Medical management after indoor fires: a review.
Fires involving mass burn casualties require extreme efforts and flexibility from the regular health care system. The café fire in Volendam, which occurred shortly after midnight on the first of January 2001, resulted in the worst indoor mass burns incident in Dutch history. During the extensive medical evaluation of this disaster, it became obvious that information on similar incidents is relatively scarce in the literature. This article systematically reviews the existing information in the medical literature on indoor fires and provides findings and knowledge used in the evaluation of the medical management after indoor fires and for future mass burn casualty preparedness, mitigation and response.


METHODS
A literature review was undertaken for burn disasters with characteristics similar to the indoor Volendam fire disaster. In all fires, the following aspects were investigated: characteristics of the fire; the initial emergency response; triage and on-site treatment; primary and secondary distribution; hospital admission; severity of the sustained injuries and mortality.


RESULTS
A total of nine similar indoor fires were selected. The number of people involved was reported in seven fires (range 137-6000). All reports provided the mortality rate (range 1.4% to over 50%). Data regarding the emergency response could be collected in half of the studies. On-scene triage was performed in five fires. The number of hospitals participating in the primary distribution ranged from 1 to 19. Except for the Volendam fire, all patients were primarily distributed to general hospitals.


CONCLUSIONS
Characteristics of indoor fires, which are relevant for disaster preparedness, mitigation and response are not frequently reported in medical literature. The current articles on indoor fires, mainly report on numbers of casualties and the mortality. Limited data are available to provide insight in the characteristics of management and medical treatment and to come up with suggestions for improvement of future burn incidents management. The evaluation of disasters should be based on uniform methods and structured reports and effective record keeping is essential to achieve this.
Welling
L
L
Department of Surgery, Academic Medical Centre, 1100 DD, P.O. Box 22660, Amsterdam, The Netherlands. L.Welling@amc.uva.nl
van Harten
S M
SM
Patka
P
P
Bierens
J J L M
JJ
Boers
M
M
Luitse
J S K
JS
Mackie
D P
DP
Trouwborst
A
A
Gouma
D J
DJ
Kreis
R W
RW
D002056:Burns / Q000401:mortality / Q000628:therapy*; D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005390:Fires / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014218:Triage