuses largely on education, ranging from basic public education to that required for the most advanced and highly specialized postgraduate burn students. One chapter describes safety and fire prevention in a large research center and two chapters deal with protective equipment and clothing for fire-fighters.
Section IV, the heart of the book, includes 23 chapters that describe various theories and practices of managing problems encountered in actual fire disasters. Search and rescue, civilian relief, the use of air support, databank services, setting up field hospitals, protocols for nonspecialized doctors, and bum treatment materials are all discussed briefly.
Section V presents several clinical problems in the treatment of burns. Although not a comprehensive text for burn treatment, early basic treatment is described adequately and brief chapters suggest practical solutions to acute renal failure, psychological reactions to burns, treatment of hand injuries, and the treatment of traumatic tattoos.
Finally, Section VI includes the important issues of facilitating national and international disaster relief through information and communications. The role of the mass media, the philosophy of prevention campaigns, and various national civil defense and relief organizations are described.
This book serves as a disquieting reminder that, all over the world, burn disasters are imminent. But it also provides a degree of comfort for the public to know that, finally, as the 20th century comes to a close, an organized, well-conceived approach to the management of bum injuries is developing. The perils of experience put to words in this book can make it a'little more prepared for the next mass bum casualty or fire disaster.

Thomas E. Knuth, MD