title: The ABC daycare disaster of Hermosillo, Mexico.
abstract: On June 5, 2009, the ABC Daycare facility in Hermosillo, Mexico, caught on fire with an estimated 142 children and 6 adult caregivers inside. The purpose of this article is to describe the factors contributing to the disaster including care of the survivors, tertiary burn center triage, patient transport, and treatment for this international mass casualty event. Finally, the results of an investigation performed by the Mexican Government are reviewed. A summary of the Mexican Government's investigation of the circumstances of fire and an examination of prevention lapses in other Mexican daycare centers was obtained from their public Web site. The demographic and clinical characteristics of the children transported to the burn center were obtained from the patients' medical records and transport data sheets. The ABC Daycare had many fire safety breaches that contributed to the severity of the tragedy. Twenty-nine children died at the scene and more than 35 children were hospitalized throughout Mexico. A total of 12 children were transported to two Shriners Hospitals, 9 to Sacramento, and 3 to Cincinnati. The mean age of patients sent to the Shriners Hospitals was 2.9 ± 0.16 years (2-4 years), with 5 being male and 7 female. The mean duration between injury and arrival was 9.2 ± 2.1 days, the burn size was 43.0 ± 6.8% TBSA (6.5-80%), and there were 3.75 operations per patient. Four had fourth-degree burns requiring finger amputations (2), flaps to cover bone (1), or a through-knee amputation (1). Ten patients were admitted to the intensive care unit, and nine patients (seven with inhalation injury) required mechanical ventilation for a mean of 23.6 ± 10.3 days. All the surviving children were discharged after a mean length of stay of 45.9 ± 8.7 days. In the first year postinjury, seven children were readmitted a total of 11 times for reconstructive surgery, wound care, or rehabilitation. Ultimately, a total of 49 children died. A review of other daycare centers in Mexico revealed similar safety lapses that could lead to future major disasters. This burn disaster in Hermosillo was potentially preventable with adherence to standard prevention principals. The young age of the victims and the need for an international medical response posed special problems. Prevention efforts need to be improved to prevent future disasters in Mexico.
authors: Burn Department, Shriners Hospitals for Children Northern California, Sacramento, California 95817, USA.
authors: David G
authors: DG
authors: Greenhalgh
authors: Philip
authors: P
authors: Chang
authors: Pirko
authors: P
authors: Maguina
authors: Elena
authors: E
authors: Combs
authors: Soman
authors: S
authors: Sen
authors: Tina L
authors: TL
authors: Palmieri
mesh_terms: D002056:Burns / Q000401:mortality* / Q000628:therapy*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004189:Disaster Planning; D005260:Female; D005390:Fires; D006801:Humans; D007223:Infant; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015208:Smoke Inhalation Injury / Q000401:mortality / Q000628:therapy; D014187:Transportation of Patients / Q000458:organization & administration; D014218:Triage