title: Complex chemical burns following a mass casualty chemical plant incident: how optimal planning and organisation can make a difference.
abstract: BACKGROUND
  Four employees at a chemical plant sustained extensive chemical burns following the explosion of a pipeline containing 100% sulphuric acid. We describe the management of these patients from the initial ED triage through to discharge from hospital in life and limb threatening chemical burns.
  
  
  METHODS
  Four patients who sustained chemical burns to the torso and extremities are reviewed. Data was retrieved from patient case notes and operating theatre logbooks.
  
  
  RESULTS
  Four patients sustained chemical burns during the blast and were immediately transferred to a local ED where a prompt referral was made to the burns service. All patients were male aged 25-59 years (mean 46.5). Burn size was 2-50% BSA (mean 22.5). Following RFDS transfer to the state burns service two patients required immediate excisional surgery. In these patients the chemical burn involved full thickness skin loss with extensive underlying muscle and neurovascular damage. One patient required immediate above knee amputation of one leg and fascial burn excision of the other. The other patient required fascial burn excision of both legs followed by Integra placement 24h later. Both patients had prolonged hospital stays due to the complex nature of their injuries requiring multiple trips to theatre and lengthy rehabilitation. The two patients with smaller burns had straightforward surgery and an unremarkable recovery.
  
  
  CONCLUSIONS
  Early communication following this mass casualty incident allowed for organisation of tertiary services and early radical surgery which was life saving. Management lessons were learnt following this mass casualty chemical burn incident.
authors.affiliation: Burns Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia. tomasoneill@gmail.com
authors.forename: Tomás B
authors.initials: TB
authors.lastname: O'Neill
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rawlins
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rea
authors.forename: Fiona
authors.initials: F
authors.lastname: Wood
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D001315:Australia; D002053:Burn Units / Q000458:organization & administration*; D002057:Burns, Chemical / Q000209:etiology / Q000628:therapy*; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005107:Explosions; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D054527:Mass Casualty Incidents; D008875:Middle Aged; D013464:Sulfuric Acids / Q000633:toxicity*
chemical_list: D013464:Sulfuric Acids; C033158:sulfuric acid