title: Responding to major burn disasters in resource-limited settings: lessons learned from an oil tanker explosion in Nakuru, Kenya.
abstract: BACKGROUND
  On January 31, 2009, a fuel tanker exploded in rural Kenya, killing and injuring hundreds of people. This article describes the care of >80 burn victims at a rural hospital in Kenya, Nakuru Provincial General Hospital, and provides lessons for care of a large number of burned patients in a resource-limited setting.
  
  
  METHODS
  Data were obtained from retrospective review from hospital registers and patient files.
  
  
  RESULTS
  Treatment was provided for 89 victims. Eighty-six (97%) were men; median age was 25 years (interquartile range [IQR], 19-32). Half of the patients (45) died, the majority (31, 69%) within the first week. The median total body surface area burned for those who died was 80% (IQR, 60-90%) compared with 28% (IQR, 15-43%) for those who survived (p < 0.001). Twenty patients were transfused a total of 73 units of blood including one patient who received 9 units. Eighty surgical interventions were performed on 31 patients and included 39 split-thickness skin grafts, 21 debridements, 7 escharotomies, 6 dressing changes, 4 contracture releases, and 3 finger amputations. Of the 44 survivors, 39 (89%) were discharged within 4 months of the event.
  
  
  CONCLUSIONS
  Mortality after mass burn disasters is high in Africa. In areas where referral to tertiary centers is not possible, district hospitals should have mass disaster plans that involve collaboration with other organizations to augment medical and psychologic services. Even for patients who do not survive, compassionate care with analgesics can be given.
authors.affiliation: Médecins Sans Frontières-Kenya, Nairobi, Kenya.
authors.forename: Eline
authors.initials: E
authors.lastname: van Kooij
authors.forename: Inge
authors.initials: I
authors.lastname: Schrever
authors.forename: Walter
authors.initials: W
authors.lastname: Kizito
authors.forename: Martine
authors.initials: M
authors.lastname: Hennaux
authors.forename: George
authors.initials: G
authors.lastname: Mugenya
authors.forename: Elvis
authors.initials: E
authors.lastname: Otieno
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Ford
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Chu
mesh_terms: D000328:Adult; D002056:Burns / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003906:Developing Countries; D005107:Explosions; D005260:Female; D005648:Fuel Oils; D006780:Hospitals, Rural; D006801:Humans; D007630:Kenya; D008297:Male; D054527:Mass Casualty Incidents; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005648:Fuel Oils